Pharm Fluids

Body is what % water?

60%

What is the purpose of fluid therapy?

To correct fluid losses through dehydration.

Movement of water is through?

Osmosis

Movement of solutes is by?

Diffusion

5-6% dehydration

Slight loss of skin elasticity

6-8% dehydration

Noticeable delay of elasticity, slight increase CRT and dry MM.

10-12% dehydrated

Skin stays tented, high CRT, sunken eyes, Tachycardia, weak pulses.

12-15% dehydration

Signs of shock or death.

How to determine how much fluid to give?

Hydration deficit = % of dehydration X patients body weight. Or how much you need to give in Liters.

Maintenance fluid rates

dogs: 50-60ml/kg/day. OR 25-30ml/lb/day.

How many mls are in about 2 pound?

500

About how many mls are in 1 kg?

1,000

Ongoing fluid loss

From vomiting, diarrhea, continually losing fluid. Estimate the number to add from these losses.

How to get total maintenance amount?

Hydration deficit + Maintenance + ongoing loss = total mls for 24 hours.

Monitoring patient on fluids

Check body weight every 12 hours, Monitor and estimate volume of urination, check catheter, monitor any diarrhea/vomiting, TPR every 8 hours, PCV/TP every 24 hours.

Avoiding Overhydration

Watery nasal discharge, Restlessness, Tachycardia, panting, dyspnea, SQ edema/swelling, Jello-like feel to sub-q tissues.

SubQ vs IV fluid administering.

IV is fastest and preferred with severe losses, needs catheter. SubQ is used in less severe cases, depends on size, care needs to be taken to prevent sloughing of tissue, avoiding hypertonic and irritating solutions.

What is included in an ideal small animal IV fluid setup?

Fluid pole, Fluid bag, Fluid line warmer, Fluid pump.

Things to think about with older patients

Skin turgor is less, overloading heart, kidney issues.

Types of fluids

Crystalloids, Colloids, Hypertonic solutions, fluid additives, oral electrolytes, parenteral nutrition.

Crystalloids - what do they contain?

Contain electrolyte and non-electrolyte substances capable of passing through cell membranes. BASED ON SALTS!

Crystalloids - what are they used for

Correcting dehydration, shock, replacing nutrients, electrolytes, etc.

Side effects of crystalloids

Associated with over-hydration, restlessness, shivering, nasal discharge, coughing, pulmonary edema.

Types of Crystalloids

Physiologic Saline (0.9% NaCl) “Normal saline, Lactated Ringer’s Solution (LRS).

0.9% NaCl “Normal Saline”

Increases plasma volume to correct dehydration. Can be used to lavage tissues in surgery.

Who should normal saline be avoided in?!

In patients with heart disease bc of sodium.

LRS solution

Balanced electrolyte solution, very common. Contains lactate for liver to turn into bicarbonate to protect against acidosis. Don’t give blood products (could form clots)

Colloids what they contain

Contain large molecular weight particles that cannot cross the cell membrane.

Colloids what they used for

Patients with cerebral, pulmonary edema, or hypovolemic or septic shock.

Types of Colloids

Dextrans and Hetastarch.

Dextrans

Large molecular weight polysaccharide solution used for shock. Can cause allergic reactions or clotting deficits.

Hetastarch

Large molecular weight starch used for treating hypovolemia and hypoproteinemia. Expands plasma volume longer and less side effects than Dextrans.

Downside to Hetastarch?

Quite more expensive than dextrans.

What are hypertonic solutions used for?

Hemorrhagic and endotoxic shock. GDV, brain or pulmonary edema. shcok associated with trauma, burns, pancreatitis.

Common types of Hypertonic solutions

3, 4, 5, 7, 23.4% solutions.

Side effects of hypertonic solutions.

Can include vein or tissue irritation, re-hemorrhage in trauma patient, electrolyte imbalances. When administration rate is too fast, hypotension, bronchoconstriction, and bradycardia can occur.

Which breed has common GDV and what fluid do they need?

Dalmatians, hypertonic solutions.

Potassium Chloride as fluid additive

Supplement potassium for deficits. Requires dilution to be given.

Causes of hypokalmia

Anorexia, diuresis, and diarrhea.

Common types of KCl

Potassium chloride injection, needs to be diluted!!****

Side effects of KCl

Hyperkalemia, muscle weakness, cardiac conduction disturbances.

What do you ALWAYS need to do with potassium before giving?

Dilute and mix well!!

Calcium for fluid additives.

Needs to be diluted at least 1:1. Corrects Hypocalcemia. Can be given undiluted but very slowly.

Common types of Calcium additives

Calcium Gluconate injection 10%, and Calcium Chloride Injection 10%.

Side effects of calcium supplements in fluids.

Hypercalcemia that can cause hypotension, cardiac arrhythmias and cardiac arrest. Seen if given too rapidly.

Dextrose as fluid additive

Used to aid body in caloric need, correct hypoglycemia fever, sepsis, insulin overdose, insulinoma, or liver disease.

What is used when too much insulin as been given?

Dextrose, doesn’t have many side effects.

When are vitamins added to fluids?

When patients undergo long periods of diuresis.

Common type of Vitamin given and side effects

Vitamin B and hypersensitivity reactions to thiamine.

What vitamin can dogs make themselves and we do not have to give?

Vitamin C?

When are oral electrolytes used?

For mild or moderate cases of dehydration.

Parenteral nutrition

Usually used when patient has long-term illness with a caloric demand and no desire to eat. Giving TOTAL nutrition parenterally.