–   
Small volumes produce immediate
increases in blood pressure

bigger = longer

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•     
Duration of effect is determined by
molecular size:

•     
Stays within the vasculatureà maintain
blood pressure

•     
Used when quantity of a crystalloid is
too great to be able to infuse quickly

•     
Dextrans, Hetastarch

Synthetic Colloids

 

–   
Packed RBC’s

–   
Platelet-rich plasma

–   
Plasma

–   
Whole blood

•     
Blood products:

          Natural Colloids

Colloids are
large-molecular-weight substances that are restricted to the plasma compartment
in patients with an uncompromised intact endothelium

Colloids

•     
Used for hypoglycemia, neonates,
hyperkalemia, as part of Total Parenteral Nutrition

•     
25%, 50% dextrose commonly found

•     
5% dextrose is isotonic

Dextrose
Solutions

•     
Used as a carrier for some drugs

•     
Used for hyperkalemia, hypercalcemia

•     
Lacking in K+, Ca2+

•     
0.9% Sodium chloride = ISOTONIC

Saline

–   
Because
small animals that are sick or under anesthesia tend towards acidosis

–   
Also contains lactate, which is
metabolized by the liverà
alkaline-forming

–   
Contains physiological concentrations
of: sodium, chloride, potassium, and calcium

•     
Composition closely resembles ECF

Lactated Ringer’s
Solution

–   
Osmolality higher than plasma, RL

•     
Hypertonic

–   
Mimic plasma electrolyte
concentrations, NS

•     
Isotonic

Crystalloid
Fluids

–   
Plasmalyte, Normosol, etc

–   
5% Dextrose in water

–   
Ringers Solution

–   
Lactated Ringers Solution

–   
0.9% NaCl

•     
Crystalloids

Types of Fluids:

 

–   
Used frequently in birds

– 
Femur or Humerus are commonly used

•     
Into the medullary (bone marrow)
cavity of long bones

•     
If situation is dire and no vein
accessible

 

•     
Intraosseous

•     
Catheter reactions (swelling, fever)

•     
Volume overload

–   
Possible problems:

–   
Best route in dehydrated animals

•     
Intravenous

–   
Can’t add glucose, large quantity KCl,
or some drugs

–   
Sometimes need to use multiple sites

–   
Works well in most animal  

•     
Subcutaneous

–   
Safest route if tolerated

–   
If the stomach works, use it!

•     
Oral

Administration
Routes

 

–   
Increased BP

–   
Decreased PCV, TP

–   
Restlessness

–   
Dyspnea, crackles

–   
Serous nasal discharge

•     
Overdose:

•     
Central venous pressure

•     
Urine production – 1-2ml/kg/min

–   
Serous nasal discharge

–   
Wheezes

–   
Crackles

•     
Auscult the lungs – presence of the
following signs indicate overhydration

•     
Weigh patient daily

Monitoring While on Fluids:

 

•     
It usually is not necessary to replace
the hydration deficit rapidly in chronic diseases, it should be done over a
period of 24 hours

•     
Severe ongoing losses (e.g., vomiting
and diarrhea in a patient with acute gastroenteritis) may necessitate rapid
administration to keep pace with contemporary fluid loss

•     
Reminder of the deficit + maintenance
req. + ongoing losses should be administered over a period of 24 hrs

•     
1/4th to ½ of fluid defecit
should be administerd over a period of 2-3 hrs

 

                                             colloids 20ml/kg/hr

•     
In case of shock – crystolloids 80-90
ml/kg/hr

•     
In Normal cases (peri-operative) it is
10ml/kg/hr

•     
Rate of fluid to be administered is
determined by the magnitude and rapidity of fluid loss

Rate of Administration:

 

It includes
losses related to vomiting, diarrhea, polyuria, large wounds or burns, drains,
peritoneal or pleural losses, panting, fever, and blood loss

On-going Losses: These are losses
that are occurring during the course of treatment

 

·       Usually
40-60 ml/kg/day

Maintenance requirement: The maintenance
fluid requirement is the volume needed per day to keep the animal in balance
(i.e., no net change in body water).

•     
Fluid req
(L) = Weight (Kg) X %dehydration

Fluid deficit: It is the deficit of plasma volume
calculated by multiplying weight in Kgs by percent dehydration which gives the
fluid deficit in litres

 

3.   
On-going
losses

2.   
Maintenance
requirement

1.   
Fluid deficit

  Fluid therapy contains
three components that should be taken into consideration.

Components of Fluid Therapy:

 

 

 

•      Skin tenting test – >3 sec indicate
dehydration

•      BUN, creatinine  – increased =”Prerenal azotemia”

•      albumin or total protein increased

–    PCV (HCT) – increased

•      Weight loss

•      Physical exam

Diagnosing Dehydration:

 

 

(
Muir WW, DiBartola SP: Fluid therapy. In Kirk RW, editor: Current veterinary
therapy VIII, Philadelphia, 1983, WB Saunders, p 33.)

·      
12-15      Definite signs of shock Death imminent

   Possibly signs of shock
(tachycardia, cool extremities, rapid and weak pulses)

   Dry mucous membranes

   Eyes sunken in orbits

   Definite prolongation of
capillary refill time

·      
10-12      Tented skin stands in place

               Possibly dry mucous membranes

               Eyes possibly sunken in orbits

               Slight prolongation of capillary
refill time 

·      
6-8          Definite delay in return of skin to
normal position

·      
5-6          Subtle loss of skin elasticity

·      

x

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