Hyponatremia and metabolic alkalosis in a foal with gastroesophageal reflux: a case report 

https://doi.org/10.17221/11931-VETMEDCitation:Diez E., Estepa J.C., Lopez I., Zafra R., Rodriguez M. (2009): Hyponatremia and metabolic alkalosis in a foal with gastroesophageal reflux: a case report . Veterinarni Medicina, 54: 501-506.
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A foal with a history of diarrhea and fever was presented to the Equine Clinic of the University of Cordoba for acute onset of abundant serous nasal discharge. On endoscopic examination the oesophagus was found to be atonic and ulcerated, the cardia was permanently open and the stomach showed extensive ulceration. In addition, the nasal discharge was identified to have a gastric origin (gastroesophageal reflux). The electrolyte and acid-base profiles showed marked hyponatremia (99 mEq/l) and metabolic alkalosis (pH = 7.46, Strong Ion Difference = 50 mEq/l). The foal was also uremic (plasma creatinine = 12.6 mg/dl). Although the foal experienced an improvement in its hydroelectrolytic status after treatment with 7.5% NaCl for 36 h, the owner requested euthanasia. The foal described here developed severe hyponatremia and hyposmolarity but, contrary to most reported cases, showed metabolic alkalosis instead of metabolic acidosis. Another interesting feature of this case is the lack of overt neurologic signs in the face of extreme hyposmolarity. The paucity of neurologic signs in this foal may have been influenced by slow instauration of hyponatremia, concurrent azotemia, or acid-base status.

Aldemir M., Ozen S., Kara I.H., Sir S., Bac B. (2001): Predisposing factors for delirium in the surgical intensive care unit. Critical Care, 5, 265–270.https://doi.org/10.1186/cc1044
Arroyo L.G., Vengust M., Dobson H., Viel L. (2008): Suspected transient pseudohypoaldosteronism in a 10-day-old quarter horse foal. Canadian Veterinary Journal, 49, 494–498.
Behr M.J., Hackett R.P., Bentinck-Smith J., Hillman R.B., King J.M., Tennant B.C. (1981): Metabolic abnormalities associated with ruptured bladder in neonatal foals. Journal of the American Veterinary Medical Association, 178, 263–266.
BELLENGER CR, MADDISON JE, MACPHERSON GC, ILKIW JE (1990): Chronic hypertrophic pyloric gastropathy in 14 dogs. Australian Veterinary Journal, 67, 317-320 https://doi.org/10.1111/j.1751-0813.1990.tb07813.x
Cluitmans Frans H.M., Meinders Arend E. (1990): Management of severe hyponatremia: Rapid or slow correction?. The American Journal of Medicine, 88, 161-166 https://doi.org/10.1016/0002-9343(90)90467-R
Couetil L.L., Hoffman A.M. (1998): Adrenal insufficiency in a neonatal foal. Journal of the American Veterinary Medical Association, 212, 1594–1596.
Decaux G. (2001): Treatment of severe hyponatremia
(< 120 mEq/l). Revue Medicale de Bruxelles, 22, 413–419.
Fubini S.L., Grohn Y.T., Smith D.F. (1991): Right displacement of the abomasum and abomasal volvulus in dairy cows: 458 cases (1980–1987). Journal of the American Veterinary Medical Association, 198, 460–464.
Genetzky R.M., Hagemoser W.A. (1985): Physical and clinical pathological findings associated with experimentally induced rupture of the equine urinary bladder. Canadian Veterinary Journal, 26, 391–395.
Heidmann P., Saulez M. N., Cebra C. K. (2004): Pyloric stenosis with reflux oesophagitis in a Thoroughbred filly. Equine Veterinary Education, 16, 172-176 https://doi.org/10.1111/j.2042-3292.2004.tb00290.x
KABLACK K. A., EMBERTSON R. M., BERNARD W. V., BRAMLAGE L. R., HANCE S., REIMER J. M., BARTON M. H. (2000): Uroperitoneum in the hospitalised equine neonate: retrospective study of 31 cases, 1988-1997. Equine Veterinary Journal, 32, 505-508 https://doi.org/10.2746/042516400777584712
LAING JA, HUTCHINS DR (1992): Acquired pyloric stenosis and gastric retention in a mare. Australian Veterinary Journal, 69, 68-69 https://doi.org/10.1111/j.1751-0813.1992.tb07455.x
Lakritz J., Madigan J., Carlson G.P. (1992): Hypovolemic hyponatremia and signs of neurologic disease associated with diarrhea in a foal. Journal of the American Veterinary Medical Association, 200, 1114–1116.
