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The goal of this plan is to maintain intravascular fluids after resuscitation and during conditions like systemic inflammatory response syndrome.
The goal of this plan is to maintain intravascular fluids after resuscitation and during conditions like systemic inflammatory response syndrome.
Three Ongoing Fluid Requirements
Three Ongoing Fluid Requirements
• Rehydration: Replacement of lost interstitial volume.
• Rehydration: Replacement of lost interstitial volume.
• Maintenance: Fluids required for normal homeostasis.
• Maintenance: Fluids required for normal homeostasis.
• Ongoing Losses: Replacement of current fluid being lost (e.g., vomit, diarrhea).
• Ongoing Losses: Replacement of current fluid being lost (e.g., vomit, diarrhea).
Calculations & Formulas
Calculations & Formulas
• Rehydration Volume: Calculated as: % dehydration × body wt (kg) × 0.6 (total body water). Typically administered over 4–12 hours.
• Rehydration Volume: Calculated as: % dehydration × body wt (kg) × 0.6 (total body water). Typically administered over 4–12 hours.
• Maintenance Rates:
• Maintenance Rates:
◦ Standard: 30 × body weight (kg) + 70 = mL/24 hours.
◦ Standard: 30 × body weight (kg) + 70 = mL/24 hours.
◦ Extreme Weights (<2 kg or >70 kg): 70 × body weight (kg) = mL/24 hours.
◦ Extreme Weights (<2 kg or >70 kg): 70 × body weight (kg) = mL/24 hours.
• Insensible & Increased Losses:
• Insensible & Increased Losses:
◦ Estimated via urine/fecal output, nasogastric suction, or bandage weight.
◦ Estimated via urine/fecal output, nasogastric suction, or bandage weight.
◦ Fever/Wounds: Can increase maintenance rate by 15–20 mL/kg/day.
◦ Fever/Wounds: Can increase maintenance rate by 15–20 mL/kg/day.
◦ Fever Rule: In humans (often applied here), fluid requirements may increase by 10%–12% for every 1°C above normal.
◦ Fever Rule: In humans (often applied here), fluid requirements may increase by 10%–12% for every 1°C above normal.
Fluid Selection:
Fluid Selection:
• Crystalloids: Small molecules that move freely into the interstitial space.
• Crystalloids: Small molecules that move freely into the interstitial space.
◦ Replacement: Standard isotonic, balanced electrolyte fluids.
◦ Replacement: Standard isotonic, balanced electrolyte fluids.
◦ Maintenance: Half-strength saline or 5% dextrose used to replace free water deficits.
◦ Maintenance: Half-strength saline or 5% dextrose used to replace free water deficits.
• Colloids (e.g., Hydroxyethyl starch - HES): Large molecules that stay in the intravascular space.
• Colloids (e.g., Hydroxyethyl starch - HES): Large molecules that stay in the intravascular space.
◦ Rates: 0.5–1 mL/kg/hour (dogs) or 0.25–1 mL/kg/hour (cats).
◦ Rates: 0.5–1 mL/kg/hour (dogs) or 0.25–1 mL/kg/hour (cats).
◦ Interaction: When used with crystalloids, the crystalloid dose should be reduced by 40%–60%.
◦ Interaction: When used with crystalloids, the crystalloid dose should be reduced by 40%–60%.
Monitoring Fluid Therapy
Monitoring Fluid Therapy
• Physical Checks: Physical exam, body weight, and hydration status should be checked regularly; urine production at least twice daily.
• Physical Checks: Physical exam, body weight, and hydration status should be checked regularly; urine production at least twice daily.
• Objective Markers: Monitoring CVP (target <8–10 cm H2O), blood pressure, electrolytes, and PCV/total solids.
• Objective Markers: Monitoring CVP (target <8–10 cm H2O), blood pressure, electrolytes, and PCV/total solids.
• Signs of Fluid Overload: Increased respiratory effort/crackles, serous nasal discharge, chemosis (swelling of the conjunctiva), jugular distention, and rapid weight gain (>12%–15%).
• Signs of Fluid Overload: Increased respiratory effort/crackles, serous nasal discharge, chemosis (swelling of the conjunctiva), jugular distention, and rapid weight gain (>12%–15%).
Complications
Complications
• Delivery Related: Phlebitis, thrombosis, sepsis, or fluid extravasation.
• Delivery Related: Phlebitis, thrombosis, sepsis, or fluid extravasation.
• Prescription Related:
• Prescription Related:
◦ Fluid Intolerance: Resulting in edema or ascites.
◦ Fluid Intolerance: Resulting in edema or ascites.
◦ Physiological Shifts: Exacerbation of anemia, coagulopathies, renal injury (specifically with colloids), or acid-base/electrolyte abnormalities.
◦ Physiological Shifts: Exacerbation of anemia, coagulopathies, renal injury (specifically with colloids), or acid-base/electrolyte abnormalities.
Discontinuation (Tapering)
Discontinuation (Tapering)
• Criteria: Animal can maintain hydration via voluntary drinking/eating or enteral feeding.
• Criteria: Animal can maintain hydration via voluntary drinking/eating or enteral feeding.
• Method: Taper the IV volume over 24–48 hours. This allows the renal medulla to reestablish its osmotic gradient and prevents excessive diuresis.
• Method: Taper the IV volume over 24–48 hours. This allows the renal medulla to reestablish its osmotic gradient and prevents excessive diuresis.
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