Fluid therapy is important for treating various medical conditions and involves selecting the appropriate fluid based on the patient's needs, including volume, rate, composition, and location of fluid administration. Therapy must be tailored to each individual patient and constantly re-evaluated as the patient's status changes. The key aspects of fluid therapy involve assessing and addressing any changes in the patient's fluid volume, content, or distribution. Fluid selection and therapy are dictated by the condition being treated, such as dehydration, hypovolemia, or fluid imbalances.
This document provides recommendations from a consensus of UK medical associations regarding intravenous fluid therapy for adult surgical patients. It aims to address concerns about high rates of postoperative sodium and water overload. The recommendations cover preoperative, intraoperative, and postoperative fluid management, with an emphasis on using balanced crystalloid solutions over saline. Close monitoring of fluid balance and electrolytes is advised. Higher molecular weight starches should be avoided in patients with sepsis or kidney injury due to risks of kidney damage.
This document discusses fluid and electrolyte management. It covers fluid compartments in the body, reasons for fluid prescription including resuscitation, maintenance and replacement. It describes different types of intravenous fluids including crystalloids like normal saline and Hartmann's solution, and colloids. Factors to consider when prescribing fluids like daily requirements, fluid status assessment, correcting deficits and replacing ongoing losses are outlined. Close monitoring of fluid balance is emphasized.
This document provides information on continuous renal replacement therapy (CRRT) modalities and dosing. It discusses CRRT principles, indications, modes of therapy including CVVH, CVVHD and CVVHDF. Details are given on vascular access, replacement fluids, anticoagulation options, and monitoring patients on CRRT. Examples show calculations for setting flow rates based on patient weight and condition. Guidelines are provided for initiating and managing heparin anticoagulation during CRRT.
This document discusses fluid management in the ICU. It covers assessing volume status through history, exam, and tests. Common types of IV fluids are described including crystalloids like normal saline and lactated Ringer's, as well as colloids like albumin and HES. Normal saline can cause hyperchloremic acidosis while HES is no longer recommended due to safety concerns. Guidelines for fluid resuscitation in hypovolemia and septic shock are provided, emphasizing initial bolus volumes and ongoing reassessment. In general, balanced crystalloids are preferred to normal saline due to safety advantages.
This document discusses fluid and blood therapy. It begins by outlining the goals of fluid management during surgery and introduces the concepts of fluid deficits, insensible losses, and third spacing. It then critiques the classical fluid management strategy of aggressive fluid replacement and presents evidence that restrictive fluid protocols reduce complications. The document advocates goal-directed fluid therapy using cardiac output monitoring. It also discusses fluid choices, transfusion triggers, blood component therapy, and complications of blood transfusion.
This document discusses fluid therapy in companion animals. It covers the body's fluid compartments and how fluids move between compartments. Factors like water content, electrolyte balances, and fluid losses are examined. Shock, its causes and treatment with fluid therapy are addressed. Methods to assess dehydration like clinical history, exam, and lab tests are summarized. The document also reviews choosing the appropriate fluid based on the type of fluid loss and compares uses of colloids, crystalloids, and blood products.
Vasopressor and inotropic_support_in_septic_shock_an_evidence_based_review_cr...Gaston Droguett
This document discusses vasopressor and inotropic support in septic shock. It begins by describing the pathophysiology of septic shock and how it differs from other forms of shock. It then reviews the available vasopressor agents used in clinical practice for septic shock, including norepinephrine, dopamine, epinephrine, and phenylephrine. The document discusses the challenges in making recommendations due to the lack of controlled trials. It then outlines the end points used to guide resuscitation in septic shock, including arterial blood pressure, cardiac output, mixed venous oxygen saturation, blood lactate levels, and gut tonometry.
This document discusses goal directed fluid therapy (GDFT) and the evidence surrounding conventional fluid administration practices. It reviews the assumptions of perioperative fluid therapy and examines factors related to intravascular volume and tissue perfusion. The evidence suggests there is great variability in how providers administer fluids. GDFT uses cardiac output measurements to guide IV fluids with the goal of optimizing tissue oxygen delivery and preventing complications. A case study demonstrates using dynamic variables like stroke volume variation to determine fluid responsiveness and optimize a patient's fluid status.
This document provides recommendations from a consensus of UK medical associations regarding intravenous fluid therapy for adult surgical patients. It aims to address concerns about high rates of postoperative sodium and water overload. The recommendations cover preoperative, intraoperative, and postoperative fluid management, with an emphasis on using balanced crystalloid solutions over saline. Close monitoring of fluid balance and electrolytes is advised. Higher molecular weight starches should be avoided in patients with sepsis or kidney injury due to risks of kidney damage.
This document discusses fluid and electrolyte management. It covers fluid compartments in the body, reasons for fluid prescription including resuscitation, maintenance and replacement. It describes different types of intravenous fluids including crystalloids like normal saline and Hartmann's solution, and colloids. Factors to consider when prescribing fluids like daily requirements, fluid status assessment, correcting deficits and replacing ongoing losses are outlined. Close monitoring of fluid balance is emphasized.
This document provides information on continuous renal replacement therapy (CRRT) modalities and dosing. It discusses CRRT principles, indications, modes of therapy including CVVH, CVVHD and CVVHDF. Details are given on vascular access, replacement fluids, anticoagulation options, and monitoring patients on CRRT. Examples show calculations for setting flow rates based on patient weight and condition. Guidelines are provided for initiating and managing heparin anticoagulation during CRRT.
This document discusses fluid management in the ICU. It covers assessing volume status through history, exam, and tests. Common types of IV fluids are described including crystalloids like normal saline and lactated Ringer's, as well as colloids like albumin and HES. Normal saline can cause hyperchloremic acidosis while HES is no longer recommended due to safety concerns. Guidelines for fluid resuscitation in hypovolemia and septic shock are provided, emphasizing initial bolus volumes and ongoing reassessment. In general, balanced crystalloids are preferred to normal saline due to safety advantages.