Lindinger M.I. (2004): Acid- base physiology during exercise and in response to training. In: Hinchcliff K.W., Kaneps A.J., Geor R.J. (eds.): Equine Sports Medicine and Surgery: Basic and Clinical Sciences of the Equine Athlete. 1st ed. WB Saunders, New York. 872–897.
Morley P.S., Desnoyer M. (1992): Diagnosis of ruptured urinary bladder in a foal by the identification of calcium carbonate crystals in the peritoneal fluid. Journal of the American Veterinary Medical Association, 200, 1515–1517.
Murray M.J. (2002): Stomach diseases of the foal. In: Mair T.S., Divers T.J., Ducharme N.G. (eds.): Manual of Equine Gastroenterology. 1st ed. W.B. Saunders, London. 469–476.
Oo Than Naing, Smith Charles L., Swan Suzanne K. (2003): Fellows’ Forum in Dialysis
edited by Mark A. Perazella: Does Uremia Protect against the Demyelination Associated with Correction of Hyponatremia during Hemodialysis? A Case Report and Literature Review. Seminars in Dialysis, 16, 68-71 https://doi.org/10.1046/j.1525-139X.2003.03015.x
Ramirez Sammy, Williams Jamie, Seahorn Thomas L., Blas-Machado Uriel, Partington Beth Paugh, Valdes Miguel, McClure J. Raymond (1998): ULTRASOUND-ASSISTED DIAGNOSIS OF RENAL DYSPLASIA IN A 3-MONTH-OLD QUARTER HORSE COLT. Veterinary Radiology <html_ent glyph="@amp;" ascii="&amp;"/> Ultrasound, 39, 143-146 https://doi.org/10.1111/j.1740-8261.1998.tb01981.x
Richardson D.W., Kohn C.W. (1983): Uroperitoneum in the foal. Journal of the American Veterinary Medical Association, 182, 267–271.
Rose B.D. (1989): Clinical Physiology of Acid-Base and Electrolyte Disorders. 3rd ed. McGraw-Hill. New York. 479–489.
Shannon J.B., Johnson P.J., David A., Cook C.R. (2004): Idiopathic gastroesophageal reflux disease in an adult horse. Journal of the American Veterinary Medical Association, 12, 1967–1970.
Soupart A., Decaux G. (1996): Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications. Clinical Nephrology, 46, 149–169.
Soupart A., Penninckx R., Stenuit A., Decaux G. (2000): Azotemia (48 h) decreases the risk of brain damage in rats after correction of chronic hyponatremia. Brain Research, 852, 167-172 https://doi.org/10.1016/S0006-8993(99)02259-3
Soupart A., Schroeder B., Decaux G. (2007): Treatment of hyponatraemia by urea decreases risks of brain complications in rats. Brain osmolyte contents analysis. Nephrology Dialysis Transplantation, 22, 1856-1863 https://doi.org/10.1093/ndt/gfm138
STäMPFLI H. R., MISIASZEK S., LUMSDEN J. H., CARLSON G. P., HEIGENHAUSER G. J. F. (1999): Weak acid-concentration A tot and dissociation constant K a of plasma proteins in racehorses. Equine Veterinary Journal, 31, 438-442 https://doi.org/10.1111/j.2042-3306.1999.tb05262.x
Sterns R.H., Ocdol H., Schrier F., Narins R.G. (1994): Hyponatremia: pathophysiology, diagnosis, and therapy. In: Narins R.G. (ed.): Maxwell and Kleeman’s Clinical Disorders of Fluid and Electrolyte Metabolism. 5th ed. McGraw Hill, London. 583–615.
Van Reeth O., Decaux G. (1989): Rapid Correction of Hyponatraemia with Urea may Protect against Brain Damage in Rats. Clinical Science, 77, 351-355 https://doi.org/10.1042/cs0770351
Wong David M., Sponseller Beatrice T., Brockus Charles, Fales-Williams Amanda J. (2007): Neurologic deficits associated with severe hyponatremia in 2 foals. Journal of Veterinary Emergency and Critical Care, 17, 275-285 https://doi.org/10.1111/j.1476-4431.2007.00228.x
Zicker S.C., Marty G.D., Carlson G.P., Madigan J.E., Smith J.M., Goetzman B.W. (1990): Bilateral renal dysplasia with nephron hypoplasia in a foal. Journal of the American Veterinary Medical Association, 196, 2001–2005.
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