Pericardial Effusion in Dogs . Insensible losses, and fluid requirements associated with surgically induced trauma (tissue handling) suggest fluid administration rates during operation closer to 2-3 ml/kg/hr (< 5 ml/kg/hr), rather than the current conventional rates of 10-15 ml/kg/hr published in most texts and clinical proceedings. In giant breeds, a hypertonic saline-dextran (HSD) combination (7% NaCl in 6% dextran 70) administered at 5 ml/kg over a five-minute period may provide more rapid initial circulatory resuscitation. Each 2.2 lb (1 kg) more than the normal weight of the absorbent pad will equal about 1,000 mL of urine.13 Insensible losses are those that cannot be quantified (e.g. Hypertonic solutions are useful in patients that need to regain large amounts of fluid in the intravascular space quickly and is aimed at retaining more free water in the intravascular space by raising its osmolarity. 2nd ed. For example, fluids can be added to replace fluid losses (e.g. Any boluses that were given initially should be considered a part of the replacement volume and accounted for in this value. These solutions are given to patients for perfusion support and intravascular volume replacement. The size of the catheter will be determined, placing the largest catheter possible to provide adequate rates of fluid. Fluid overload is especially risky in small patients, such as this 6-week-old kitten with a femur fracture. To calculate the dehydration deficit, the following formula is used, in which the percent dehydration is the estimated dehydration based on physical assessment mentioned earlier: Body weight in kg x percent dehydration (as a decimal) x 1000 mL/L = the fluid deficit in mL. Since not all fluids are the same (crystalloids vs. colloids vs. blood product), the IV administration of identical doses should not be expected to produce the same pharmacologic response. Required infusion rate of fluids: 4ml/kg/hr. Can shockwave therapy help canine back pain? Dosage of propofol at induction of anaesthesia was 3.6 ± 1 mg/kg in dogs with pyometra and 4.1 ± 1 in healthy controls (P = 0.37). Fluid therapy should be started at a rate of 90 ml/kg/hr using a balanced electrolyte solution. The intracellular and extracellular compartments are separated by specialized membranes that are semipermeable to allow water to equilibrate across the membrane according to the osmotic-pressure gradient. The calculated deficit is then replaced over 2 to 24 hours. Most of the drugs and techniques used to anesthetize animals have some effect on the circulation. 6. Monitoring Standard mammalian monitoring techniques apply to dogs. So to calculate using these simple formulas: 180 mL/6 = 30 drops per minute. The volume of ongoing loss per hour is estimated to be added to the fluid replacement plan. The veterinarian will estimate the insensible losses and incorporate that into the total fluid rate, should they feel it be significant. An updated approach calls for a more conservative dosage of 10 to 20 mL/kg over 15 to 20 minutes and reassessing the patient's perfusion parameters (heart rate, … Specifically, in patients with traumatic brain injury, hypertonic saline may be useful in reducing intracranial pressure.6 Hypertonic saline is commonly administered as 7% or 7.5% solution at 3 to 5 mL/kg over 10 minutes. IV fluids are necessary when dogs and cats are sick,injured, can't eat or drink, or don't feel like eating or drinking, or need support during surgery If there are no contraindications, every patient must receive nutritional support, at least consistent with the resting energy requirement (RER). The difference between end goals and means goals, News wrap-up: This week’s veterinary headlines, plus May Fetch Virtual conference coverage, 3 safeguards for managing social media at your veterinary practice, intravenous (IV) fluids are administered correctly. Introduction Justine A. Lee, DVM, DACVECC, DABT CEO, VetGirl justine@vetgirlontherun.com . Effect of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in cats: a retrospective analysis (2010–2015). Traditional shock doses cited are 90 mL/kg for dogs and 60 mL/kg for cats, though these numbers represent the total estimated blood volume of a patient and can lead to volume overload, especially if the patient has reasons to be less tolerant of fluid administration (heart disease, for example). Newer HES solutions may be administered at higher rates (2 mL/kg/hour) without impacting coagulation. Pulse variability index has recently been incorporated into a multiparameter monitoring device (Masimo Corp.; Radical 7) for clinical use. Don’t intraoperative fluids improve hemodynamics, such as blood flow and tissue perfusion? 35kg dog: Maintenance = 35kg x 2 = 70mL/hour or 50mL x 35kg = 1750mL/24 hours • Maintenance fluid rate for puppy or kitten may be estimated as 3-4mL/kg/hr • More detailed guidelines are available in the ‘2013 AAHA/AAFP Fluid Therapy If the patient does not respond to the crystalloid fluids, then a colloid solution bolus is indicated. 