J Vet Intern Med 2005;19:816–821

Acid-Base and Electrolyte Abnormalities in Dogs

with Gastrointestinal Foreign Bodies
Amanda K. Boag, Richard J. Coe, Teresa A. Martinez, and Dez Hughes

Gastrointestinal foreign bodies occur commonly in dogs. The objective of the study was to describe the acid-base and electrolyte
abnormalities identified in dogs with gastrointestinal foreign bodies and determine if these abnormalities are related to the site or
type of foreign body present. Medical records of 138 dogs were reviewed, and information on signalment, initial venous electrolyte
and acid-base values, surgical findings, relevant historical information, imaging modalities used, cost of hospital visit, intra- or
postoperative complications, and survival was obtained. The site of the foreign body was recorded in 94.9% of cases and the most
common site was the stomach (50%), followed by the jejunum (27.5%). The foreign bodies were linear in 36.2% of cases. The
most common electrolyte and acid-base abnormalities regardless of the site or type of foreign body were hypochloremia (51.2%),
metabolic alkalosis (45.2%), hypokalemia (25%), and hyponatremia (20.5%). No significant association was found between elec-
trolyte or acid-base abnormalities and the site of foreign body. Linear, as opposed to discrete, foreign bodies were more likely to
be associated with a low serum sodium concentration (odds ratio, 0.85; 95% confidence interval, 0.75–0.95). Hyperlactatemia
(.2.4 mmol/L) was seen in 40.5% of dogs. A wide variety of electrolyte and acid-base derangements are found in dogs with
gastrointestinal foreign bodies. Hypochloremia and metabolic alkalosis are common in these dogs. Hypochloremic, hypokalemic
metabolic alkalosis is seen with both proximal and distal gastrointestinal foreign bodies.
Key words: Alkalosis; Hypochloremia; Hypokalemia; Hyponatremia; Linear.

D ogs with clinical signs resulting from gastrointestinal

foreign bodies are common in small-animal veteri-
nary practice.1 Dogs ingest a large variety of objects that
either pass through the gastrointestinal (GI) tract or cause
a complete or partial obstruction. Other ingested objects act
as linear foreign bodies and cause plication of the small
intestine.2
Animals with GI disease frequently have acid-base and
electrolyte abnormalities.3 Large volumes of fluid and elec-
trolytes are secreted and reabsorbed by the healthy GI tract
daily. In a 20-kg dog, approximately 2.5 L of fluid enters
the GI tract from diet and normal gastrointestinal secretions
and over 98% is reabsorbed daily.4 Experimental studies of
GI obstruction in dogs have revealed that, after an obstruc-
tion has been present for over 24 hours, there is secretion
of sodium, potassium, and water rather than absorption in
the bowel proximal to the obstruction. Gastrointestinal
function is also abnormal distal to the obstruction.5 Thus,
disturbances in normal GI tract function secondary to com-
plete or partial obstruction can rapidly result in disturbances
of fluid balance, acid-base status, and serum electrolyte
concentrations. Protracted or profuse vomiting and diarrhea
with reluctance to consume adequate volumes of food and
fluid can also affect the intravascular volume and hydration
From the Department of Veterinary Clinical Science, Royal Veter-
inary College, Hawkshead Lane, North Mymms, Hertfordshire, United
Kingdom (Boag, Martinez, Hughes); Department of Clinical Veteri-
nary Sciences, University of Bristol, Langford House, Langford, Bris-
tol, United Kingdom (Coe). Presented in part as an abstract at British
Small Animal Veterinary Association Annual Congress 2002, Inter-
national Conference Centre, Birmingham, UK.
Reprint requests: Amanda K. Boag, MA, VetMB, DipACVIM
MRCVS, Department of Veterinary Clinical Science, Royal Veterinary
College, Hawkshead Lane, North Mymms, Hertfordshire, United King-
dom; e-mail: aboag@rvc.ac.uk.
Submitted December 10, 2004; Revised April 5, 2005; Accepted
June 22, 2005.
Copyright q 2005 by the American College of Veterinary Internal
Medicine
0891-6640/05/1906-0005/$3.00/0
status of the dog and can therefore lead to further alterations
in acid-base and electrolyte status.
