- wo 13 jun 2007, 08:50
#777553
Ik weet dat de DA allopurinol heeft besteld. Maar nou las ik dit Erna, dus misschien moet je daar toch wel voorzichtig mee zijn:
Urine alkalinization minimizes renal ammonia production; the goal is to achieve a urine pH >7. If required, urine alkalinization can be achieved by administering NaHCO3, 1 g (1/4 tsp)/5 kg, PO, tid, with food. Potassium citrate, administered to effect (25-50 mg/kg/day) is an alternative, more palatable alkalinizing agent.
Urinary urate output should be reduced. This can be accomplished by feeding a low purine, low-protein commercial diet. In addition, the xanthine oxidase inhibitor allopurinol (15 mg/kg, PO, bid) may be administered to ensure the nucleic acid metabolite load is excreted as a combination of xanthine, hypoxanthine, uric acid, and allantoin, rather than almost entirely as urate. However, the effectiveness of allopurinol in reducing urinary urate output is variable, and urinary urate levels should be measured (although this may be difficult). Allopurinol must be used cautiously in dogs with hepatic disease or primary renal failure because it is metabolized to its active form in the liver and is excreted via the kidneys. It is important that diets high in purines not be fed to dogs receiving allopurinol because xanthine uroliths may result.
Prevention strategies aim to reduce the concentration of ammonium and urate in urine to levels unlikely to induce flocculation. A low-protein, low-purine diet should be fed to reduce urinary urate output. Alkalinization should be used as needed to ensure alkalinuria. Treatment with allopurinol (10 mg/kg, PO, sid) can be considered. Ideally, allopurinol is not needed as a supplement to dietary management; however, if urate crystals persist, a low maintenance dose of allopurinol is appropriate.
These dissolution and prevention strategies were developed for use in Dalmatians in which hepatic conversion of urate to allantoin is reduced, but the liver is otherwise normal. They may not be safe for use in dogs with portosystemic vascular shunts. Such dogs tend to develop hypoalbuminemia, edema, and ascites when fed a low-protein diet. The safety of allopurinol in these dogs has not been established. In addition, alkalinization can predispose to hepatic encephalopathy because of increased GI absorption of dietary protein metabolites.