Canine Feline Fluid therapy

Keys to fluid therapy planning

Right type, right amount, right speed.

Considerations for doing fluid therapy

Body fluid compartments, fluid types, rates and routes, effectiveness, potential complications.

What are some indications for doing fluid therapy?

Replacement of lost fluids, maintaining basic water needs, treatment of shock or hypo-proteinemia, increasing urine output, correcting acid-base or electrolyte disturbances.

What are some of our body fluid compartments?

Intracellular (ICF)(most of it), extracellular(ECF): which one is interstitial(around the tissues), and intervasculature (plasma)

What does TBW stand for

Total body water

How much of our bodies are water?

60%

How much of the TBW does the intracellular fluid make up?

2/3

How much of the TBW is made up of our extracellular fluid?

1/3.

How much of the TBW is made up of the interstitial fluid? (between cells)

3/4

How much of the TBW is made up of intravascular fluids?

1/4.

What is important to remember about permeability of membranes and different fluid component movements?

Permeability of membranes allow different components to move or stay in the vasculature.

What is a sensible (can measure) fluid loss?

Urine output

What are some insensible (cant measure) fluid losses?

Feces, respiration, fever.

What are some contemporary fluid losses?

Ongoing problems like vomiting, diarrhea.

Assessing hydration status with a PE?

Skin turgor, MMs, CRT, eye sinkage, extremities (cold), high HR and RR, dull mentation, urine output, BP.

What electrolytes are in intracellular fluids?

Potassium and hydrogen.** Magnesium too? (on final)

Laboratory findings to asses hydration status

Hematocrit, TP, USG, Body weight!

How can we use bodyweight to measure hydration?

per 1 pound should have 480ml of fluid.

What is Osmolality?

A measure of the number of dissolved particles in a fluid.

What can/can’t move in permeability membranes

Water (follows particles) and electrolytes can move intravascular, but colloids, the large particles cannot.

Factor that you use to decide what type of fluid to use.

Based of the osmolality compared to the osmolality of the blood.

Crystalloid fluids.

Volume expansion rapidly redistribute to extracellular space (75% gone in 30mins).

What do crystalloid fluids have in them?

electrolytes.

Different osmolality of crystalloids, and most common.

Hypotonic, Isotonic (most common), and hypertonic

Colloids fluids.

Expands vascular volume, high molecular weight particles that remain in vascuature! Natural and synthetic.

What is the crystalloid hypotonic fluid solution?

5% dectrose in water (D5W), Norm-M, 0.45% NaCl.

Isotonic crystalloid fluids

0.9% NaCl, Plasmalyte, Norm-R, LRS.

Hypertonic Crystalloid fluids

3%, and 7% NaCl.

Types of Colloids fluids

Natural: Plasma, and whole blood. Synthetic: Hetastarch.

What fluid would you choose for cardiac diseases?

Low-dose maintenance crystalloid like 0.45% saline with dextrose. (Don’t want to increase BP and overload heart but do want to rehydrate patient)

What fluid would you choose for vomiting/ diarrhea AND Diabetic ketoacidosis

Replacement crystalloid like LRS, Normosol-R or Plasmalyte-A.

What fluid would you choose for Hemorrhage

Natural Colloid, such as plasma, whole blood, pRBCs.

What is the purpose of giving fluids during an emergency/resuscitation

Restoring vascular volume (patients lost 30% of blood volume), and reversing hypovolemic shock.

What are the “Shock doses” for reversing hypovolvemic shock with fluids)

Dogs: 60-90ml/kg. Cats: 60ml/kg. Type of fluid determines rate.

What fluids are you mixing to get your resuscitation.hypovolemic shock fluid.

Colloid and hypertonic saline to make a 7% solution. “Turbostarch”.

How many mls of ISOTONIC fluid replaces 1ml of blood loss?

3-4mls of isotonic fluid to replace 1ml of blood.

How many mls of COLLOIDs fluid replaces 1ml of blood loss?

1ml of colloids replace 1-1.5mls.

How many mls of HYPERTONIC fluid replaces 1ml of blood loss?