It is often stated that a proximal (ie, gastric or upper
duodenal) GI obstruction is likely to lead to the develop-
ment of a hypochloremic, hypokalemic metabolic alkalosis
due to the loss of chloride, potassium, and acid-rich gastric
secretions, whereas a more distal obstruction is more likely
to lead to a metabolic acidosis.6,7 For instance, 10/13 dogs
with metabolic alkalemia had GI disease and 7/10 of these
had evidence of gastric outflow obstruction.8 Both meta-
bolic acidosis and alkalosis occur in dogs with other GI
conditions, such as gastric dilation and volvulus syn-
drome9,10 and parvoviral enteritis.11 Metabolic acidosis was
the more common abnormality in dogs with gastric dilation
and volvulus and metabolic alkalosis the more common ab-
normality in dogs with parvoviral enteritis. Knowledge of
the acid-base and electrolyte status of the dog can be im-
portant in determining the optimal fluid therapy plan and
in stabilizing the patient prior to anesthesia and surgery.
The aims of this retrospective study were to describe the
site and type of naturally occurring GI foreign bodies in a
population of dogs that presented to a busy, urban emer-
gency clinic; to describe the acid-base and electrolyte dis-
turbances identified early in the course of their manage-
ment; and to assess whether acid-base or serum electrolyte
abnormalities were related to the site and type of the foreign
body found at subsequent surgery.
Materials and Methods
Medical records from the Veterinary Hospital of the University of
Pennsylvania were searched from January 1997 to February 2000 for
dogs recorded as having had a foreign body removed from their GI
tract. Records were excluded if they were unavailable for review or if
the foreign body was esophageal, successfully retrieved endoscopically
or an incidental finding during celiotomy undertaken for another rea-
son (eg, ovariohysterectomy).
Data obtained from the medical records included age, breed, sex,
reproductive status, duration of vomiting, whether fluid therapy had
been administered by the referring veterinarian prior to referral, im-
aging modalities undertaken prior to surgery, duration of surgery, de-
scription of the foreign body/bodies identified at celiotomy (number
 Gastrointestinal Foreign Bodies in Dogs
of foreign bodies, site of foreign body, and whether it formed a linear
foreign body), whether resection and anastomosis of the GI tract was
performed, cost of hospital visit, any intra- or postoperative compli-
cations and survival. Hematological and biochemical parameters mea-
sured shortly after admission were also recorded (packed cell volume
[PCV]; refractometric total solids [TS]; serum concentrations of so-
dium, potassium, chloride, bicarbonate, lactate; pH, and pCO2, base
excess, and anion gap). These tests were performed on venous blood
samples obtained from the cephalic or jugular vein. PCF and TS mea-
surements were performed routinely using a microhematocrit centri-
fuge and refractometer.a Electrolyte and acid-base values were mea-
sured by an amperometric autoanalyzerb on heparinized blood (30 IU/
mL) that was analyzed within 1–2 minutes of venipuncture. Reference
ranges for the autoanalyzer had been previously determined from 60
clinically normal dogs (pH, PVCO2, sodium, potassium, chloride, lac-
tate). Standard published reference ranges were used for PCV, TS, base
excess, bicarbonate, and anion gap.12
Frequency distribution analysis and descriptive statistics were gen-
erated for all data using statistical software.c Two binary outcomes for
each dog were analyzed using multivariable methods. One was if the
foreign body was in the proximal GI tract (proximal to the major
duodenal papilla) (n 5 74) or in a portion of the GI tract distal to the
duodenal papilla (n 5 51). Animals with multiple foreign bodies at
more than 1 site (n 5 3), those where the site of the foreign body was
not recorded (n 5 7), and those where a linear foreign body was found
anchored in the mouth (n 5 3) were not considered in this part of the
analysis. Second, whether the recovered foreign bodies were recorded
as being linear (n 5 50) or present in a discrete site (or sites) (n 5
87). Univariate analysis was carried out to detect associations between
the independent variables and the 2 binary outcomes. Based on the
univariate analysis results, 2 logistic regression models were evaluated
using backward stepwise regression. Independent variables with P-
values , .25 in the univariate analysis were included in the multivar-
iate models. Univariate and multivariate analyses were carried out us-
ing STATA 7 statistical software.d
Results
Records from 138 dogs were included in the study. The
dogs ranged in age from 4 months to 14 years (mean 3.8
years; median 3.0 years). Fifty-two dogs (37.7%) were male
entire, 24 dogs (17.4%) were male neutered, 41 dogs
(29.7%) were female entire, and 19 dogs (13.8%) were fe-
male neutered; in 2 dogs, the sex was unrecorded. Forty-
nine breeds were represented with Labrador Retriever (22/
138), mixed breed (21/138), Golden Retriever (8/138), and
Dalmatian (6/138) being the most common. The duration
of vomiting was recorded in 124 dogs. The median duration
of vomiting was 48 hours (range 0–504 hours). In 10 dogs,
the owners did not report vomiting and in most of these
cases the dogs were presented to the hospital because the
owners had seen them eat a foreign object. In 4 cases, the
presence or absence of vomiting could not be ascertained.
