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Hypertension is not unexpected once fluid replacement has been achieved. If the systolic blood pressure exceeds 150 mm Hg or diastolic blood pressure exceeds 90 mm mmHg, an antihypertensive agent should be considered. A calcium channel blocker (diltiazem as listed above), oral hydralazine (0.5 – 2 mg/kg PO Q12h) or amlodipine (0.2 – 0.4 mg/kg PO Q12h in dogs, 1⁄4 of a 2.5 mg tablet PO once daily in cats) can be administered. Hydralazine usually has an effect within hours of administration, while amlodipine may not decrease blood pressure for 24 hours after administration.
Diuretics such as furosemide will not improve outcome, but are occasionally given to increase urine volume when overhydration is a complication in the face of oliguria (<0.27-1 ml/kg/h). Furosemide, 2 mg/kg bolus infusion
is followed by a continuous rate infusion of 1 mg/kg/hr. Diuretics can result in dehydration and hypovolemia if urine output is not monitored and fluid balance adjusted.
Renal replacement therapy is a final method which
can rapidly eliminate toxic byproducts in the plasma. Indications for dialysis include severe, intractable uremia, severe hyperkalemia, intractable volume overload, and acute toxicities.
REFERENCES: available on request
An Urban Experience
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