Читать книгу Canine and Feline Epilepsy - Luisa De Risio - Страница 95

Treatment is aimed at increasing serum sodium levels and treating the underlying cause of the hyponatraemia. Isotonic (0.9%) saline or balanced electrolytes solutions can be administered to hypovolemic animals, while water restriction (i.e. limiting water intake to less than urine output) can be performed for animals with normovolaemia or hypervolaemia associated with excessive water intake or renal retention. A loop diuretic and dietary sodium restriction can be considered in hypervolaemic animals. To avoid life-threatening neurologic complications such as brain stem myelinolysis, recommended rates of correction for chronic (>2 days) hyponatraemia are 10–12 mEq/l/day or approximately 0.5 mEq/l/h (0.5 mmol/l/h) (Benitah, 2010). When hyponatraemia is corrected too rapidly, the increasing osmolality of the extracellular space results in water movement from the intracellular to the extra-cellular space, and consequent cellular dehydration and shrinkage. This cellular shrinkage can separate the neurons from their myelin sheaths leading to myelinolysis. Mental status, hydration and electrolytes (particularly serum sodium concentration) need to be monitored frequently (e.g. every 4–6 h) during correction of hyponatraemia. Seizure can be treated as described in Chapters 12 and 24, however dosage and choice of AEMs will vary depending on the underlying aetiology of hyponatraemia.