Changes

Treatment is usually an '''emergency''', and involves several components:

Treatment is usually an '''emergency''', and involves several components:

#'''<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 multi-lumen central (jugular) 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.