This document discusses fluid and blood therapy. It begins by outlining the goals of fluid management during surgery and introduces the concepts of fluid deficits, insensible losses, and third spacing. It then critiques the classical fluid management strategy of aggressive fluid replacement and presents evidence that restrictive fluid protocols reduce complications. The document advocates goal-directed fluid therapy using cardiac output monitoring. It also discusses fluid choices, transfusion triggers, blood component therapy, and complications of blood transfusion.
This document discusses fluid therapy in companion animals. It covers the body's fluid compartments and how fluids move between compartments. Factors like water content, electrolyte balances, and fluid losses are examined. Shock, its causes and treatment with fluid therapy are addressed. Methods to assess dehydration like clinical history, exam, and lab tests are summarized. The document also reviews choosing the appropriate fluid based on the type of fluid loss and compares uses of colloids, crystalloids, and blood products.
Vasopressor and inotropic_support_in_septic_shock_an_evidence_based_review_cr...Gaston Droguett
This document discusses vasopressor and inotropic support in septic shock. It begins by describing the pathophysiology of septic shock and how it differs from other forms of shock. It then reviews the available vasopressor agents used in clinical practice for septic shock, including norepinephrine, dopamine, epinephrine, and phenylephrine. The document discusses the challenges in making recommendations due to the lack of controlled trials. It then outlines the end points used to guide resuscitation in septic shock, including arterial blood pressure, cardiac output, mixed venous oxygen saturation, blood lactate levels, and gut tonometry.
This document discusses goal directed fluid therapy (GDFT) and the evidence surrounding conventional fluid administration practices. It reviews the assumptions of perioperative fluid therapy and examines factors related to intravascular volume and tissue perfusion. The evidence suggests there is great variability in how providers administer fluids. GDFT uses cardiac output measurements to guide IV fluids with the goal of optimizing tissue oxygen delivery and preventing complications. A case study demonstrates using dynamic variables like stroke volume variation to determine fluid responsiveness and optimize a patient's fluid status.
This document provides information about continuous renal replacement therapies (CRRT). It begins by explaining that CRRT is a type of hemodialysis used for critically ill patients with acute or chronic kidney failure. CRRT circulates blood through a filter and slowly removes waste and excess fluid over an extended period, preventing rapid fluid shifts. The document then discusses the different modes of CRRT, including continuous venovenous hemofiltration, hemodialysis, and hemodiafiltration. It covers the principles, processes, equipment, and nursing management of CRRT.
Basic science of fluid therapy - Robert Hahn - SSAI2017scanFOAM
A talk by Robert Hahn at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
1) Preoperative intake of fluids containing carbohydrates up to 2 hours before surgery can improve postoperative well-being and strength while reducing insulin resistance.
2) During major abdominal surgery, a "zero-balance" fluid strategy that aims to avoid fluid overload has been shown to significantly reduce postoperative complications compared to standard fluid therapy.
3) For elective surgery, a zero-balance approach is recommended due to evidence that it reduces complications while being less expensive and simpler than other approaches like goal-directed fluid therapy.
Characteristics of resuscitation, and association between use of dynamic test...Ariel Martin Barros
Characteristics of resuscitation,
and association between use of dynamic tests
of fluid responsiveness and outcomes in septic
patients: results of a multicenter prospective
cohort study in Argentina
1) The study compared outcomes of treating septic shock using either conventional sepsis bundles guided by central venous pressure or improved sepsis bundles guided by pulse-indicated continuous cardiac output (PiCCO) measurements.
2) Patients receiving improved bundles guided by PiCCO had significantly lower organ failure scores, required less vasoactive drugs and fluid resuscitation, and had shorter durations of mechanical ventilation and ICU stays.
3) The improved bundles using PiCCO to guide fluid administration and cardiac function resulted in better clearance of lactate and reduced severity of septic shock compared to conventional bundles.
This document discusses the history and evidence surrounding intravenous (IV) fluid administration in critically ill patients. It notes that while IV fluids were traditionally seen as beneficial, recent evidence shows that excessive fluid administration can cause harm by leading to fluid overload and accumulation. The document reviews several clinical trials that demonstrate associations between fluid overload, positive fluid balance, and increased mortality. It argues that IV fluids should be prescribed carefully and tailored to individual patient needs, with the goal of achieving zero cumulative fluid balance to avoid potential complications of overzealous fluid therapy.
Hemodialysis is a medical procedure that removes waste and excess fluid from the blood. It involves filtering the patient's blood through a dialyzer, which acts as a semipermeable membrane. Wastes and fluid move from the blood to a dialysate solution through diffusion, osmosis, and ultrafiltration. Proper nursing management is needed to minimize complications and infections from the procedure, which is often needed long-term or permanently for patients with kidney disease.
1) Evidence suggests restrictive fluid infusion and avoidance of fluid overload during and after surgery can significantly reduce complications and length of postoperative hospital stay.
2) Goal-directed fluid therapy using cardiac output monitoring can help guide fluid titration and has been shown in some studies to reduce complications compared to standard fluid management without monitoring.
3) For lower risk surgery in fast-track programs, restrictive fluid protocols limiting intravenous fluids after surgery and encouraging early oral intake may be sufficient.
This document discusses renal replacement therapy for acute kidney injury (AKI) in intensive care unit patients. It defines AKI and its prevalence in ICU patients. It describes the various modes of renal replacement therapy including intermittent hemodialysis, continuous renal replacement therapy and peritoneal dialysis. It discusses indications for starting renal replacement therapy and debates the optimal timing, modality and dosing of therapy. While several studies have examined these issues, the document concludes that the choice of renal replacement therapy should be individualized for each critically ill patient based on their condition and available resources.
The document discusses acute normovolemic hemodilution (ANH), a blood saving technique where blood is removed and replaced with fluids to dilute the blood volume. The authors conducted a study comparing ANH patients monitored with the Vigileo system to a control group. Both groups underwent ANH for hip surgery. The Vigileo system continuously monitored cardiac output, stroke volume variation, and other parameters to ensure hemodynamic stability during ANH. Results showed hematocrit and oxygen delivery dropped as expected with ANH but remained within safe limits. No complications occurred, suggesting ANH can be performed safely when carefully monitored with Vigileo.