Thirteen dogs had received subcutaneous fluids and 19 dogs
had received intravenous fluids at the referring practice pri-
or to presentation.
Imaging studies were undertaken in all cases. All dogs
had plain abdominal radiographs. Thirty-one dogs (22.5%)
had an abdominal ultrasound examination, and 28 dogs
(20.3%) had an upper gastrointestinal contrast study. Five
dogs (3.6%) had both ultrasound and an upper gastrointes-
tinal contrast study. In 8 dogs (5.8%), endoscopy was at-
tempted unsuccessfully prior to celiotomy. In these 8 dogs,
the foreign body was identified at surgery in the stomach
817
(5 dogs), duodenum (1 dog), jejunum (2 dogs), and ileum
(1 dog).
The location of the foreign body found at celiotomy was
recorded in 131 (94.9%) cases. It was identified in the stom-
ach in 69/138 cases (50%), proximal duodenum in 5/138
cases (3.6%), distal duodenum in 4/138 cases (2.9%), je-
junum in 38/138 cases (27.5%), ileum in 4/138 cases
(2.9%), and colon in 5/138 cases (3.6%). In 3/138 of cases
(2.2%), the foreign body was recorded as linear and an-
chored in the mouth (around the base of the tongue) and in
3/138 cases (2.2%), there were multiple foreign bodies
identified at different sites.
The foreign body was described as being linear in 50/
138 (36.2%) cases. The linear foreign body was anchored
in the mouth in 3/50 cases (6%), the pylorus in 39/50 cases
(78%), the duodenum in 1/50 cases (2%), the jejunum in
4/50 cases (8%), and the anchoring site was unrecorded in
2/50 cases (4%). In 1 case, the foreign body (string) was
found in the colon at surgery but a jejunal resection and
anastomosis was required as the jejunum was plicated and
perforated, suggesting that the string had acted as a linear
foreign body prior to surgical exploration.
A resection and anastomosis was performed in 38/138
cases (28%). Of these cases, 21 had linear and 17 discrete
foreign bodies.
Mortality was low, with 137/138 dogs surviving to hos-
pital discharge. One dog was euthanized due to septic peri-
tonitis. Three dogs (2.2%) had complications requiring re-
operation; 1 with a linear foreign body and septic perito-
nitis, where open peritoneal management was used; and 2
that suffered wound dehiscence (1 body wall and 1 intes-
tinal). Eight dogs (5.8%) had complications that did not
require reoperation, including presumed postoperative pan-
creatitis (n 5 3), pneumonia (n 5 1), presumed GI motility
problems (n 5 2), and seroma formation at the celiotomy
wound (n 5 2).
A wide range of acid-base and electrolyte abnormalities
was found (Table 1). There were no dogs for which both
sodium and potassium values were available that had a so-
dium : potassium ratio of less than 27 : 1.
The most common acid-base and electrolyte abnormali-
ties were hypochloremia (51.2%), metabolic alkalosis
(45.2%), hyperlactatemia (40.5%), hypokalemia (25%), and
hyponatremia (20.5%) (Table 1). These abnormalities were
common regardless of the site of the foreign body found at
subsequent surgery (Table 2). Twelve percent (9/74) of
dogs with proximal GI obstructions and 13.7% (7/51) of
dogs with distal GI obstructions had a hypochloremic, hy-
pokalemic metabolic alkalosis. In dogs for which both val-
ues were available, 29/94 (28.7%) had a high lactate value
and a positive base excess indicative of a mixed metabolic
acidosis and alkalosis.
