Emergency fluids/electrolytes

What is this medication for?

• NaHCO₃: metabolic acidosis, urine alkalinization, hyperkalemia/hypercalcemia adjunct
• Dextrose: hypoglycemia (insulin overdose, insulinoma, neonates, toy-breed)
• Magnesium (into a vein): hypomagnesemia (refractory hypokalemia companion), refractory ventricular arrhythmias, anticonvulsant, MH adjunct (swine)
• into a vein lipid emulsion (ILE): lipophilic-drug intoxication RESCUE — local anesthetics, macrocyclic lactones (ivermectin/moxidectin — incl. MDR1 dogs), CCBs, beta-blockers, others

How is it given?

Give exactly as your veterinarian prescribed — never change the dose or stop on your own unless your veterinarian has told you to.

What if I miss a dose?

• Give it as soon as you remember — unless it is almost time for the next dose (then skip the missed one; never double up).
• Call your clinic if you miss more than one dose in a row.

Side effects — what should I watch for?

Effects listed as common in this handout

• Hyperglycemia, phlebitis, osmotic diuresis (Dextrose)
• Lipemia, pancreatitis, infection, fat overload (ILE)

Worth a phone call to your veterinarian

• Any new symptom that worries you.

⚠️ Contact your veterinarian or an emergency clinic IMMEDIATELY if you notice

• Overshoot alkalosis, hypokalemia, hypocalcemia (tetany!), hypernatremia, volume overload, left-shifted O₂ curve, paradoxical CNS acidosis → respiratory arrest; V-fib risk in CPR (NaHCO₃)
• Hypermagnesemia: CNS depression, weakness, unusually slow heart rate, low blood pressure, ↑QT, respiratory depression, neuromuscular block → arrest (Magnesium)

Before starting (or refilling), tell your veterinarian if your pet:

• has or has had: Metabolic/respiratory alkalosis, chloride-loss states, hypocalcemia (alkalosis tetany), poor ventilation
• has or has had: Hypermagnesemia → into a vein calcium 10–50 mg/kg (Macintire) — the mirror-image rescue
• has or has had: Don't run other drugs through the lipid line
• (mention everything — even herbal products)

• is pregnant, nursing, or used for breeding
• is taking any other medications, supplements, or flea/tick products, including:

Storage and handling

| Practical rules | | --- | | Never push NaHCO₃ undiluted/fast; never with calcium in same line (precipitation); D50 dilute before peripheral use; ILE 20% via clean line (binds/adsorbs other drugs) |

Good to know

• NaHCO₃ trinity: calculate don't blast (⅓ of deficit), ventilate before you medicate (CO₂ problem), and watch potassium/calcium swing together.
• Hypoglycemia two-step: D50 bump → D5 drip bridge (especially long-acting insulin/insulinoma) — the rebound is the trap.
• The hypokalemia-that-won't-fix is often hypomagnesemia — Mg 0.5–1 mEq/kg/day CRI unlocks refractory K repletion.
• ILE = the lipid sink era: ivermectin-comatose MDR1 collie, bupivacaine-arrest, amlodipine/verapamil overdose — 1.5 mL/kg bolus + infusion, ≤8 mL/kg/day; rescue-tier evidence but low-risk.