Crrt indications and modalities [autosaved]FAARRAG
The document discusses continuous renal replacement therapy (CRRT) modalities for acute kidney injury (AKI) patients in the intensive care unit (ICU). It provides details on different CRRT modalities including CVVH, CVVHD, and CVVHDF. CVVHDF is described as the safest combination as it utilizes both diffusion and convection. The document also discusses indications for specific CRRT therapies and notes that patient hemodynamic stability is the main determinant for choice of dialysis modality.
This document provides an overview of key considerations for pediatric anesthesia. It discusses how children's physiology differs from adults, especially regarding airways, drug dosing, development milestones. It covers age group classifications and specific organ system considerations for the cardiovascular, respiratory, renal and hepatic systems. Factors like preoperative evaluation, NPO guidelines and potential developmental impacts of anesthesia like apoptosis are also reviewed at a high level. The document emphasizes that pediatric anesthesia requires accounting for normal developmental changes as children grow.
This document discusses continuous renal replacement therapy (CRRT). It defines CRRT as an extracorporeal blood purification therapy intended to substitute impaired renal function over an extended period of 24 hours. It describes the requirements, indications, principles, and modalities of CRRT including vascular access, semi-permeable membranes, transport mechanisms, dialysate, replacement fluids, and different types of CRRT like CVVH, CVVHD, and CVVHDF. It also discusses dosing of CRRT, anticoagulation methods, and complications.
This document discusses guidelines for hemodialysis prescription. It provides details on various aspects of the dialysis prescription including modality, frequency, duration, dose, dialysate composition and temperature. It emphasizes the importance of achieving adequate dialysis as defined by fluid removal, normalized electrolytes and minerals, adequate dialysis dose and absence of symptoms. The criteria for optimal dialysis are more stringent and include normalization of blood pressure and minerals without medications, absence of symptoms during and between treatments, no interference with daily life and near-normal life expectancy.
Renal replacement therapies like dialysis and continuous renal replacement therapies are used to replace kidney function in patients with kidney failure. Dialysis involves diffusion of toxins out of the bloodstream across a semipermeable membrane. The main types of dialysis are hemodialysis, which uses an external dialysis machine, and peritoneal dialysis, which uses the patient's peritoneum. Hemodialysis requires vascular access via an arteriovenous fistula or graft and occurs several times per week. Peritoneal dialysis involves infusing dialysate into the peritoneal cavity daily to remove waste through the peritoneum. Continuous renal replacement therapies continuously filter blood using convection and diffusion.
This document summarizes strategies for preventing and managing intra-dialytic hypotension (IDH). It reports that IDH occurs in 10-27% of hemodialysis patients and defines it as a drop in blood pressure or mean arterial pressure of at least 10 mmHg accompanied by symptoms. Risk factors include older age, female sex, diabetes, and cardiovascular disease. IDH is caused by an imbalance between ultrafiltration and refilling of blood volume during dialysis and can impair solute clearance. Prevention strategies include proper assessment of dry weight, monitoring of fluid status, dialysate composition adjustments, and management of medications. Treatment involves stopping ultrafiltration, administering intravenous fluids, and positioning the patient upright.
The document discusses dialysis as a renal replacement therapy for patients with kidney failure or injury. It describes the process of diffusion and ultrafiltration that occurs during hemodialysis and peritoneal dialysis to remove waste and excess fluid. Complications related to each type of dialysis are also outlined. Nursing considerations are provided for pre-dialysis assessment, monitoring patients during treatment, and post-dialysis care.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
This document outlines the standard of care for patients receiving a hemodialysis treatment. It details assessing the patient's condition before, during, and after treatment, monitoring the dialysis delivery system, setting the dry weight and ultrafiltration rate, developing and implementing a treatment plan, educating the patient, and evaluating outcomes to ensure the patient receives a safe and effective treatment and is free of complications. The goal is to provide optimal care for the patient's physical and psychosocial needs during their hemodialysis sessions.
Fluid management is essential for peri-operative patient care and impacts outcomes. Three key considerations for fluid prescription include the purpose of the fluid, the patient's weight and comorbidities, and laboratory values. Crystalloids are commonly used for volume resuscitation while colloids provide more sustained plasma expansion but risk allergic reactions. Proper fluid status assessment and strict input-output monitoring are important to avoid overhydration or dehydration.
This document discusses disorders of fluid and electrolyte homeostasis. It begins by outlining the learning objectives, which are to estimate body fluid compartments, calculate daily fluid requirements, differentiate fluid types, identify electrolyte compartments, describe the sodium-water relationship, and review electrolyte disorders. It then describes the various body fluid compartments and their volumes. Later sections discuss fluid management strategies, monitoring parameters, and sodium disorders like hyponatremia.
This document provides information about continuous renal replacement therapies (CRRT). It begins by explaining that CRRT is a type of hemodialysis used for critically ill patients with acute or chronic kidney failure. CRRT circulates blood through a filter and slowly removes waste and excess fluid over an extended period, preventing rapid fluid shifts. The document then discusses the different modes of CRRT, including continuous venovenous hemofiltration, hemodialysis, and hemodiafiltration. It covers the principles, processes, equipment, and nursing management of CRRT.
Basic science of fluid therapy - Robert Hahn - SSAI2017scanFOAM
A talk by Robert Hahn at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
1) Preoperative intake of fluids containing carbohydrates up to 2 hours before surgery can improve postoperative well-being and strength while reducing insulin resistance.
2) During major abdominal surgery, a "zero-balance" fluid strategy that aims to avoid fluid overload has been shown to significantly reduce postoperative complications compared to standard fluid therapy.
3) For elective surgery, a zero-balance approach is recommended due to evidence that it reduces complications while being less expensive and simpler than other approaches like goal-directed fluid therapy.
