Changes

#'''<u>Fluids</u>''': most cats are moderately to severely dehydrated on presentation, and require fluids. '''O.9% saline''' is commonly used, however may worsen a metabolic acidosis and buffered crystalloid such as lactated '''Ringer's or Hartmann's solution''' may be a more appropriate choice. Fluid deficits should be '''corrected over 12 to 18 hours''', monitoring for signs of cerebral oedema and hyperosmolarity. High continuing fluid losses are common until glucosuria and ketonuria are reduced, and maintenance fluid requirements are relatively high. The cat must be '''monitored carefully for adequacy of hydration and urine output'''. '''Weight''' is a useful indicator during hospitalisation.

#'''<u>Fluids</u>''': most cats are moderately to severely dehydrated on presentation, and require fluids. '''O.9% saline''' is commonly used, however may worsen a metabolic acidosis and buffered crystalloid such as lactated '''Ringer's or Hartmann's solution''' may be a more appropriate choice. Fluid deficits should be '''corrected over 12 to 18 hours''', monitoring for signs of cerebral oedema and hyperosmolarity. High continuing fluid losses are common until glucosuria and ketonuria are reduced, and maintenance fluid requirements are relatively high. The cat must be '''monitored carefully for adequacy of hydration and urine output'''. '''Weight''' is a useful indicator during hospitalisation.

#'''<u>Electrolytes</u>''': fluids should be supplemented with '''potassium''' if levels are normal or decreased. '''Phosphate''' should be supplemented if levels are normal or decreased, as hypophosphataemia leads to Heinz body formation and haemolytic anaemia. Phosphate cannot be added to calcium-containing fluids such as Hartmann's, so it may be necessary to run fluids through two separate intravenous cannulas, or preferably through a central catheter. Electrolyte deficits can be addressed by adding Potassium chloride and potassium phosphate to fluids.

#'''<u>Electrolytes</u>''': fluids should be supplemented with '''potassium''' if levels are normal or decreased. '''Phosphate''' should be supplemented if levels are normal or decreased, as hypophosphataemia leads to Heinz body formation and haemolytic anaemia. Phosphate cannot be added to calcium-containing fluids such as Hartmann's, so it may be necessary to run fluids through two separate intravenous cannulas, or preferably through a multi-lumen central (jugular) catheter. Electrolyte deficits can be addressed by adding Potassium chloride and potassium phosphate to fluids.

#'''<u>Acidosis</u>''': '''Fluid expansion''', sodium chloride-containing fluids and insulin therapy should correct the acidosis. '''Bicarbonate administration''' is only recommended when levels are below 7mmol/L. There are many '''disadvantages''' to bicarbonate therapy, including accelerated development of hypokalaemia and hypophosphataemia, and these usually outweigh the advantages.

#'''<u>Acidosis</u>''': '''Fluid expansion''', sodium chloride-containing fluids and insulin therapy should correct the acidosis. '''Bicarbonate administration''' is only recommended when levels are below 7mmol/L. There are many '''disadvantages''' to bicarbonate therapy, including accelerated development of hypokalaemia and hypophosphataemia, and these usually outweigh the advantages.

#'''<u>Insulin</u>''': this is needed to stop ketone formation and provide glucose to insulin sensitive tissues. '''Insulin therapy can worsen hypokalaemia and hypophosphataemia''', and fluid and electrolyte correction should be started before insulin is administered. Insulin therapy should be commenced '''1-2 hours after fluids are started''', but no more than 4 hours after fluid therapy is started, ideally when potassium levels are normal. The goal of therapy is to '''decrease serum glucose by 4mmol/L/hour until 12-14mmol/L'''. '''Continuous intravenous protocols and intramuscular protocols''' are available, depending on the clinical setting. Once serum glucose is maintained at 10-14mmol/L, insulin can be given '''subcutaneously every 6-8 hours'''.

#'''<u>Insulin</u>''': this is needed to stop ketone formation and provide glucose to insulin sensitive tissues. '''Insulin therapy can worsen hypokalaemia and hypophosphataemia''', and fluid and electrolyte correction should be started before insulin is administered. Insulin therapy should be commenced '''1-2 hours after fluids are started''', but no more than 4 hours after fluid therapy is started, ideally when potassium levels are normal. The goal of therapy is to '''decrease serum glucose by 4mmol/L/hour until 12-14mmol/L'''. '''Continuous intravenous protocols and intramuscular protocols''' are available, depending on the clinical setting. Once serum glucose is maintained at 10-14mmol/L, insulin can be given '''subcutaneously every 6-8 hours'''.