The independent variables that significantly improved the
fit of a multivariate model with the outcome being location
of the foreign body in the GI tract (ie, the foreign body
was identified either in a proximal or a distal location) were
chloride ion concentration, duration of vomiting, and sur-
gical time. Increased surgery time was associated with the
foreign body being in the upper GI tract with an odds ratio
(OR) of 0.98 (95% confidence interval [CI] 0.97–0.99). The
surgical time for proximal foreign bodies was 96 (643)
818 Boag et al

Table 1. Mean, SD, and range of acid-base and serum electrolyte concentrations measured shortly after presentation and
percentage of animals with variables outside the reference range in 138 dogs with GI foreign bodies.
Percentage Percentage Percentage
, Within .
Reference Mean Reference Reference Reference
Range n (SD) Range Range Range Range
PCV (%) 37–55 136 52.7 (7.9) 36–80 1.5 65.4 33.1
TS (g/L) 55–73 130 76 (11) 55–110 3.1 53.8 43.1
Sodium (mmol/L) 140–153 132 143.7 (6.1) 122–155 20.5 78 1.5
Potassium (mmol/L) 3.6–4.6 136 3.8 (0.4) 2.4–5.0 25 72.8 2.2
Chloride (mmol/L) 106–120 129 104.5 (6.9) 82–124.5 51.2 48.1 0.7
pH 7.36–7.47 128 7.428 (0.53) 7.282–7.612 7.8 74.2 18
PVCO2 (mmHg) 33–52 125 42.7 (6.2) 20.3–63.8 1.6 93.6 4.8
Bicarbonate (mmol/L) 18–25 126 28.1 (5.3) 11.5–58.8 0.8 24.6 74.6
Base excess 24–14 126 13.9 (5.8) 213.7–137.2 3.2 51.6 45.2
Lactate (mmol/L) 0.6–2.4 116 2.6 (1.5) 0.3–8.4 1.7 53.5 44.8
Anion gap 15–25 103 15.3 (5.6) 1–29 36.9 58.3 4.8

minutes, whereas for distal foreign bodies, it was 95 (61 conditions (such as ruptured diaphragm) that may have sig-
minutes). No biochemical abnormalities were significantly nificantly affected their electrolyte and acid-base results.
associated with the location of the foreign body identified Others were undergoing routine elective surgery and did
at surgery (Fig 1a–d). When comparing linear and nonlin- not have preoperative blood-gas analysis performed.
ear foreign bodies as the outcome, the final multivariate A large range of ages and breeds of dog were repre-
model contained the variables lactate, sodium, chloride, du- sented, with the most common signalment being a young,
ration of vomiting, cost of hospital stay, and surgical time. large-breed dog. This signalment is similar to previous ret-
The variables found to be significantly associated with lin- rospective studies of foreign bodies in dogs.2,13 The high
ear foreign bodies were sodium (OR 5 0.85; 95% CI 0.75– proportion of intact animals in the study is likely to reflect
0.95), with a higher sodium being associated with discrete the young age of the study population.
foreign bodies and surgical time (OR 5 1.02; 95% CI The survival rate reported in this study is high, with only
1.008–1.035), with linear foreign bodies being associated 1 patient not surviving to hospital discharge and only 3
with an increased surgical time. patients suffering serious complications that required re-
operation. This compares favorably with the mortality rate
Discussion of 22% reported in a previous study of dogs with linear
foreign bodies.2 There are several possible reasons for this.
Only foreign bodies removed surgically were included in First, due to the nature of linear foreign bodies, greater
this study. This allowed accurate characterization of the compromise of the bowel tissue may be expected than with
number, site, and nature of the foreign bodies. Although a discrete foreign body leading to a higher complication
endoscopic retrieval may be successful in some cases of and mortality rate. Second, the majority of patients in this
gastric foreign bodies, it is impossible to be certain that study were admitted as emergencies and the median dura-
other foreign material is not present distally in the GI tract. tion of vomiting was much shorter (2 days as opposed to
Foreign bodies found incidentally at celiotomy performed 5 days) than in the previous study. It is possible that, due
for other reasons were also excluded. Some of these pa- to the more rapid presentation, bowel compromise and met-
tients were undergoing surgery for other potentially serious abolic derangements were not as severe in the patient pop-
ulation in this study. Blood-gas analysis was not reported
Table 2. Serum electrolyte and acid-base abnormalities in in the study by Evans et al,2 but the proportions of dogs
dogs with proximal versus distal GI foreign bodies (com- displaying hypokalemia and hyponatremia were similar to
pared with reference range). those reported here. Third, patients presenting primarily
with septic peritonitis may not have been identified using
Proximal GI Distal GI our search criteria. As septic peritonitis is associated with
Foreign Bodies Foreign Bodies
Comparison a guarded prognosis,14,15 identification and inclusion of
With % % % % % % these patients may have increased the number of animals
Reference Cases Cases Cases Cases Cases Cases with a poor outcome.
