1. Fluid Therapy in Companion Animals
CTVT pgs

2. Indications for Fluid Administration
_______________________
Potential of fluid loss or excessive blood loss
Maintenance of __________________and perfusion
Disease that depletes the normal fluid, electrolyte or acid-base balances
(polyuria, decreased __________intake of fluids, _______________)

3. Contraindications for Fluid Therapy
Conditions that carry a risk of __________________ edema from fluid shifting into the ___________ necessitate the need for caution and frequent monitoring
Pulmonary contusions
Existing pulmonary edema
_______________________________
____________ injury
**Adjust rates according to patient response to fluid therapy and veterinarian orders

4. Normal Fluid Balance
The body is made up of approximately _________% water
This is divided into _____________________ fluids, or ICF (2/3 of body fluid) and ________________________ fluids or ECF (1/3 of body fluid)
Extracellular fluid is further divided into
________________________- what the body’s cells are floating in
________________________- plasma in your vessels
The body maintains fluid balance (homeostasis) on a constant basis
Water can move anywhere freely
What about electrolytes?
Cannot move freely into ICF

5. Blood Volume Normal dogs = 80-90 mL/kg Normal cats = 40-60 mL/kg
**This is important when figuring out fluid rates for patients who have lost substantial amounts of blood.

6. Fluid Treatment Questions
How much fluid will be needed to ________________ the patient, right now?
How much fluid will be needed to ________________ the animals requirements?
How much fluid will be needed to compensate for ___________________ losses?
Total circulating blood volume:
Dog = 85 ml/kg
Cat = 50 ml/kg

7. Daily Maintenance Requirements
Fluid Losses
Daily Maintenance Requirements
Ongoing Losses
Sensible losses (measurable losses)
Urine output
1-2 ml/kg/hr = normal
Insensible losses
Feces
Respiration
Cutaneous losses
Vomiting
Diarrhea
Polyuria
Pleural effusion

8. Assessing Dehydration
__________________- the amount of time it takes for the skin to return to the animal’s body after gently pulling up into a “tent” along the back of the neck and along the spine
What about obese animals?
Emaciated animals?
Mucous membranes (MM)
Moist/tacky/dry?
Eye position
___________ body weights
*A loss of 1 kg during a 24 hour period is about equal to a loss of 1 L of water.

9. Assessing Perfusion Capillary refill time (CRT) Heart rate & pulse
Normal?
Heart rate & pulse
Blood pressure
Cool extremities
*1 lb body weight = 1 pint of fluid (___ml)

10. Laboratory Dehydration Assessment
Packed Cell Volume (PCV)
Total Plasma Protein Concentration (TP)
PCV and TP will be _______________ Why??
 except in cases of severe hemorrhaging…Why??
_________________ urine specific gravity (SG)
Electrolyte assessment
Only reflects dehydration if the kidneys are healthy

11. Central Venous Pressure (CVP)
Monitors _____________________ response to the fluid load
Must be done through a _____________ line (cranial vena cava)
Via jugular vein, IV catheter tip is level with the right atrium
Patient must be in _______________ recumbency
________ readings should be done to ensure accuracy
*****Optimal is 5-8cm H2O

14. Other Indicators of Dehydration
Decreased urine output
*Normal production is ml/kg/hr
____________________
Cold extremities
Short term change in body weight
Signs of shock including a rapid, thready pulse, _______________, and ________________.

15. Reading Assignment: Page 515 in Daily Reference Guide
Hydration status:
<5% dehydrated = normal
***** Know the clinical signs and all levels of assessing dehydration

16. Routes of Fluid Administration
*__________________: (minimal loss) Easy, cheap and safe
*__________________: (mild-moderate dehydration)
Given on dorsal midline/flank; ml/kg/day
*__________________: (Severe dehydration; perioperative precaution)
*_________________________: (mild to moderately dehydrated; large volumes) -this method is not commonly used in cats and dogs.
*Can be dangerous if you accidentally hit an organ

17. Intraosseous (head of the femur or humerus of small animals)
Neonates or animals with poor venous access; birds and reptiles
Via 16 gauge bone marrow needle and other materials. IO infusion provides a direct conduit to the blood stream through the bone. This technique must be sterile!

