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Kinnia pisze:jedno wiem na pewno - ringera nie daje się ani ludziom ani futrom z chorymi nerkami
Mi_mi pisze:(...)
Trochę mnie nastraszyłyście tym ringerem - dlaczego się nie podaje?
pixie65 pisze:[Zastanawiam się,] czy długie podawanie NaCl kotu z pnn jest/może być powodem hiperchloremii w efekcie "nadpodaży" Cl czy raczej problemem jest tu brak uzupełniania innych jonów, w tym - anionów wodorowęglanowych.
LRS (płyn ringera z mleczanem) również zawiera jony chlorkowe a jednak podaje się go właśnie m.in. po to aby zapobiec kwasicy.
Dr Kathy James, cytowana już tutaj kiedyś, pisze m.in.:"LRS is buffered with lactate which is converted to bicarbonate by the liver."
Stąd chyba pojawiło się twierdzenie, że LRS "obciąża wątrobę". Tymczasem chodzi raczej o to, że aby ten mechanizm zadziałał - wątroba musi być na tyle sprawna, żeby ten mleczan "przerobić" na wodorowęglany.
Być może w niektórych przypadkach wystarczy właśnie zmiana płynu aby kontrolować poziom chlorków.
Jakiś czas temu ktoś gdzieś pisał też o podawaniu kotu (z zalecenia weta) sody oczyszczonej (wodorowęglanu sodu NaHCO3).
Pełny cytat dr K.James:
"The saline vs lactate Ringers solution question is one we did have a little discussion of a couple of months ago.
I disagree with the vet who said there's some golden rule about the use of saline for crf patients. I believe LRS is the preferred solution for crf, certainly better than full-strength saline.
Roughly, 0.9% NaCl is 154 mEq/l of Na, which is the electrolyte they don't need in excess, as compared with 130 mEq/l Na in LRS.
There's good evidence in humans that chronic high sodium intake raises blood pressure and this may well true for cats and a contributing factor to the problem of hypertension in crf. Also there is no K+ in NaCl which is an electrolyte they do need; there's not much K+ is LRS either, but there is some.
Also saline has no buffer. LRS is buffered with lactate which is converted to bicarbonate by the liver. There was something published by the critical care folks about sepsis (overwhelming bacterial infection) and how those patients couldn't convert lactate to bicarbonate because their liver function is compromised in septic shock so if you used IV LRS exclusively you could create high blood lactate levels and that would be a problem.
But that's one specific disease condition and concerns rapid fluid administration IV. There's no relationship between that and crf and there's no data to support or any theortical reason to believe that the livers of crf cats don't convert lactate to bicarbonate just fine.
Lactate is still the preferred buffer solution for humans with crf on dialysis. In cats with simultanous compensated heart failure or some other disease condition that makes them intolerant of a sodium load, half strength (0.45% NaCl) may be preferred over LRS because the Na is only 77mEq/l. However, I would suspect that most crf cats on full strength NaCL SQ chronically would get hypernatremia (too high a blood Na) because of not enough solute-free water. A rare cat with some sort of salt-wasting kidney disease might need full- strength NaCl but that would be very, very unusual and dictated by finding and verifying a low Na on a blood."
Kinnia pisze:jedno wiem na pewno - ringera nie daje się ani ludziom ani futrom z chorymi nerkami
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