5. First convert hours into minutes: 180 mL per hour divided by 60 minutes in an hour: 3 mL per minute. This practice likely decreases morbidities associated with excessive fluid administration, such as pulmonary gas exchange impairment, coagulopathy, hypothermia, ileus and delayed wound healing. Mortazavi MM, Romeo AK, Deep A, et al. North Am Vet Conf, 2007. Amount of potassium to add to 250ml NaCl: 15mmol. The standard shock rate of colloid solution bolus is 10 to 20 ml/kg for dogs and 5 to 10 ml/kg for cats (given slower in cats). Objective - To determine fluid retention, glomerular filtration rate, and urine output in dogs anesthetized for a surgical orthopedic procedure. Royal Canin expands its line of gastrointestinal diets with the first and only formulas designed specifically for puppies and kittens. Conventional rates for fluid administration (10-15 ml/kg/hr) during surgery are not justifiable and become excessive the longer they are administered; Recipe-based fluid therapy regimens should be replaced by goal-directed approaches; Fluid therapy should be procedure-specific Reduce fluid administration rate if anesthetic procedure lasts > 1 hr; A typical guideline would be to reduce the anesthetic fluid rate by 25% qhr until maintenance rates are reached, provided the patient remains stable; Rule of thumb for cats for initial rate: 3 mL/kg/hr Rule of thumb for dogs for initial rate: … Applied physiology of body fluid in dogs and cats. It is divided into three subcompartments: interstitial, intravascular and transcellular.1, The interstitial compartment contains three-quarters of all the fluid in the extracellular space. In addition, many sedatives and anesthetics will adversely affect the circulatory system, requiring fluids for hemodynamic support. A patient that has fluid leaking into spaces within the body cavity (third spacing) will have a rapid change in fluid from the intravascular compartments before the interstitial loss is seen.5 Therefore, one must evaluate the patient with individual clinical situations in mind instead of relying on a few parameters to gauge hydration status. If the patient's mean arterial pressure decreases below 60 mm Hg, some tissues and organs may experience inadequate oxygen delivery from reduced perfusion and subsequent hypoxia. tenance fluid rate) ensures that the patient’s fluid deficit is identified and corrected in a timely manner (see Examples of ... 4. It consists of four chambers and is enclosed with a thin, two-layered membranous sac, the pericardium. You administration set will give 10 drops per 1 … What is the ideal fluid to administer during surgery? 3. Dehydrated patients have a water loss in the extravascular space, and when fluids are intravenously administered, they are redistributed into the other compartments until all the solutes are in equilibrium again, thus correcting the water loss in the extravascular space.2 Sources of acute hemorrhaging can lead to hypovolemia and a loss of water primarily from the intravascular space in the short term, which can be corrected through IV fluid administration. The administration of a crystalloid for this purpose is highly variable, less effective and likely to result in fluid overload. Fluids are administered to patients not only to replace fluid loss but also to correct electrolyte abnormalities, promote kidney diuresis and maintain the tissue or organ perfusion rate while a patient is undergoing anesthesia. J Am Anim Hosp Assoc 2013; 49:149-159. The intracellular compartment consists of the largest volume of fluid, about two-thirds of total body water (approximately 40% of body weight).1 The extracellular space, which constitutes about one-third of the total body water, contains the fluid that is not in the cells. 1. An isotonic crystalloid fluid is a balanced electrolyte solution equivalent to the osmolality of the patient's red blood cells and plasma. 3. Available at: www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/160403.htm. How should this rate be adjusted to compensate for, Conventional rates for fluid administration (10-15 ml/kg/hr) during surgery are not justifiable and become excessive the longer they are administered, Recipe-based fluid therapy regimens should be replaced by goal-directed approaches, Fluid therapy should be procedure-specific, Increased rates of fluid administration are most effective if administered when needed (demand-related), not before or after. The administration of saline (0.9 percent NaCl), for example, is inappropriate for animals suspected or known to have metabolic acidosis or hypokalemia. Fluid rate (ml/hr) Drops/ml of giving set . Patient assessment and formulation of a fluid plan is a vital component of patient care in a veterinary practice, and veterinary technicians and nurses play a significant role in both. Appropriate