1ml of hypertonic replaces 5-10mls

When is replacement phase of fluid given

After resuscitation has been achieved or when it isn’t needed.

What is replacement phase of fluids given for?

Correcting dehydration, replacing ongoing losses, maintaining fluids requirenments (Usually with isotonics)

What is the replacement rate equation??? *highlighted*

Dehydration + Ongoing Losses + Maintenance = Replacement rate.

How to calculate dehydration? *highlighted*

% dehydration X weight in kg = Liters needed to replace (Liters dehydrated) (Ex: 20kg patient is 10% dehydrated would mean 20 X 0.1 = 2L***)

How long does it take to replace acute dehydration

6-8 hours

How long does it take to replace acute dehydration

24 hours

Can you detect less than 5% dehydration?

No

5-6% dehydration signs

Subtle loss of skin elasticity.

6-8% dehydration signs

Definite delay in normal skin return, slight prolongation of CRT, possible dry mm.

10-12% dehydration

Tented skin stays, prolonged CRT, sunken eyes, dry mm, possible shock.

12-15% dehydration

Definite signs of shock, death is imminent.

What are ongoing fluid losses?

Fluids lost during observation: Vomiting diarreha.

Maintenance phase of fluid administration. HOW MUCH?

Volume normally needed to maintain life (status quo). 40-60ml/kg/day

Factors determining administration route

Disease, patients stability, ongoing losses, length of stay, equipment.

Routes of fluid administraiton

IV, SQ, IO, Enteral (intestines)

Gravity fed fluid administration

Fluids are elevated and flow by gravity. Buretrol placed between fluid bag and going into patient to decrease risk of overload.

What is a Buretrol?

Syringe added onto fluid line that can measure out exactly how much mls you want to drip out with gravity into patient.

What is the most common fluid pump/what does it do?

Ensures accuracy of fluids given, programmed to deliver any volume over given amount of time. Volumetric pump.

Adding Potassium Chloride to fludis

Treat hypokalemia (GI or urinary losses).

What diseases/causes would we add potassium chloride to fluids

CKD, Hyperadrenocorticism, diabetic ketoacidosis, with certian medications like diuretics, penicillins.

When to add Potassium Chloride to fluids.

When K+ is lower than 3.0 mEq/L.

Things seen with hypokalemia/when potassium is lower than 3.0mEq/L

PU/PD, cannot concentrate urine, muscle weakness, cardiovascular signs (arrhythmias)

Things seen with hypokalemia/when potassium is lower than 2.0mEq/L

Prolonged QT, unresponsive to antiarrhythmics, sever muscle weakness, respiratory paralysis.

What should potassium rate in fluids NOT exceed?

Should not exceed 0.5mEq/kg/hour.

Adding Dextrose to fluids

If hypoglycemia is suspected. Glucose checked in any patients with signs of weakness, seizures, ataxia, collapse, stupor, muscle tremors.

What fluid additive should NEVER go SQ

Dextrose!

Dextrose dosage

0.5-1ml/kg IV.

Adding Sodium Bicarbonate to fluids

Controversial, usually fixing underlying problem of metabolic acidosis.

With what pH level is Sodium Bicarbonate added into fluids?

Below 7.1

Sodium bicarbonate is given with severe hyperkalemia under?

>8 mEq/L

3 phases of giving fluids

Resuscitation, Replacement, Maintenance.

What does the resuscitation phase of giving fluids do/what are we assessing?

Restores vascular and tissue perfusion. Asses cardiovascular stability, blood volume, perfusion.

What are we assessing and doing with replacement phase?

Assessing dehydration and then restoring whatever that gap is of hydration.

What are we assessing and doing with maintenance fluid phase?

Assessing fluid needs after dehydration is corrected and maintaining correct hydration status for the animal.

Signs of improvement with fluids.

Improved BP, mentation, CRT and MM color, HR, Resolution of hypothermia,

2 complications of fluid therapy

Volume overload, and electrolyte/acid-base disturbance.

What can volume overloading a patient cause?

Pulmonary edema, cavitary effusion, peripheral edema, hemorrhage, nasal drainage.