The usual principles apply - daily requirements = losses + approx 500ml (for insensible losses). In anuric patients without extra losses this may mean that they only require 500mls daily, and almost no sodium, though this can be hard for other wards and units to remember.
After an acute illness in which large amounts of fluid have been required, it may be necessary to remove large excesses of extracellular fluid. This may require prolonged periods of ultrafiltration and often daily treatments will be best. Remember that patients may have lost significant flesh weight and their new dry weight may be significantly lower than before the illness.
Sodium restriction is as important as ever once patients are euvolaemic again. Look out for sodium-containing drugs - antibiotics and soluble/effervescent medications are common culprits.
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High anion gap metabolic acidosis in this population results from chronic kidney disease, type A lactic acidosis caused by tissue hypoxia, and type B lactic acidosis.( 47 ) Type B lactic acidosis presents with markedly elevated blood lactate levels, possibly caused by drug-induced mitochondrial dysfunction. Affected patients show no evidence of hypoxemia, tissue hypoperfusion, malignancy, or sepsis. This disorder has been reported with use of nucleoside reverse transcriptase inhibitors such as zidovudine, didanosine, zalcitabine, lamivudine, and stavudine.( 48 ) Although life-threatening acidosis is rare, 5-25% of treated patients may develop mildly elevated lactate levels (-5 mmol/L) without acidosis. The value of screening and the predictive value of small, asymptomatic elevations in lactate are unknown.( 48,49 ) Routine monitoring for hyperlactatemia with lactic acid levels is not recommended, but lactic acid levels should be measured in patients who present with low bicarbonate levels, an elevated anion gap, or abnormal liver enzymes.( 50 )
It takes you directly into the heart of the rendering facility; and what has been kept hidden from the consumer. Leftover meat scraps and any unused animal parts began to be added to pet foods around the time of World War II. Back then, very few people understood the nutritional requirements of cats or dogs, and so the idea stuck for many years; and continues to do so to this day. While recent years have brought many advances in animal nutrition and veterinary research, we still have a long way to go before most pet foods contain the kinds of protein that our companions need.