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This plan is essential in cases of hypovolemic shock to restore blood volume and meet metabolic demands when compensatory mechanisms are exhausted.
This plan is essential in cases of hypovolemic shock to restore blood volume and meet metabolic demands when compensatory mechanisms are exhausted.
Determination of Fluid Deficit
Determination of Fluid Deficit
• Intravascular Deficit (Poor Perfusion/Shock):
• Intravascular Deficit (Poor Perfusion/Shock):
◦ Mechanism: Lower vessel wall tension reduces baroreceptor stimulation, triggering the sympathetic nervous system.
◦ Mechanism: Lower vessel wall tension reduces baroreceptor stimulation, triggering the sympathetic nervous system.
◦ Clinical Signs: Changes in heart rate, pulse intensity, blood pressure, capillary refill time (CRT), mucous membrane (MM) color, level of consciousness, and rectal temperature.
◦ Clinical Signs: Changes in heart rate, pulse intensity, blood pressure, capillary refill time (CRT), mucous membrane (MM) color, level of consciousness, and rectal temperature.
• Extravascular Deficit (Dehydration):
• Extravascular Deficit (Dehydration):
◦ Physical Guidelines:
◦ Physical Guidelines:
▪ 4%–5%: Semi-dry MM; normal skin turgor and eye moisture.
▪ 4%–5%: Semi-dry MM; normal skin turgor and eye moisture.
▪ 6%–7%: Dry MM; mild loss of skin turgor.
▪ 6%–7%: Dry MM; mild loss of skin turgor.
▪ 8%–10%: Considerable loss of skin turgor, retracted eyes, and weak pulses (concurrent intravascular deficit).
▪ 8%–10%: Considerable loss of skin turgor, retracted eyes, and weak pulses (concurrent intravascular deficit).
▪ ≥12%: Severe retraction, thready/weak pulses, and possible altered consciousness.
▪ ≥12%: Severe retraction, thready/weak pulses, and possible altered consciousness.
◦ Misleading Factors: Geriatric or emaciated animals (naturally poor turgor) and third-space losses (fluid shifts rapidly before clinical dehydration is visible).
◦ Misleading Factors: Geriatric or emaciated animals (naturally poor turgor) and third-space losses (fluid shifts rapidly before clinical dehydration is visible).
Selection of Fluids
Selection of Fluids
• Crystalloids (Water-based with small molecules):
• Crystalloids (Water-based with small molecules):
◦ Replacement (Isotonic): e.g., Lactated Ringer’s, 0.9% Saline, or Plasmalyte-A. These are ideal for sodium-rich losses but move into the extravascular space within one hour.
◦ Replacement (Isotonic): e.g., Lactated Ringer’s, 0.9% Saline, or Plasmalyte-A. These are ideal for sodium-rich losses but move into the extravascular space within one hour.
◦ Maintenance (Hypotonic): e.g., 5% Dextrose. Used for free water loss but should not be used for resuscitation as they cause intracellular water accumulation.
◦ Maintenance (Hypotonic): e.g., 5% Dextrose. Used for free water loss but should not be used for resuscitation as they cause intracellular water accumulation.
◦ Hypertonic (7%–7.5% NaCl): Rapidly draws water into the intravascular space; best used when hydration is normal and combined with colloids.
◦ Hypertonic (7%–7.5% NaCl): Rapidly draws water into the intravascular space; best used when hydration is normal and combined with colloids.
• Colloids (Large molecules that stay intravascular):
• Colloids (Large molecules that stay intravascular):
◦ Synthetic: e.g., Hydroxyethyl starch (HES) or Dextran 70. These achieve rapid volume expansion and help prevent the "washout" of interstitial proteins.
◦ Synthetic: e.g., Hydroxyethyl starch (HES) or Dextran 70. These achieve rapid volume expansion and help prevent the "washout" of interstitial proteins.
◦ Natural: e.g., Plasma, Albumin, or Whole Blood. Choice for patients needing clotting factors, albumin, or red blood cells.
◦ Natural: e.g., Plasma, Albumin, or Whole Blood. Choice for patients needing clotting factors, albumin, or red blood cells.
◦ Hemoglobin-Based Oxygen Carriers (HBOC): Provide oxygen-carrying capacity and mild vasopressor activity.
◦ Hemoglobin-Based Oxygen Carriers (HBOC): Provide oxygen-carrying capacity and mild vasopressor activity.
Determination of Resuscitation Endpoints
Determination of Resuscitation Endpoints
• Supranormal (High-end): Used for SIRS-related diseases (e.g., sepsis, pancreatitis) to deliver excess oxygen and glucose to promote cellular repair.
• Supranormal (High-end): Used for SIRS-related diseases (e.g., sepsis, pancreatitis) to deliver excess oxygen and glucose to promote cellular repair.
• Hypotensive (Low-end): Used for trauma, brain/lung injury, or heart failure. The goal is to avoid dislodging clots or worsening edema by using the smallest effective volume.
• Hypotensive (Low-end): Used for trauma, brain/lung injury, or heart failure. The goal is to avoid dislodging clots or worsening edema by using the smallest effective volume.
• Objective Markers: Targeted heart rate, blood pressure, CRT, lactate (< 2 mmol/dL), and urine output (1–2 mL/kg/hour).
• Objective Markers: Targeted heart rate, blood pressure, CRT, lactate (< 2 mmol/dL), and urine output (1–2 mL/kg/hour).
Determination of Resuscitation Technique
Determination of Resuscitation Technique
• Large-Volume Technique: Initial rapid infusions (e.g., 20–50 mL/kg crystalloids for dogs) followed by assessment for supranormal endpoints.
• Large-Volume Technique: Initial rapid infusions (e.g., 20–50 mL/kg crystalloids for dogs) followed by assessment for supranormal endpoints.
• Small-Volume Technique: Titrated doses (e.g., 5–10 mL/kg for cats) administered over 10–15 minutes and repeated as needed.
• Small-Volume Technique: Titrated doses (e.g., 5–10 mL/kg for cats) administered over 10–15 minutes and repeated as needed.
◦ Preferred for: Cats, closed cavity hemorrhage, head injury, and pulmonary edema.
◦ Preferred for: Cats, closed cavity hemorrhage, head injury, and pulmonary edema.
• Thermal Consideration: Active warming is critical, especially for hypothermic cats, as cold temperatures limit the cardiovascular response to fluids.
• Thermal Consideration: Active warming is critical, especially for hypothermic cats, as cold temperatures limit the cardiovascular response to fluids.
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