Table 126-4.

IMPORTANT METABOLIC ENCEPHALOPATHIES IN SMALL ANIMALS

Condition	Causes	Brain Region Affected	Clinical Signs	Treatment
Global hypoxia/ischemia	Pulmonary disease, anemia, carbon monoxide, cyanide, shock, cardiac disease or arrest	Cerebrum (occipital region), cerebellum, hippocampus	Blindness, seizures, ataxia, memory loss, coma	Correct underlying cause; give fluids, oxygen, mannitol and furosemide for edema
Hypoglycemia	Juvenile hypoglycemia, insulinoma, sepsis, severe liver disease, Addison's disease	Cerebrum, cerebellum, hippocampus	Ataxia, weakness, collapse, pupillary changes, depressed mentation, seizures, focal facial twitches	Correct underlying cause
Hypocalcemia	Eclampsia, hypoparathyroidism, renal failure, others	Cerebrum (neuromuscular junction)	Muscle tremors, spastic tetraparesis/tetany, behavior change, seizures, myoclonus	0.5–1.5 ml/kg, up to 10 ml total of 10% calcium gluconate, slow IV
Hypernatremia	Diabetes insipidus, severe dehydration, adipsia, primary hyperaldosteronism	Cerebrum	Ataxia, weakness, tremors depression, seizures, coma	Slow correction with normal saline then half-strength saline
Hyponatremia	Diuretics, Addison's disease, inappropriate adh secretion, water intoxication	Cerebrum	Depression, stupor, coma	Slow correction with normal saline then hypertonicsaline; will induce pontine or thalamic myelinolysis if corrected too fast
Uremia	ARF, CRF	Cerebrum	For ARF: Seizures, tremors, myoclonus, non-fixed muscle twitches	Correct underlying cause; use anticonvulsants if seizures, oral phosphate binders, cimetidine
			For CRF: Dementia, depression, coma
Hepatic encephalopathy	Portocaval shunt, acquired liver disease	Cerebrum	Episodic dementia, head pressing, pacing, ataxia, visual deficits, seizures, ptyalism	IV fluids with potassium, colon evacuation, lactulose or dilute providone enemas, metronidozole PO; low-protein, high-carbohydrate diet; surgery for shunt ligation

ARF, acute renal failure; CRF, chronic renal failure.