Characteristics of resuscitation, and association between use of dynamic test...Ariel Martin Barros
Characteristics of resuscitation,
and association between use of dynamic tests
of fluid responsiveness and outcomes in septic
patients: results of a multicenter prospective
cohort study in Argentina
1) The study compared outcomes of treating septic shock using either conventional sepsis bundles guided by central venous pressure or improved sepsis bundles guided by pulse-indicated continuous cardiac output (PiCCO) measurements.
2) Patients receiving improved bundles guided by PiCCO had significantly lower organ failure scores, required less vasoactive drugs and fluid resuscitation, and had shorter durations of mechanical ventilation and ICU stays.
3) The improved bundles using PiCCO to guide fluid administration and cardiac function resulted in better clearance of lactate and reduced severity of septic shock compared to conventional bundles.
This document discusses the history and evidence surrounding intravenous (IV) fluid administration in critically ill patients. It notes that while IV fluids were traditionally seen as beneficial, recent evidence shows that excessive fluid administration can cause harm by leading to fluid overload and accumulation. The document reviews several clinical trials that demonstrate associations between fluid overload, positive fluid balance, and increased mortality. It argues that IV fluids should be prescribed carefully and tailored to individual patient needs, with the goal of achieving zero cumulative fluid balance to avoid potential complications of overzealous fluid therapy.
Hemodialysis is a medical procedure that removes waste and excess fluid from the blood. It involves filtering the patient's blood through a dialyzer, which acts as a semipermeable membrane. Wastes and fluid move from the blood to a dialysate solution through diffusion, osmosis, and ultrafiltration. Proper nursing management is needed to minimize complications and infections from the procedure, which is often needed long-term or permanently for patients with kidney disease.
1) Evidence suggests restrictive fluid infusion and avoidance of fluid overload during and after surgery can significantly reduce complications and length of postoperative hospital stay.
2) Goal-directed fluid therapy using cardiac output monitoring can help guide fluid titration and has been shown in some studies to reduce complications compared to standard fluid management without monitoring.
3) For lower risk surgery in fast-track programs, restrictive fluid protocols limiting intravenous fluids after surgery and encouraging early oral intake may be sufficient.
This document discusses renal replacement therapy for acute kidney injury (AKI) in intensive care unit patients. It defines AKI and its prevalence in ICU patients. It describes the various modes of renal replacement therapy including intermittent hemodialysis, continuous renal replacement therapy and peritoneal dialysis. It discusses indications for starting renal replacement therapy and debates the optimal timing, modality and dosing of therapy. While several studies have examined these issues, the document concludes that the choice of renal replacement therapy should be individualized for each critically ill patient based on their condition and available resources.
The document discusses acute normovolemic hemodilution (ANH), a blood saving technique where blood is removed and replaced with fluids to dilute the blood volume. The authors conducted a study comparing ANH patients monitored with the Vigileo system to a control group. Both groups underwent ANH for hip surgery. The Vigileo system continuously monitored cardiac output, stroke volume variation, and other parameters to ensure hemodynamic stability during ANH. Results showed hematocrit and oxygen delivery dropped as expected with ANH but remained within safe limits. No complications occurred, suggesting ANH can be performed safely when carefully monitored with Vigileo.
Crrt indications and modalities [autosaved]FAARRAG
The document discusses continuous renal replacement therapy (CRRT) modalities for acute kidney injury (AKI) patients in the intensive care unit (ICU). It provides details on different CRRT modalities including CVVH, CVVHD, and CVVHDF. CVVHDF is described as the safest combination as it utilizes both diffusion and convection. The document also discusses indications for specific CRRT therapies and notes that patient hemodynamic stability is the main determinant for choice of dialysis modality.
This document provides an overview of key considerations for pediatric anesthesia. It discusses how children's physiology differs from adults, especially regarding airways, drug dosing, development milestones. It covers age group classifications and specific organ system considerations for the cardiovascular, respiratory, renal and hepatic systems. Factors like preoperative evaluation, NPO guidelines and potential developmental impacts of anesthesia like apoptosis are also reviewed at a high level. The document emphasizes that pediatric anesthesia requires accounting for normal developmental changes as children grow.
This document discusses continuous renal replacement therapy (CRRT). It defines CRRT as an extracorporeal blood purification therapy intended to substitute impaired renal function over an extended period of 24 hours. It describes the requirements, indications, principles, and modalities of CRRT including vascular access, semi-permeable membranes, transport mechanisms, dialysate, replacement fluids, and different types of CRRT like CVVH, CVVHD, and CVVHDF. It also discusses dosing of CRRT, anticoagulation methods, and complications.
This document discusses guidelines for hemodialysis prescription. It provides details on various aspects of the dialysis prescription including modality, frequency, duration, dose, dialysate composition and temperature. It emphasizes the importance of achieving adequate dialysis as defined by fluid removal, normalized electrolytes and minerals, adequate dialysis dose and absence of symptoms. The criteria for optimal dialysis are more stringent and include normalization of blood pressure and minerals without medications, absence of symptoms during and between treatments, no interference with daily life and near-normal life expectancy.
Renal replacement therapies like dialysis and continuous renal replacement therapies are used to replace kidney function in patients with kidney failure. Dialysis involves diffusion of toxins out of the bloodstream across a semipermeable membrane. The main types of dialysis are hemodialysis, which uses an external dialysis machine, and peritoneal dialysis, which uses the patient's peritoneum. Hemodialysis requires vascular access via an arteriovenous fistula or graft and occurs several times per week. Peritoneal dialysis involves infusing dialysate into the peritoneal cavity daily to remove waste through the peritoneum. Continuous renal replacement therapies continuously filter blood using convection and diffusion.