18. Oral Route
Contraindications:
___________________

19. sloughing of the skin and abscesses
Subcutaneous Route
Absorption of SQ fluids will occur over 6 to 8 hours
Contraindications:
Infected skin
____________________
The patient requires high
amount of ____________
Shock/life threatening
-peripheral vasoconstriction
*Never use >2.5% dextrose, as this will cause
sloughing of the skin and abscesses

20. Client Education

21. Intravenous Route

22. Primary IV drip sets come in different shapes, colors and sizes

23. Drip sets in gtt/ml:
Macro (10, 15, 20)
Micro (60)

24. Primary IV set for intravenous therapy.
The catheter and fluid drip set must be kept sterile and free
of blood clots to allow long-term use (3 to 5 days maximum).

25. Fluid bag
IV line attachment
You can see the drops while manually calculating fluid rates here
Drip chamber

26. Spike is very sharp and can cut through the line, bag, or you.
Air vent cap
Injection port aka injection Y-site
Roller clamp

27. Roller clamp
Rolling the wheel all the way down, shuts off fluid flow to the patient.

28. IV pumps come in many brands and sizes.
BAXTER 6300 DOUBLE PUMP
IV Pump/
Fluid Stand

29. Inside of the IV pump

30. HESKA VET IV infusion pump

31. Gravity system with pressurized bag
Automated fluid pump
Gravity system with pressurized bag

32. Intraperitoneal Lower right quadrant of abdomen
Common in laboratory animals
NOT common in dogs/cats

33. Crystalloids –vs- Colloids
Crystalloids are solutions of _________ and water with variable electrolyte composition and contain no __________ or colloids
Are in intravascular compartment for less than an hour
Rapidly excreted in urine (if renal function is normal)
Classified by their osmolality:
_____________, _____________, or _____________
Colloids contain ____________ insoluble molecules, which act to retain existing fluid and promote movement of fluid into intravascular spaces
Remain within the circulation (cannot cross vascular endothelium)

34. Helpful hint
____________________- fluid deficit in the interstitial and intracellular spaces
____________________- fluid deficit in the intravascular space

35. Types of Crystalloids
Normal plasma osmolality = mOsm/L

36. Hypotonic Crystalloids
Lower osmotic pressure (osmolality) than blood – thereby encouraging movement of fluids into interstitial fluid and then into cells
Contain low amounts of Na
Indicated for maintenance of cardiac patients
Examples:
5% Dextrose in water (D5W)
0.45% Saline (NaCl)
Normasol-M; Plasmalyte 56
*Provide more water than electrolytes*

37. Hypotonic Crystalloids
Contraindications:
____________________ shock
Acute ___________ failure
Pulmonary or cerebral edema

38. Isotonic Crystalloids
Most common type of fluids used to replace body fluids; osmolality = to blood
Can be administered via __________ route
Cells are not affected by this type of solution
***For each 1 ml increase in vasculature fluid, you need to give 3-4 mls of isotonic fluid

39. Isotonic Cyrstalloids
Normal Saline (0.9% NaCl)
-slightly acidifying effect due to high Cl
Balanced electrolyte solutions
Contain other electrolytes in addition to Na and Cl
-_________________ affects due to bicarbonate precursors (lactate and acetate)
Examples: Normasol-R, LRS, Plasmalyte 148

40. Hypertonic Crystalloids
Greater osmotic pressure than blood
-encouraging movement of fluid from the interstitial space into ________________ (vasculature)
Why is this a “quick fix”?
Administered for resuscitation or shock, cerebral edema
Increases blood volume and pressure
For each 1 ml given, increases vasculature volume by 5-10 mls
*Provides more electrolytes than it provides water*