Range Below Within Above Below Within Above Diagnosis of a GI foreign body was achieved in the ma-
pH 14.7 64.7 20.6 0 91.5 8.5 jority of cases by history, physical examination, and plain
PVCO2 1.5 92.3 6.2 0 97.9 2.1 radiography. In a number of cases, other imaging modalities
Base excess 3 55.2 41.8 4.3 52.2 43.5 (ultrasound or contrast radiography) were utilized. It could
Lactate 1.6 59.7 38.7 2.4 48.8 48.8 be speculated that other imaging modalities were used in
Sodium 21.7 76.8 1.4 16 82 0 patients where the degree of GI obstruction was less severe,
Potassium 23.6 73.6 2.8 25.5 72.5 1.9 leading to less marked changes on plain radiography and
Chloride 40.8 57.7 1.4 56.3 43.7 0
less severe metabolic derangements. The use of alternative
 Gastrointestinal Foreign Bodies in Dogs 819

Fig 1. Scatter plots of (a) blood pH, (b) serum potassium concentration, (c) base excess, and (d) serum chloride concentration in dogs with
proximal and distal GI foreign bodies. The 2 horizontal lines represent the upper and lower limits of the reference range.

imaging modalities was not associated with either of the
binary outcomes examined. It is possible that the decision
to perform alternative imaging was at least partly based on
the immediate availability of the other modalities and the
experience of the clinician interpreting the plain radio-
graphs.
This study shows that electrolyte and acid-base distur-
bances are common in dogs with gastrointestinal foreign
bodies, are variable in nature, and can be severe. This is
expected considering the large fluid and electrolyte fluxes
that occur across the GI mucosa daily4 and that experimen-
tal studies have shown there are marked alterations in the
bowel’s secretory and absorptive capacities following ob-
struction.5,16 In a clinical situation, it is impossible to assess
accurately the degree and duration of obstruction caused by
each foreign body. It is likely that a range of severities of
obstruction existed in the patients studied and this may part-
ly account for the variability in acid-base and electrolyte
derangements found.
Hypochloremia and metabolic alkalosis were the most
common findings. These abnormalities have been associ-
ated specifically with chronic hypertrophic pyloric gastro-
pathy17 and are generally considered to occur with proximal
GI obstruction,6,7 with vomiting of chloride and hydrogen
ion-rich gastric fluid. In the multivariate analysis, no sig-
nificant association between any biochemical abnormalities
and the site of foreign body at celiotomy was found. A
number of cases in this study demonstrated a hypochlor-
emic metabolic alkalosis with the foreign body being iden-
tified distal to the duodenum. It is possible that, in these
cases, the foreign body had been in a more proximal lo-
cation prior to or around the time the blood was drawn and
had moved distally in the period before surgery; however,
this period was generally quite short. Alternatively, exper-
imental studies of complete small-intestinal obstruction
have shown that the bowel proximal to an obstruction be-
comes a net secretor of fluids and electrolytes within 24
hours, resulting in sequestration of electrolytes (sodium, po-
tassium, and chloride) in the bowel lumen.5 This hyperse-
cretion does not occur in gnotobiotic dogs and may result
from the presence of a secretagogue released from the
abundant bacterial flora in the luminal fluid.18 The hypo-
chloremia, hypokalemia, and potentially hypovolemia cre-
ated in this way will tend to perpetuate any metabolic al-
kalosis that develops as a result of vomiting of gastric con-
tents. Adequate chloride and potassium ion concentrations
and intravascular volume are required for renal handling of
bicarbonate and correction of alkalosis.19
The finding of hypochloremic alkalemia in dogs with for-
eign bodies distally in the GI tract has been reported pre-
viously.13 However, in that study,13 only pH was reported,
making it impossible to assess the etiology of the alkalemia.
820 Boag et al
Another experimental study where dogs underwent com-
plete surgical ligation of their GI tract at the level of the
proximal duodenum or distal ileum demonstrated that both
groups of dogs developed a similar degree of hypochlor-
emia, hypokalemia, and hyponatremia.20 Acid-base values
were not reported.