This document summarizes strategies for preventing and managing intra-dialytic hypotension (IDH). It reports that IDH occurs in 10-27% of hemodialysis patients and defines it as a drop in blood pressure or mean arterial pressure of at least 10 mmHg accompanied by symptoms. Risk factors include older age, female sex, diabetes, and cardiovascular disease. IDH is caused by an imbalance between ultrafiltration and refilling of blood volume during dialysis and can impair solute clearance. Prevention strategies include proper assessment of dry weight, monitoring of fluid status, dialysate composition adjustments, and management of medications. Treatment involves stopping ultrafiltration, administering intravenous fluids, and positioning the patient upright.
The document discusses dialysis as a renal replacement therapy for patients with kidney failure or injury. It describes the process of diffusion and ultrafiltration that occurs during hemodialysis and peritoneal dialysis to remove waste and excess fluid. Complications related to each type of dialysis are also outlined. Nursing considerations are provided for pre-dialysis assessment, monitoring patients during treatment, and post-dialysis care.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
This document outlines the standard of care for patients receiving a hemodialysis treatment. It details assessing the patient's condition before, during, and after treatment, monitoring the dialysis delivery system, setting the dry weight and ultrafiltration rate, developing and implementing a treatment plan, educating the patient, and evaluating outcomes to ensure the patient receives a safe and effective treatment and is free of complications. The goal is to provide optimal care for the patient's physical and psychosocial needs during their hemodialysis sessions.
Fluid management is essential for peri-operative patient care and impacts outcomes. Three key considerations for fluid prescription include the purpose of the fluid, the patient's weight and comorbidities, and laboratory values. Crystalloids are commonly used for volume resuscitation while colloids provide more sustained plasma expansion but risk allergic reactions. Proper fluid status assessment and strict input-output monitoring are important to avoid overhydration or dehydration.
This document discusses disorders of fluid and electrolyte homeostasis. It begins by outlining the learning objectives, which are to estimate body fluid compartments, calculate daily fluid requirements, differentiate fluid types, identify electrolyte compartments, describe the sodium-water relationship, and review electrolyte disorders. It then describes the various body fluid compartments and their volumes. Later sections discuss fluid management strategies, monitoring parameters, and sodium disorders like hyponatremia.
Intended Learning Outcomes:
Describe the physiology of human fluid dynamics.
Define Intravenous therapy.
List the aims of adult perioperative fluid therapy.
Recognize the commonly used fluid preparations.
Describe the properties and indications of widely used IV solutions.
Describe the side effects and precautions of widely used IV solutions.
Explain the (NICE) principles and protocols for intravenous fluid therapy.
Discuss the assessment and management of hydration and volume status of surgical patients.
Describe the type, rate, and volume of fluid administered to surgical patients.
Recognize the different types of venous access.
Explain the potential local complications of peripheral IV therapy.
Identify the universal equations used by nurses to calculate the IV flow rate and medication dosage.
This document discusses fluid therapy in animals. It begins by describing the distribution of water in the body and the composition of intracellular and extracellular fluids. It then discusses three types of fluid disturbances: changes in volume, content, and distribution. The document outlines different types of fluid therapy including replacement, adjunctive, and supportive therapies. It provides details on routes of fluid administration and indications for intravenous fluids. Throughout, it discusses evaluating and monitoring fluid therapy, diagnosing and treating dehydration, and complications of intravenous fluids.
Dehydration and hypovolemia refer to deficits in total body water and intravascular volume, respectively. Key signs and symptoms include thirst, lethargy, decreased skin turgor, and abnormal vital signs. Laboratory tests are not routinely needed for diagnosis but may help evaluate severe fluid loss or underlying causes. Treatment goals are to restore circulatory volume and correct any fluid or electrolyte deficits. For mild to moderate deficits, oral rehydration is preferred but intravenous fluids may be required for vomiting, inability to take oral intake, or more severe deficits. Initial fluid resuscitation focuses on isotonic crystalloids administered based on estimated fluid loss to correct hypovolemia.
This document provides an overview of fluid management for a patient admitted to the ICU. It discusses fluid types, their components and uses. It describes how to assess a patient's fluid status and calculate fluid requirements. The document outlines fluid monitoring, electrolyte disorders like hyponatremia and hypernatremia, and their management. It emphasizes the importance of maintaining fluid balance and addressing imbalances to support organ function.
This document discusses fluid imbalances and their management. It defines fluid balance and types of fluid imbalances including fluid volume deficit and excess. Fluid volume deficit can result from loss of fluids and causes symptoms like weight loss and decreased skin turgor. Treatment involves replacing fluids intravenously with crystalloid or colloid fluids. Fluid volume excess, seen in conditions like heart failure, causes symptoms like respiratory distress. Treatment focuses on improving oxygenation through positioning and oxygen therapy, administering diuretic medications, and monitoring the patient's response.
Fluid and electrolyte imbalance [autosaved]Jays George
This document discusses fluid and electrolyte imbalance. It begins by explaining the importance of fluid and electrolytes in maintaining homeostasis. It then defines key terms like homeostasis, osmolality, diffusion, isotonic solutions, and active transport. The document goes on to describe different fluid imbalances like extracellular fluid volume deficit, third spacing of fluids, and intracellular fluid volume excess. It also covers various electrolyte imbalances including hypocalcemia, hypokalemia, hyperkalemia, hyponatremia, and hypernatremia. For each imbalance, it discusses etiology, clinical manifestations, laboratory findings, and treatment approaches.
Fluid and electrolyte management is crucial for surgical patients as changes can occur before, during, and after surgery as well as with trauma and sepsis. Careful monitoring of fluid volume and electrolyte levels is needed along with replacement as directed to avoid deficiencies or excesses that could impact the patient's condition.
This document provides guidelines for intravenous fluid therapy for surgical patients. It discusses:
1. The consensus process used to develop the guidelines, which involved meetings between 2006-2008 of medical associations to establish recommendations.
2. Types of intravenous fluids that can be used, including crystalloids like Ringer's lactate and normal saline, as well as colloids and blood products.
3. Recommendations for pre-operative, intra-operative, and post-operative fluid management of surgical patients based on factors like fluid deficits, ongoing losses, and monitoring of volume status and hemodynamics.