41. Hypertonic Crystalloids
Contraindications:
Renal/cardiac failure
Cannot be given ______
Most have an osmolality >600 mOsm/L
Example: Hypertonic NaCl ( %)
If given too quickly, can cause:
interstitial or intracellular __________________
reflex bradycardia
mOsm = milliosmole

42. Colloids Contains large molecules suspended in an isotonic crystalloid
Natural or synthetic
Whole blood and plasma transfusions
Increase IVF and perfusion when RBCs are abnormal
Anaphylaxis
Hetastarch, VetStarch, Dextran, Oxyglobin
Increase IVF and perfusion when RBCs are normal
Coagulopathy
Resusistation and hypoproteinemia
For each 1 ml of colloid given, vascular volume increases by mls

43. Crystalloids – vs. - Colloids
LRS
Normosol-R/M
Plasma-Lyte
Ringers Solution
Sodium Chloride 0.9%-Normal Saline
Dextrose 5% in Water (D5W)
Colloids
Whole blood
Plasma
Dextran 70*used less and less
Hetastarch
Oxyglobin

44. Fluid Protocols and Rates
Resuscitation/Shock
Rehydration
Maintenance
Anesthesia
Pediatric

45. Resuscitation/Shock Protocol
Patient:
Is experiencing hypovolemia or shock state
has lost significant amount of total blood volume
If a 20 lb dog lost 10% of its blood volume, how many mls of blood would this be?
Goal is to replace fluid in the vasculature AND increase perfusion
Dogs Cats
Isotonic fluids: ml/kg ml/kg
Hypertonic fluids: 3-6 ml/kg ml/kg
Colloids: ml/kg ml/kg

46. Resuscitation/Shock Give ¼ of total dose as a bolus over 10-15 mins
Check parameters and reassess
By using crystalloids and colloids together, you can increase benefits and decrease side effects.
Give half the shock dose of each

47. Resuscitation Problem
A 3 year old 50 lb Labrador retriever has lost about 24% of her total blood volume and needs IV Hetastach to treat her shock state.
About how much blood has she lost?
How much Hetastarch will you give initially?

48. Solving 1) Convert lb to kg: 50lb = _________
2) Calculate blood lost: (80-90 mL/kg x 24%)= ___________mL
3) Is Hetastarch a crystalloid or colloid?
4) Calculate total fluids _____kg x ________ = _________mL
5) Calculate initial bolus: ________/4 = _________mL
22.72kg / has1,931.2mL x 24% lost = mL / Colloid SO… ml/kg. 25 is middle. 25 x = 568 mL

49. Rehydration Formula Ex: 20 ml urine = 20 ml fluid
% dehydrated x body weight (kg) x 1000 ml/kg
= ml of fluid needed for replacement
This formula is used for patients who are dehydrated and may or may not have ongoing losses (i.e. vomiting / diarrhea)
To be given over 4-6 hours
We also have to account for ongoing losses
Ex: 20 ml urine = 20 ml fluid

50. Rehydration Problem
A 5 yr old 11lb Pomeranian is 8% dehydrated and has vomited about 5 mls since he was admitted to your clinic. Your vet asks to correct his fluid status over the next 4 hours with IV LRS.
1. What vein would you most likely put an IV catheter in?
2. What gauge would you choose?
3. How many mls/hr will you set your fluid pump to?

51. Solving 1) Convert lb to kg : 11 lb = ____kg 2) Remember the formula:
wt in kg x % dehydrated x 1000 so:
__________ x 8% = _________ x 1000 = _______mL total
3) Calculate ml/hour needed:
________ml total / 4 hours = _________mL/hr.
4) Catheter? Gauge?
11/2.2 = 5 kg
400mL total needed over 4 hours SO 100 mL per hour

52. Maintenance Rate
Maintenance volume is the amount of fluid and electrolytes needed on a daily basis to keep the volume of water and electrolyte content normal in a well-hydrated patient
Animals that refuse or cannot eat, recently dehydrated
Remember insensible and sensible losses?
40-60 ml/kg/24h
Usually isotonic crystalloids
What about all of those extra electrolytes?