Hyperlactatemia was present in 40.5% cases. This might
reflect intestinal ischemia21,22 or, more likely, systemic hy-
poperfusion23,24 secondary to fluid loss into the GI tract cou-
pled with inadequate fluid intake. As many patients with a
high lactate concentration did not have intestinal ischemia
severe enough for the attending surgeon to perform a re-
section, we believe it is more likely to reflect systemic hy-
poperfusion. It proved impossible to make a reliable as-
sessment of the clinical signs of systemic hypoperfusion
from the medical records. A previous veterinary study has
shown elevated lactate levels to be associated with death in
gastric dilation and volvulus syndrome.25 As only 1 dog in
this study did not survive, it was not possible to assess any
association between survival and lactate concentration. The
degree of hyperlactatemia in the dogs of this study was
never as profound as was reported in some of the patients
with gastric dilation-volvulus.25
Hyponatremia and hypokalemia were common findings
reflecting loss through vomiting and sequestration into the
GI tract. Packed cell volume and plasma total solids were
elevated in approximately one third of cases reflecting de-
hydration. There were several examples of patients with
marked hyponatremia in the face of an elevated PCV and
total solids (eg, sodium 130 mmol/L, PCV 60%, TS 90 g/
L), suggesting that the patient was dehydrated but that the
total body loss of sodium exceeded that of water. Although
this could occur with loss of hypertonic fluid, it is more
likely to reflect continued drinking and intake of free water
in the face of reduced circulating blood volume. Fluid ther-
apy with a hypo-osmolar fluid (orally or parenterally) in
this situation would have the potential to further reduce the
sodium and potentially lead to clinical signs of hyponatre-
mia (principally neurological).26
Although metabolic alkalosis was the most common
acid-base abnormality, it might be expected that some pa-
tients would demonstrate a concurrent metabolic acidosis
as a result of the hypovolemia that frequently accompanies
vomiting with inadequate fluid intake. A mixed metabolic
alkalosis and acidosis could be confirmed in 27/94 patients
with a high lactate and positive base excess. It is possible
that other patients also had mixed acid-base disorders and
these could be suspected in patients where it appeared that
inappropriate compensation for the primary disorder was
occurring. However, although venous blood (as used in this
study) accurately reflects the acid-base status of dogs that
are not in circulatory collapse,27 acid-base compensation
tables published for dogs are based on arterial samples.28
This, coupled with the fact that the chronicity of the prob-
lem was unknown, made more accurate quantification of
the number of patients with a mixed acid-base disorder im-
possible.
Linear foreign bodies typically do not cause complete
obstruction of the bowel and thus may be associated with
less severe vomiting.1 The only variables that differed sig-
nificantly between linear and nonlinear foreign bodies were
surgical time and sodium levels. It may be expected that
surgical time would be increased if a linear foreign body
has to be removed, as this may require multiple enteroto-
mies. Sodium levels were significantly lower in dogs with
linear foreign bodies. It is possible that, if the patients with
linear foreign bodies were not as likely to suffer complete
obstructions or such severe vomiting, they may have con-
tinued to drink and absorb free water for a longer period
than dogs with discrete foreign bodies. This could lead to
a more marked lowering of serum sodium in dogs with
linear foreign bodies. It was not possible to accurately as-
sess the severity of vomiting or the degree of obstruction
retrospectively.
In conclusion, a wide variety of electrolyte and acid-base
derangements are found in patients that require surgical re-
moval of GI foreign bodies, with hypochloremia and met-
abolic alkalosis being the most common. Linear foreign
bodies were associated with a lower serum sodium concen-
tration. No measured biochemical variable was associated
with the site of the foreign body. The presence of a hypo-
chloremic, hypokalemic metabolic alkalosis is not neces-
sarily indicative of a current proximal GI obstruction. Due
to the wide variability in abnormalities between dogs, all
dogs suspected of having a GI foreign body should undergo
measurement of electrolyte and acid-base values to allow
optimization of fluid therapy prior to surgery.
Footnotes
a
Refractometer, Kernco Instruments Co, Inc, El Paso, TX
b
Stat Profile Plus 9, Nova Biomedical, Waltham, MA
c
MS-Excel, MS Office 2003, Seattle, WA
d
StataCorp. 2001. Stata statistical software: Release 7.0. Stata Cor-
poration, College Station, TX
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