There are two main types of intravenous fluids used for volume expansion: crystalloids and colloids. Crystalloids include saline solutions while colloids contain larger insoluble molecules like gelatin. Normal saline is commonly used initially but can cause acidosis with large volumes, so Ringer's Lactate is preferred after chloride levels rise. Colloids preserve intravascular volume better than crystalloids but concerns include effects on coagulation. The choice depends on the patient's condition, and neither colloids nor crystalloids have clearly proven superior for dengue shock. Careful fluid management is important to avoid complications like fluid overload.
This slide share includes definition,indications,dehydration status,types of fluids,when to administer which fluid,how to calculate the fluid to be administered and how to monitor fluid therapy.Hope its helpful.
A presentation I gave on Pediatric Fluid Therapy, with the main focus around perioperative fluid therapy in the Pediatric population. This lecture was delivered to my colleagues in the department of Anesthesia, and it was invigilated by consultant Anesthetist, Dr. Anatolly Kravchenko at the Intermediate Hospital Katutura.
This document provides guidance on fluid balance monitoring responsibilities for various hospital staff. Trained nurses are responsible for identifying patients needing monitoring, communicating the monitoring plan, and escalating issues. HCAs and student nurses support monitoring by ensuring accurate measurements and charts. Doctors conduct daily reviews. Patients must demonstrate understanding of their monitoring plan. Monitoring helps identify acute illnesses that can cause fluid imbalances through changes in capillary permeability. Maintaining accurate fluid balance charts can be challenging and requires clear communication between staff, patients, and the multidisciplinary team.
This document discusses nutrition and fluid therapy in the peri-operative period. It covers several topics:
- The normal distribution of water in the body and barriers between fluid compartments.
- Developments in fluid management practices from liberal to restrictive/goal-directed strategies.
- Evidence that crystalloids are preferred to colloids and balanced solutions to saline for fluid therapy.
- Techniques for assessing fluid status and predicting fluid responsiveness like fluid challenges.
- The importance of considering both macrocirculation and microcirculation in fluid management.
- Guidelines for perioperative nutritional support based on albumin levels and optimal enteral feeding.
This document summarizes a seminar on fluid and electrolyte management in surgical patients. It discusses body fluid compartments and composition, causes of fluid imbalance, evaluation of fluid status, and fluid therapy for surgical patients. It also covers causes and treatment of various electrolyte abnormalities like sodium, potassium, calcium, phosphate, and magnesium imbalances that can occur in surgical patients. The objective is for attendees to understand fluid disturbances and therapy, and be able to manage electrolyte abnormalities in surgical patients.
This document discusses goal-directed fluid therapy and summarizes key points about fluid management for various clinical situations. The main points are:
- Goal-directed therapy aims to optimize physiologic variables like cardiac output and oxygen delivery through fluid administration and inotropes/vasopressors to improve tissue perfusion and outcomes.
- Special populations like heart failure, kidney disease, sepsis, burns and liver disease require a delicate fluid balance to avoid complications from overhydration or underhydration.
- Fluid management in pregnancy-induced hypertension and preeclampsia must be conservative to prevent pulmonary edema given the clear association between positive fluid balance and this complication.
This nursing care plan addresses a patient with a diagnosis of fluid volume deficit. The plan includes assessments of vital signs, skin turgor, urine output, and weight to monitor the patient's fluid status. Interventions include encouraging oral fluid intake, assisting with feeding if needed, providing IV fluids, administering blood products if indicated, and educating the patient and family on monitoring intake and output. The goals are for the patient to understand factors contributing to their fluid deficit, how to treat and prevent it, and symptoms requiring follow up with their provider within 2 days, and to maintain normal fluid balance and demonstrate lifestyle changes to avoid dehydration within 2 weeks.
This document discusses intravenous (IV) fluid therapy. It begins by introducing the components of solutions like water and solutes, and the functions of water in the body including transport, waste elimination, and temperature regulation. It then discusses fluid balance, the thirst mechanism, and fluid gains and losses. The document outlines the purposes of IV fluid regulation including rehydration and medication administration. It describes identifying dehydration and types of IV fluids available like crystalloids and colloids. It concludes with nursing considerations for different fluid types and complications of IV fluid treatment.
Similar to Flud therapy in veterinary practices (20)
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
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1. Fluid Therapy
Fluid therapy is important for many medical conditions in veterinary patients. The assessment of
patient history, chief complaint,physical exam findings, and indicated additional testing will
determine the need for fluid therapy. Fluid selection is dictated by the patient’s needs, including
volume, rate, fluid composition required, and location the fluid is needed (e.g., interstitial versus
intravascular). Therapy must be individualized, tailored to each patient, and constantly re-
evaluated and reformulated according to changes in status. Needs may vary according to the
existence of either acute or chronic conditions, patient pathology (e.g., acid-base, oncotic,
electrolyte abnormalities), and comorbid conditions. All patients should be assessed for three
types of fluid disturbances: changes in volume, changes in content, and/or changes in
distribution.
Introduction
· Acute versus chronic conditions
· Patient pathology (e.g., acid-base balance, oncotic pressure,
electrolyte abnormalities)
· Comorbid conditions
A variety of conditions can be effectively managed using three types of fluids: a balanced
isotonic electrolyte (e.g., a crystalloid such as lactated Ringer’s solution [LRS]); a hypotonic
solution (e.g., a crystalloid such as 5% dextrose in water [D5W]); and a synthetic colloid (e.g., a
hydroxyethyl starch such as hetastarch or tetrastarch).
General Principles and Patient Assessment
The assessment of patient history, chief complaint, and physical exam findings will determine
the need for additional testing and fluid therapy. Assess for the following three types of fluid
disturbances:
1. Changes in volume (e.g., dehydration, blood loss)
2. Changes in content (e.g., hyperkalemia)
3. Changes in distribution (e.g., pleural effusion)
The initial assessment includes evaluation of hydration, tissue perfusion, and fluid volume/loss.