fluid rates range from 5-10 mls/kg/hour, and may vary based on the anesthetic combination. Basically, patients can experience dehydration, hypovolemia or hypotension, or any combination of each depending on the situation. Fluid boluses are re-dosed if enough improvement is not seen. The infusion of an opioid (fentanyl, hydromorphone, morphine) and/or ketamine during inhalant anesthesia is known to improve analgesia and reduce inhalant anesthetic effects (e.g. VetStarch) in a 1:1 ratio. Rates Diniz MS, Teixeira-Neto FJ, Celeita-Rodriguez N, et al. It also helps prevent inadvertent fluid boluses from potassium-supplemented fluids being administered Body mass of dog: 25kg. The fluid therapy catheter will be prepped for placement. Effects of Hydroxyethyl Starch 130/0.4 on Serum Creatinine Concentration and Development of Acute Kidney Injury in Nonazotemic Cats. Contemporary rates of intraoperative fluid administration (10-15 ml/kg/hr) are defended based on insensible water losses, the conjectured severity of surgically induced tissue trauma and anesthesia-induced increases in intravascular volume (vasodilatation). Examples of hypotonic crystalloid solutions are 5% dextrose in water and 0.45% sodium chloride. Technicians are a vital part of making sure intravenous (IV) fluids are administered correctly in fluid-deficient patients. GI disease, kidney disease, wounds, liver disease), and synthetic colloids is one method of supplementing colloid osmotic pressure. In: Merck veterinary manual. The natural form of colloids is albumin, which can be depleted due to protein depleting pathologies (e.g. Serum potassium level: 2.3mmol/L. Maintenance rate (ml/kg/day) Maintenance requirement (ml) over 24 hours. This suggests that alternative or adjunctive techniques that help to minimize the need (and effects) for inhalant or injectable anesthesia are employed particularly in aged and high risk patients. Hydroxyethyl starch solutions can be administered as a constant-rate infusion at 0.5–1 mL/kg/hour in dogs, or 0.25–1 mL/kg/hour in cats. The preferred feeding route is dependent on the condition of the patient. 5. Doses commonly used range from 10 to 20 mL/kg for dogs and 5 to 10 mL/kg for cats. It is generally recommended that animals be fasted prior to surgery, to reduce the risk of vomiting while under anesthetic; as a result, pets are usually slightly dehydrated even before the procedure begins. J Vet Int Med 2017;31:1749-1756. Traditional shock doses cited are 90 mL/kg for dogs and 60 mL/kg for cats, though these numbers represent the total estimated blood volume of a patient and can lead to volume overload, especially if the patient has reasons to be less tolerant of fluid administration (heart disease, for example). every two to four hours). Conclusions and clinical relevance: Seroma formation was more common in dogs with a higher rate of fluid production relative to body weight, but was not associated with the number of days that a closed suction drain remained in situ. 1. Hypotonic fluids are not used to correct hypovolemia since it encourages free water movement out of the intravascular space and can lead to overhydration of tissues causing edema. 2012 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. © 2021 MJH Life Sciences™ and DVM 360. These are commonly used to correct electrolyte imbalances like hypernatermia and with heart failure and renal failure in patients with less tolerance for sodium load, for example. In addition, there may be some blood loss during the procedure. ACVA, Dipl. Ongoing losses (e.g., from diarrhea, vomiting, or polyuria) must be calculated and added to the total maintenance requirement obtained from these formulas. Calculation of Maintenance Fluid Requirements* Dogs: Body weight (kg) 0.75 × 132 = 24-hour fluid requirement in milliliters. J Vet Int Med 2017;31:434-441. (30cc x kg) + 70cc IV x 2. Determining a patient's degree of dehydration, The clinical signs of dehydration and their corresponding body dehydration percentages are presented below:3,4. St. Louis, Mo: Saunders Elsevier, 2012;3-26. Maintenance fluid rates Cat: Formula = 80 body weight (kg)0.75 per 24 hr Rule of thumb 2–3 mL/kg/hr Dog: Formula = 132 body weight (kg)0.75 per 24 hr Rule of thumb 2–6 mL/kg/hr Fluids for the sick patient Assess for three types of fluid disturbances. If inserting a urinary catheter is not an option, collect the urine via free catch or on a medical absorbent pad. Colloid solutions contain larger molecules that create colloid osmotic pressure that pull water toward the compartment they reside in and do not readily cross vascular barriers. Accessed Dec. 13, 2009. Copyright ©2021 Kenilworth Media Inc. All Rights Reserved. 90mL/kg IV. © 2021 MJH Life Sciences and DVM 360. Colloid solutions are also used to pull fluid into the vascular space and require a smaller volume compared to crystalloids to achieve the same effect (given there is enough interstitial and intracellular fluid to pull from). The intravascular compartment contains the fluid, mostly plasma, that is within the blood vessels. In these cases, fluids are administered as boluses at a “shock dose.”. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. • Maintenance fluid rate for an adult dog or cat is estimated as 2mL/kg/hr OR 50mL/kg/24 hours • e.g. Sponsorship Thanks to Abbott Animal Health for sponsoring tonight’s VetGirl webinar! Procedures - 12 dogs were used as a control group. Davis H, Jensen T, Johnson A, et al. If you did not know this formula, or if you forget, just convert it using what you know. Shock dose rate of 60-90 ml/kg or 35-45l per 500kg horse in first hour, therefore can only be done with pressure bags and pump. 10. Dogs in which drains were removed when fluid production rate was > 0.2 mL/kg/h (0.09 mL/lb/h) were significantly more likely to develop a seroma. 8. Perioperative and more specifically intraoperative fluid therapy continue to be enigmatic and controversial subjects due to varying opinions regarding the type and amount of fluid to administer, inadequate monitoring techniques and most importantly a lack of evidence defining “best practice.”. 3rd ed. Boyd CJ, Claus MA, Raisis AL. Synthetic colloids have two notable adverse effects: coagulation impairment and acute kidney injury. 2x maint. mortality rate and shortens the duration of hospitalization of dogs and cats. IV fluids maintain your pet’s hydration while undergoing surgical or dental procedures. Veterinary evidence is less conclusive with contradicting evidence,8-12 keeping the veterinary community cautious in its use. Sigrist NE, Kalin N, Dreyfus A. Having a fundamental understanding of the physiology of body fluids is key in treating patients and understanding fluid calculations. To clarify the situation, we talked to Bill Muir III, DVM, Ph.D., Dipl. The kidney may see a decrease in perfusion, and acute renal failure can result from prolonged periods of extremely low blood pressure during anesthesia. Fluid therapy is commonly used during surgical procedures for cats and dogs and is important to help maintain or improve cardiac output and improve oxygen delivery. Did you know we have GI diets for puppies and kittens? J Vet Int Med 2018;32:712-721. Fluid administration should be administered when needed; every patient must be closely monitored. Cardiac output was measured in 5 dogs, and 6 dogs received carprofen for at least 14 days. Hetastarch at doses higher than 20 mL/kg/day and tetrastarch at higher than 40 mL/kg/day is thought to have potential of causing coagulation issues.7 Additionally, synthetic colloids use in humans has evidence linking it to acute kidney injury in patients with sepsis. Shock. Few topics are as controversial as the “ideal” fluid rate during surgery. Fluid plan Resuscitation What rate to use? DiBartola SP. Using a Constant Rate Infusion (CRI) is a great modality. Yozova ID, Howard J, Adamik KN. Blood loss should be treated in a 1:1 ration with blood or a colloid. In the case of patients experiencing severe hypovolemia (relative or absolute) and resulting loss of perfusion and oxygen delivery, the urgency in fluid replacement is critical to survival. Its hyperosmolar effect is transient and is redistributed within 30 minutes. The property allows their effect to be sustained for longer than crystalloids. This becomes particularly important in sick or high-risk patients. What did you mean? DiBartola SP. Changes in volume (e.g., dehydration, blood loss, heart disease) 10 The patient's heart and respiratory rates and urine volume are monitored every 15 minutes during vascular volume resuscitation. Introduction to fluid therapy. All rights reserved. Knowledge of the types, amount and strategy in administration of fluids best helps a veterinary technician aid in the formulation of a treatment plan. Fluid requirement (ml) over 24 hours. For example, emaciated animals that have metabolized the fat from around their eyes and in their skin will have sunken eyes and decreased skin turgor caused by the loss of fat and elastin in the subcutaneous area. Sponsorship Thanks to Abbott Animal Health for sponsoring tonight’s VetGirl webinar! 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Yes, but during anesthesia these effects are more likely to be linked to changes in the rheological properties of blood than to a “volume effect.”  The nagging questions that most veterinary surgeons and anesthetists ask remain: Some of these questions remain unanswered but several are clear: The last point, timing of fluid administration, highlights a key clinical caveat: Fluid therapy should be continuously monitored. The effect of the fluids on the patient is regularly evaluated to adjust as needed. 4. What is the role of fluids to treat hypotension? Requirement per hour (ml/hr) = Requirement per day (ml/24hr) ÷ 24 Requirement per minute (ml/min) = Requirement per hour (ml/hr) ÷ 60