Uploaded byUrfeya Mirza
Fluid therapy
This document discusses fluid therapy in veterinary medicine. It begins by explaining that fluids are given during surgery to prevent hypotension and acid-base abnormalities. Fluids are also given at other times to correct dehydration, electrolyte imbalances, or deliver drugs. The document then describes signs of dehydration from mild to severe and how to diagnose dehydration. It provides guidance on calculating fluid needs and types of fluids including crystalloids, colloids, lactated Ringer's solution, and 0.9% saline. The document concludes by covering administration routes, calculating flow rates, and daily monitoring of patients receiving fluids.
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Fluid therapy
- 1. Dr. Urfeya Mirza Divisionof Veterinary Surgery and Radiology
- 2. Why Give FluidsDuring Surgery? Prevent hypotension: Vasodilation Decreased cardiovascular function Blood loss Evaporative fluid losses (Maintenance during surgery 10 ml/kg/hr) Prevent/correct acid-base abnormalities (acidosis) due to: Respiratory depression: respiratory acidosis Decreased cardiac function: metabolic acidosis
- 3. Why Give FluidsAt Other Times? Correct dehydration Correct acid-base abnormalities d/t disease Correct electrolyte abnormalities Deliver drugs in a constant-rate infusion Prevent dehydration (GI disease) Diuresis (renal disease, toxicities)
- 4. Signs of Dehydration <5% No clinical signs 5-6% = “mild dehydration”: Tacky mucous membranes Slight skin tent 7-8% = “moderate dehydration” Dry mucous membranes Skin tent CRT 2-3 sec Slight depression of eyes into sockets
- 5. 10-12% = “severedehydration” Severe skin tent CRT >3 sec Markedly sunken eyeballs Cold extremities +/- shock 12-15% Obvious shock, imminent death
- 6. Diagnosis Of Dehydration Physical exam Weight loss Skin Tent PCV (HCT) INCREASED Albumin or total protein INCREASED BUN, creatinine INCREASED =“Prerenal azotemia”
- 7. Fluid Needs Correctdehydration Maintenance needs On-going losses
- 8. Fluids: How Muchto Give? Correct dehydration Weight in kg times percent dehydration equals the amount in liters that the animal is dehydrated Example: 10 kg animal who is 8% dehydrated 10kg X 0.08 = 0.8 liters Patient is lacking 0.8 liters, or 800 ml fluids Maintenance Fluids 30 ml/pound/day 10 pound animal needs: 10 X 30ml/lb =300 ml/day
- 9. On-going Losses Sensiblelosses GI disease Vomiting/diarrhea Renal disease Low specific gravity Diabetes mellitus Insensible losses (evaporation/diffusion) Weigh to determine
- 10. Principles of Rehydration Correct dehydration, electrolyte, and acid-base abnormalities prior to surgery Do not attempt to replace chronic fluid losses all at once Severe dilution of plasma proteins, blood cells and electrolytes may result Aim for 80% rehydration within 24 hours Monitor pulmonary, renal and cardiac function closely
- 11. Types of Fluids Colloids (Natural and Synthetic) Crystalloids
- 12. Natural Colloids Bloodproducts: Whole blood Plasma Platelet-rich plasma Packed RBC’s Synthetic Colloids Dextrans, Hetastarch Used when quantity of a crystalloid is too great to be able to infuse quickly Stays within the vasculature maintain blood pressure Duration of effect is determined by molecular size: bigger = longer
- 13. Crystalloids Isotonic Mimic plasmaelectrolyte concentrations Hypertonic Follow with isotonic 0.9% NaCl Lactated Ringers Solution Ringers Solution 5% Dextrose in water Plasmalyte, Normosol, etc
- 14. Lactated Ringer’s Solution Composition closely resembles ECF Contains physiological concentrations of: sodium, chloride, potassium, and calcium Also contains lactate, which is metabolized by the liver alkaline-forming Because small animals that are sick or under anesthesia tend towards acidosis
- 15. Ringer’s Solution Sameas LRS except no lactate added Commonly used in Large animals Large animals who are sick tend towards alkalosis instead of acidosis
- 16. Saline 0.9% Sodiumchloride = ISOTONIC Lacking in K+, Ca2+ Used for hyperkalemia, hypercalcemia Used as a carrier for some drugs Used if don’t want lactate
- 17. Dextrose Solutions 5%dextrose is isotonic 50% dextrose commonly found C1V1= C2V2 Used for hypoglycemia, neonates, hyperkalemia, as part of Total Parenteral Nutrition
- 18. Additives for CrystalloidSolutions Potassium available as potassium chloride (KCl) available as potassium phosphate (K3PO4) Very common additive 20 meq in 10 ml bottle DANGER: Rates higher than 0.5 meq/kg/hr will stop the heart Sodium Bicarbonate Alkalinizing Used for severe acidosis Antifreeze toxicity Ketoacidosis associated with diabetes mellitus Do not add to calcium-containing fluids or calcium precipitates will occur
- 19. B Vitamins B Complex Frequent additive; water-soluble effects Turns bag yellow Protect from light 1-2 ml/liter Appetite Stimulant Replaces lost B vitamin Always label the fluid bag with the amount and concentration of all additives immediately!
- 20. Administration Routes Oral Ifthe stomach works, use it! Safest route if tolerated Subcutaneous Works well in most animal Sometimes need to use multiple sites Can’t add glucose, large quantity KCl, or some drugs
- 21. Intravenous Bestroute in dehydrated animals Possible problems: Volume overload Catheter reactions (swelling, fever) 24-hour maintenance INTRAOSSEOUS If situation is dire and no vein accessible Into the medullary (bone marrow) cavity of long bones Femur or Humerus are commonly used Used frequently in birds
- 22. Calculate Drops PerHour Calculate ml/hr Calculate drops/hr by: ml/hr X drops/ml (from the package) Gives you drops needed in an hour Example: 100 ml X 10 drops per ml = 1000 drops in the first hour Divide drops per hour by 60 min/hr to get drops per minute Divide again by 60 to get drops per second
- 23. Daily Monitoring Whileon Fluids: Weigh patient daily Urine production Central venous pressure Auscult the lungs Crackles Wheezes Nasal discharge Overdose: Serous nasal discharge Dyspnea, crackles Restlessness Decreased PCV, TP Increased BP
- 24. References Crystalloid andColloid Fluid Therapy. In Ettinger SJ, Feldman EC, Textbook of Veterinary Internal Medicine, 7th edn. Introduction to Fluid Therapy. In Di Bartola SP - Fluid, Electrolyte and Acid Base Disorders, 4th edn.