Fluid therapyFluid therapy in Veterinary practice

ByBy Noura El-Shahat A.ANoura El-Shahat A.A..

Why fluid therapy is needed in Veterinary practice?

• It is an important and life saving therapy used in day to day veterinary practice.

• The purpose of fluid therapy is to:• correct dehydration• Electrolyte imbalances or metabolic

imbalances& hydrogen ion imbalance .• Energy losses.

Basics of Body FluidBasics of Body Fluid

• Water is the primary body fluid• Total body water =0.6x Bwt.Kg• Higher in neonates, lower in

eldery

Water is very much needed for vital metabolic activities such as:

• Excretion of metabolic wastes.• Transport of enzymes & ions.• Maintainance of blood volume and blood

pressure. • Thermoregulation.

**Hence water is one of the most important vital nutrient of the body.

Basics of Body FluidBasics of Body Fluid • