Cerebrospinal fluid composition of cattle with endotoxin-induced mastitis treated with isotonic (0.9%) or hypertonic (7.5%) sodium chloride

Acute sodium overload produces renal tubulointerstitial inflammation in normal rats

The aim of the present study was to determine whether acute sodium overload could trigger an inflammatory reaction in the tubulointerstitial (TI) compartment in normal rats. Four groups of Sprague-Dawley rats received increasing NaCl concentrations by intravenous infusion. Control (C): Na+ 0.15 M; G1: Na+ 0.5 M; G2: Na+ 1.0 M; and G3: Na+ 1.5 M. Creatinine clearance, mean arterial pressure (MAP), renal blood flow (RBF), and sodium fractional excretion were determined. Transforming growth factor beta1 (TGF-beta1), alpha-smooth muscle actin (alpha-SMA), RANTES, transcription factor nuclear factor-kappa B (NF-kappaB), and angiotensin II (ANG II) were evaluated in kidneys by immunohistochemistry. Animals with NaCl overload showed normal glomerular function without MAP and RBF modifications and exhibited a concentration-dependent natriuretic response. Plasmatic sodium increased in G2 (P < 0.01) and G3 (P < 0.001). Light microscopy did not show renal morphological damage. Immunohistochemistry revealed an increased number of ANG II-positive tubular cells in G2 and G3, and positive immunostaining for NF-kappaB only in G3 (P < 0.01). Increased staining of alpha-SMA in the interstitium (P < 0.01), TGF-beta1 in tubular cells (P < 0.01), and a significant percentage (P < 0.01) of positive immunostaining for RANTES in tubular epithelium and in glomerular and peritubular endothelium were detected in G3 > G2 > C group. These results suggest that an acute sodium overload is able 'per se' to initiate TI endothelial inflammatory reaction (glomerular and peritubular) and incipient fibrosis in normal rats, independently of hemodynamic modifications. Furthermore, these findings are consistent with the possibility that activation of NF-kappaB and local ANG II may be involved in the pathway of this inflammatory process.

Fluid and electrolyte therapy in ruminants

Five important questions always must be asked and answered regarding fluid and electrolyte therapy in ruminants: (1) Is therapy needed? (2) What type of therapy? (3) What route of administration? (4) How much should be administered? and (5) How fast should the solution be administered? Food animal veterinarians routinely should carry the following commercially available crystalloid solutions and have the knowledge of how to use the products appropriately: Ringer's solution, 1.3% NaHCO3, acetated Ringer's solution, HS (7.2% NaCl), 8% NaHCO3, 23% calcium gluconate, calcium-magnesium solutions, and 50% dextrose. Ruminants with a blood pH less than 7.20 should be treated intravenously with 1.3% or 8.0% NaHCO3, and those animals with a blood pH greater than 7.45 should be treated intravenously with Ringer's solution. Oral electrolyte solutions or intravenous acetated Ringer's solution should be administered to ruminants with a blood pH greater than 7.20 but less than 7.45, and acetated Ringer's solution is preferred to lactated Ringer's solution. HS solution should be administered whenever rapid resuscitation is required. Oral administration of electrolyte solutions is underused in neonatal and adult ruminants. The optimal solution for oral administration to neonatal ruminants has a sodium concentration between 90 and 130 mmol/L; a potassium concentration between 10 and 20 mmol/L; a chloride concentration between 40 and 80 mmol/L; 40 to 80 mmol/L of metabolizable (nonbicarbonate) base, such as acetate or propionate; and glucose as an energy source. The optimal formulation for adult ruminants is unknown, but such a solution should contain sodium, potassium, calcium, magnesium, phosphate, and propionate to facilitate sodium absorption and to provide an additional source of energy to the animal. Acidemia is treated best by intravenous or oral administration of NaHCO3. Alkalemia is treated best by intravenous administration of Ringer's solution and oral administration of chloride-rich electrolytes such as KCl; the latter provides a physiologically more appropriate treatment than oral administration of vinegar or acetic acid solutions. Hypocalcemia is treated best by administering intravenous calcium borogluconate solutions or oral CaCl2 gels. Hypomagnesemia is treated best by intravenous or subcutaneous administration of combined calcium and magnesium solutions. Hypophosphatemia is treated best by oral administration of feed-grade monosodium phosphate. Hypokalemia is treated best by oral administration of feed-grade KCl; hyperkalemia is treated best by intravenous administration of 8.0% NaHCO3 or HS. The major challenges in treating fluid and electrolyte disorders in ruminants are making treatment protocols more practical and less expensive and formulating an optimal electrolyte solution for oral administration to adult ruminants.

Hypertonic saline

A key feature in the successful resuscitation of dehydrated or endotoxemic ruminants is the total amount of sodium administered. Administration of small volumes of HS and HSD offer major advantages over large volumes of isotonic saline because HS and HSD do not require intravenous catheterization or periodic monitoring, and are therefore suitable for use in the field. Hypertonic saline and HSD exert their beneficial effect by rapidly increasing preload and transiently decreasing afterload. Contrary to early reports, HS and HSD decrease cardiac contractility and do not activate a pulmonary reflex. The osmolality of HS and HSD should be 2400 mOsm/L (7.2% NaCl solution, 8 times normal plasma osmolality). Use of HS and HSD solutions of different osmolality to 2400 mOsm/L should be avoided at all costs, as too low a tonicity removes the main advantages of HS (low cost, decreased infusion time), whereas too high a tonicity may cause rapid vasodilation and decreased cardiac contractility, resulting in death. Rapid administration (> 1 mL/kg-1/min-1) of HS (2400 mOsm/L) should be avoided, as the induced hypotension may be fatal when coupled with a transient decrease in cardiac contractility. For treating dehydrated adult ruminants, HS (2400 mOsm/L, 4-5 mL/kg i.v. over 4-5 minutes) should be administered through the jugular vein and the cow allowed to drink water. This means that 2 L of HS should be administered to adult cattle. HSD should be administered in conjunction with isotonic oral electrolyte solutions to all calves 8% or more dehydrated (eyes recessed > or = 4 mm into the orbit, cervical skin tent duration > 6 seconds) or calves with reduced cardiac output (fetlock temperature < 29 degrees C when housed at 10-24 degrees C). For treating dehydrated calves, HSD (2400 mOsm/L NaCl in 6% dextran-70, 4-5 mL/kg i.v. over 4-5 minutes) should be administered through the jugular vein and the calf allowed to suckle an isotonic oral electrolyte solution. This means that 120-200 mL of HSD of HSD should be administered to a calf. HSD should be routinely administered to severely depressed or comatose calves, as HSD provides the fastest method of resuscitation while rapidly reversing the effects of hyperkalemia.

Effect of intravenous infusion of a 7.2% hypertonic saline solution on serum electrolytes and osmotic pressure in healthy beagles

The effect of an intravenous (i.v.) infusion of hypertonic saline solution (HSS; 7.2%, 2,400 mOsmol/kg.H2O) was evaluated by serum electrolyte concentrations and osmotic pressure in the anesthetized beagles. Sixteen beagles were assigned to 3 experimental groups (2.5, 5 or 15 ml/kg of HSS i.v. infusion) or a control group (5 ml/kg of isotonic saline solution (ISS) i.v. infusion) and were monitored for 120 min after the initiation of fluid infusion. The relative plasma volume (rPV) in the 5 ml/kg and 15 ml/kg HSS groups progressively expanded to 143.1 +/- 7.4% at 3 min and 156.4 +/- 5.9% at 5 min after the initiation of the fluid infusion, respectively. Significant increases were not produced by ISS and 2.5 ml/kg HSS infusion. The serum sodium and chloride concentrations in the ISS group were not altered. The 5 ml/kg HSS infusion induced transient high osmotic and sodium levels, and the serum sodium concentration remained under the 160 mM/l after the completion of the HSS infusion. However, the 15 ml/kg HSS infusion induced a constant high osmotic level (340.5-352.8 mOsmol/kg.H2O) and hypernatremia (161.4-174.5 mM/l) from 10 to 90 min after the initiation of the fluid infusion. The 15 ml/kg HSS infusion induced significant decreases in the partial pressure of oxygen (PaO2), reaching 63.7 +/- 8.0 mmHg at 120 min after the initiation of the fluid infusion compared with an immediately before fluid infusion value. On the basis of these findings, 5 ml/kg HSS infusion can be safely administered to healthy beagles for expanding the plasma volume without inducing hypernatremia. A 5 ml/kg HSS infusion is thus recommended for the initial field resuscitation of dogs.

Effect of a 7.2% hypertonic saline solution infusion on arterial blood pressure, serum sodium concentration and osmotic pressure in normovolemic heifers

The effects of an intravenous (i.v.) infusion of a small volume (5 ml/kg) or large volume (15 ml/kg) of hypertonic saline solution (HSS; 7.2%, 2,400 mOsmol/kg.H2O) and those of an i.v. infusion of 5 ml/kg isotonic saline solution (ISS; 300 mOsmol/kg.H2O) on plasma volume, arterial blood pressure, serum sodium concentrations and osmotic pressure were investigated in conscious heifers. Nine heifers (3 heifers/group) were monitored for 120 min after the initiation of fluid replacement. The relative plasma volume (rPV) in the 5 ml/kg HSS and 15 ml/kg HSS progressively increased to 137.7 +/- 2.4% at t = 5 min and 145.2 +/- 5.4% at t = 15 min, respectively. The expanding plasma volume in the 5 ml/kg HSS group remained at an up to 10% higher level until 120 min, but not in the 15 ml/kg HSS group. The 5 ml/kg HSS infusion induced transit high-osmotic (305.3 +/- 4.0 mOsmol/kg.H2O) and sodium levels (155.7 +/- 3.5 mM/l) at t = 5 min. However, the 15 ml/kg HSS infusion induced constant high-osmotic level (321.7-336.7 mOsmol/kg.H2O) and hypernatremia (162.8-170.0 mM/l) from t = 10 min to the rest of the experiment period. In the ISS and 5 ml/kg HSS groups, no changes in PaO2 were observed. The 15 ml/kg HSS infusion induced a significant decrease in the partial pressure of oxygen at the t = 30 min compared to the t = 0 min values. On the basis of these findings, a small volume (5 ml/kg) HSS infusion can be rapidly and safely administered to cattle for expanding the plasma volume without inducing hypernatremia. A 5 ml/kg HSS infusion is thus recommended for the initial field resuscitation of cattle.