Items of particular importance in evaluating the need for fluids. Next, develop a treatment plan
by first determining the appropriate route of fluid administration Consider the temperature of the
fluids. Body temperature (warmed) fluids are useful for large volume resuscitation but provide
limited usefulness at low IV infusion rates. It is not possible to provide sufficient heat via IV
fluids at limited infusion rates to either meet or exceed heat losses elsewhere.
Fluids for Maintenance and Replacement
Whether administered either during anesthesia or to a sick patient, fluid therapy often begins
with the maintenance rate, which is the amount of fluid estimated to maintain normal patient
fluid balance. Urine production constitutes the majority of fluid loss in healthy
patients.Maintenance fluid therapy is indicated for patients that are not eating or drinking, but do
not have volume depletion, hypotension, or ongoing losses . Replacement fluids (e.g., LRS) are
intended to replace lost body fluids and electrolytes. Isotonic polyionic replacement crystalloids
such as LRS may be used as either replacement or as maintenance fluids. Using replacement
solutions for short-term maintenance fluid therapy typically does not alter electrolyte balance;
2. however, electrolyte imbalances can occur in patients with renal disease or in those receiving
long-term administration of replacement solutions for maintenance. Administering replacement
solutions such as LRS for maintenance predisposes the patient to hypernatremia and
hypokalemia because these solutions contain more sodium (Na) and less potassium (K) than the
patient normally loses .Well-hydrated patients with normal renal function are typically able to
excrete excess Na and thus do not develop hypernatremia . Hypokalemia may develop in patients
that receive replacement solutions for maintenance fluid therapy if they are either anorexic or
have vomiting or diarrhea because the kidneys do not conserve K very well. If using a
replacement crystalloid solution for maintenance therapy, monitor serum electrolytes
periodically (e.g., q 24 hr). Maintenance crystalloid solutions are commercially available.
Alternatively, fluid made up of equal volumes of replacement solution and D5W supplemented
with K (i.e., potassium chloride [KCl], 13–20 mmol/L, which is equivalent to 13–20 mEq/L)
would be ideal for replacing normal ongoing losses because of the lower Na and higher K
concentration. Another option for a maintenance fluid solution is to use 0.45% sodium chloride
with 13–20 mmol/L KCl added.
Fluids and Anesthesia
One of the most common uses of fluid therapy is for patient support during the perianesthetic
period. Decisions regarding whether to provide fluids during anesthesia and the type and volume
used depend on many factors, including the patient’s signalment, physical condition, and the
length and type of the procedure. Advantages of providing perianesthetic fluid therapy
for healthy animals include the following:
Correction of normal ongoing fluid losses, support of cardiovascular function, and ability
to maintain whole body fluid volume during long anesthetic periods
Countering of potential negative physiologic effects associated with the anesthetic agents
(e.g., hypotension, vasodilatation)
Continuous flow of fluids through an IV catheter prevents clot formation in the catheter
and allows the veterinary team to quickly identify problems with the catheter prior to
needing it in an emergency
Postanesthetic Fluid Therapy
Postanesthetic fluid administration varies based on intra-anesthetic complications and comorbid
conditions. Patients that may benefit from fluid therapy after anesthesia include geriatric patients
and patients with either renal disease or ongoing fluid losses from gastrointestinal disease.
Fluid Therapy in the Sick Patient
First, determine the initial rate and volume based on whether the patient needs whole body
rehydration or vascular space volume expansion. Next, determine the fluid type based on
replacement and maintenance needs as described in the following sections. Fluid therapy for
disease falls into one or more of the following three categories: the need to treat changes in
volume, content, and/or distribution.
Typically, the goal is to restore normal fluid and electrolyte status as soon as possible (within 24
hr) considering the limitations of comoribund conditions. Once those issues are addressed, the
rate, composition, and volume of fluid therapy can be based on ongoing losses and maintenance
needs. Replace the deficit as well as normal and abnormal ongoing losses simultaneously (e.g.,
3. continued vomiting/diarrhea as described below in the “Changes in Fluid Volume” section).
Accurate dosing is essential, particularly in small patients, to prevent volume overload.
The physical examwill help determine if the patient has whole body fluid loss (e.g., dehydration
in patients with renal disease), vascular space fluid loss (e.g., hypovolemia due to blood loss), or
hypervolemia (e.g., heart disease, iatrogenic fluid overload). Acute renal failure patients, if
oliguric/anuric, may be hypervolemic, and if the patient is polyuric they may become
hypovolemic. Reassessment of response to fluid therapy will help refine the determination of
which fluidcompartment (intravascular or extravascular) has the deficit or excess.
Dehydration
Estimating the percent dehydration gives the clinician a guide in initial fluid volume needs;
however, it must be considered an estimation only and can be grossly inaccurate due to comorbid
conditions such as age and nutritional status (Table 5).
Fluid deficit calculation
Body weight (kg)3 % dehydration ¼ volume (L) to correct General principles for fluid therapy to
correct dehydration include the following:
Add the deficit and ongoing losses to maintenance volumes. Replace ongoing losses
within 2–3 hr of the loss, but replace deficit volumes over a longer time period. The
typical goal is to restore euhydration within 24 hr (pending limitations of comorbid
conditions such as heart disease).
Frequency of monitoring will depend on the rate at which fluid resuscitation is being
administered (usually q 15–60 min). Assess for euhydration, and avoid fluid overload
through monitoring for improvement.
Maintenance solutions low in Na should not be used to replace extracellular deficits (to
correct dehydration) because that may lead to hyponatremia and hyperkalemia when
those solutions are administered in large volumes.
Hypovolemia
Hypovolemia refers to a decreased volume of fluid in the vascular system with or without whole
body fluid depletion. Dehydration is the depletion of whole body fluid. Hypovolemia and
dehydration are not mutually exclusive nor are they always linked. Hypotension may exist
separately or along with hypovolemia and dehydration
. Hypotension is discussed under “Fluids and Anesthesia.” Common causes of hypovolemia
include severe dehydration, rapid fluid loss (gastrointestinal losses, blood, polyuria), and
vasodilation.
Hypovolemic patients have signs of decreased tissue perfusion, such as abnormal mentation,
mucous membrane color, capillary refill time, pulse quality, pulse rate, and/or cold extremity
temperature. Hypovolemia due to decreased oncotic pressure.
Treating hypovolemia
When intravascular volume expansion without whole blood is needed, use crystalloids, colloids,
or both. IV isotonic crystalloid fluids are the initial fluid of choice. If electrolyte as k needed in
the emergent situation, administer through a second IV catheter. High K administration rates
may lead to cardiac arrest; therefore, do not exceed 0.5 mmol/kg/hr.
4. Hyperkalemia
Suspect hyperkalemia in cases of obvious urinary obstruction, uroabdomen, acute kidney injury,
diabetic ketoacidosis (DKA), or changes on an electrocardiogram. If life-threatening
hyperkalemia is either suspected or present (K . 6 mmol/L), begin fluid therapy immediately
along with medical therapy for hyperkalemia.35 There are several benefits associated with
administering K-containing balanced electrolyte solutions pending laboratory test results.
Volume expansion associated with the fluid administration results in hemodilution and lowering
of serum K concentration. The relief of any urinary obstruction results in kaliuresis that offsets
the effect of the administered K. The relative alkalinizing effect of the balanced solution
promotes the exchange of K with hydrogen ions as the pH increases toward normal. Most K-
containing balanced electrolyte solutions contain lower K concentrations than those typically
seen in cats with urethral obstruction, so the use of such solutions does not affect blood K in
those cats.36 LRS contains 4 mmol/L, which is typically much lower than the serum K levels in
cats with urethral obstruction.
Hypokalemia
Charts are available in many texts to aid in K supplementation of fluids and determination of
administration rate.37 It is essential to mix added KCl thoroughly in the IV bag as inadvertent K
overdoses can occur and are often fatal. Do not exceed an IV administration rate of 0.5
mmol/kg/hr of K.38 If hypophosphatemia exists along with hypokalemia (e.g., DKA), use
potassium phosphate instead of KCl.
Hypernatremia
Hypernatremia may be common, yet mild and clinically silent. Causes of hypernatremia include
loss of free water (e.g., through water deprivation), and/or iatrogenically (through the long-term
use [. 24 hr] of replacement crystalloids). Another cause of hypernatremia is salt toxicity
(through oral ingestion of high salt content materials).
Provide for ongoing losses and (in hypotensive patients) volume deficits with a replacement fluid
having a Na concentration close to that of the patient’s serum (e.g., 0.9% saline). Once
volume needs have been met, replace the free water deficit with a hypotonic solution (e.g.,
D5W). Additionally, for anorexic patients, provide maintenance fluid needs with an isotonic
balanced electrolyte solution. The cause and duration of clinical hypernatremia will dictate the
rate at which Na levels can be reduced without causing cerebral edema. Do not exceed changes
in Na levels of 1 mmol/hr in acute cases or 0.5mmol/hr in chronic cases because of the risk of
cerebral edema. Although the complexities of managing Na disorders often benefits from the
involvement of a specialist/criticalist, this is not always feasible.
Hyponatremia
Hyponatremia is most commonly seen in DKA and with water intoxication. Changes in serum
Na levels must occur slowly, as with hypernatremia. Monitor electrolyte levels frequently, and
use a fluid with Na content similar to the measured plasma Na to keep the rate of change at an
appropriate level. In patients with water intoxication, restrict water and/or use diuretics with
caution. Patients with DKA may have pseudohyponatremia associated with osmotic shifts of
water following glucose into the intravascular space. In pseudohyponatremia, a relationship
exists between serum glucose and serum Na levels: the higher the glucose, the lower theNa.
Specifically, for every 100 mg/dL increase in serum glucose over 120 mg/dL, the serum Na will
decrease by 1.6 mmol/L.39
5. Hypoproteinemia/hypoalbuminemia
Colloid osmotic pressure is related to plasma albumin and protein levels and governs whether
fluid remains in the vascular space. Fluid loss into the pulmonary, pleural, abdominal, intestinal,
or interstitial spaces is uncommon until serum albumin is , 15 g/L or total protein is , 35
g/L.19,40 Evidence of fluid loss from the vascular space is used in conjunction with either serum
albumin or total solid values in determining when to initiate colloid therapy.Guidelines for fluid
therapy when treating hypoalbuminemia
include the following:
· Nutritional support is critical to treatment of hypoalbuminemia.
· Plasma administration is often not effective for treatment of hypoalbuminemia due to the
relatively low albumin levels for the volume infused. Human serum albumin is costly and can
cause serious hypersensitivity reactions. Canine albumin is not readily available in most private
practice settings but may be the most efficient means of supplementation when available.42
· Synthetic colloids (e.g., hydroxyethyl starch) are beneficial because they can increase oncotic
pressure in patients with symptomatic hypoalbuminemia to maintain fluid in the intravascular
space; however, synthetic colloids will not appreciably change total solids as measured by
refractometry. Therefore, patient assessment determines response.43 Use up to 20 mL/kg/day
of hetastarch for dogs and 10–20 mL/kg/day for cats.29–31
Hyperglycemia
Fluid therapy in hyperglycemic patients is aimed at correcting dehydration and electrolyte
abnormalities. Monitor the patient to guide the rate of correction. As with hyperkalemia, the
choice of initial replacement fluid is not as important as correcting the patient’s hydration status.
Hypoglycemia
Initial therapy for hypoglycemia is based on severity of clinical signs more than on laboratory
findings. Treatment options include oral glucose solutions, IV dextrose-containing fluids, or food
(if not contraindicated). To prepare a dilute dextrose solution of 2.5–5% dextrose, add
concentrated stock dextrose solution (usually 50% or 500 mg/mL) to an isotonic balanced
electrolyte solution (e.g., add 100 mL of 50% dextrose to 900 mL of fluid to make a solution
containing 5% dextrose).