53. Maintenance Problem
A 9 lb 4 year old s/F DSH named Arlene has been hospitalized for major dental surgery and is not eating or drinking. Your vet would like her to be on IV fluids overnight from 7pm-7am.
What type of fluids would you prepare?
How many ml/hr will Arlene receive?
What’s the minimum amount of fluid you should ensure is in the fluid bag before clocking out?
9/2.2 = 4.09 kg
40-60 ml/kg/24hr of LRS (COMMON AND INEXPENSIVE)
50ml x 4.09kg = ml/24 hours. How long? 12 hours SO 204.5/2 = mL TOTAL = 8 ml/hour
Ensure 150 mL in bag before leaving.

54. Solving 1) Convert lb to kg. 9# = _______kg
2) Solution prepared? ____________
3) Maintenance formula? ml/kg/24 hours SO:
______mL x ______kg = ________mL Total/24 hours
4) How long are we providing fluids? ______hr(s)
5) _______total mL / _____hr = _______ml/hr
6) Minimum volume in bag? _________mL
4.09kg / LRS. (Cheap and commonly seen in clinic.)
50ml x 4.09kg = ml/24 hours. How long? 12 hours SO 204.5/2 = mL TOTAL = 8 ml/hour
Ensure 150 mL in bag before leaving.

55. Anesthetic Protocol 5-15 ml/kg/hr
To compensate for expected losses during surgery
5-15 ml/kg/hr

56. Neonate/Pediatric Protocol
BW is 80% water = higher fluid requirements
Immature organ systems
Skin turgor is not present; only use MM
Warm fluids is very important
Bolus of 3.3 ml/100 grams over 5 minutes
Maintenance rate= 6 ml/kg/hr
or ml/kg/day

57. Syringe Pump
This device is used for the administration of small volumes and slow rates of fluid (or drugs) to the cat and dog via a syringe and IV extension tubing line

58. General Rule of thumb
It is undesirable to mix multiple drugs in a syringe or intravenous fluids- sometimes drug interactions are visible, other times they are not
Physical incompatibilities include: precipitation and chemical inactivation
Fluids should be warmed before being given
Fluid incubator, line warmer, “warmies”
What colors should NOT be added to warmies?

59. Causes of Hypervolemia
Excessive total volume
Excessive rate of fluid administration
Decreased cardiac function

60. C/S of Hypervolemia (volume overload)
Restlessness
Hyperpnea- abnormal increase in depth and rate of respiration but not to the point of labored
Pulmonary edema
Serous (watery) nasal discharge
Chemosis- edema of the ocular conjunctiva
Pitting edema –skin remaining indented for a prolonged amount of time after removal of firm-finger-pressure. (Over saturation of the cells)
Weight gain

61. Putting it all together
Oliver, a 18# 8 year old beagle that has not eaten in three days, has skin turgor > 3 seconds, sunken eyes, tacky, pale MM. Heartrate is 200 bpm, with a thready pulse, and CRT is 4 seconds. He has had diarrhea several times, measuring a total of 35 ml. Calculate his resuscitation fluid dose.
= ____ mls  give how much as an initial bolus? ____ mls
Oliver stabilizes and most of his parameters are back to normal after two boluses but will remain on fluids to correct his dehydration.

62. Assuming he was 10% dehydrated, calculate Oliver’s rehydration dose to be corrected over the next 12 hours. Account for maintenance needs in your total rate. Also, he will continue to have ongoing losses equaling 100 mls for the next 12 hour period.
How many total mls will need to be hung to make it through all 12 hours?
How many drops/sec will you set your rate to if you use a 15 gtt/ml infusion set? You do not have a fluid pump.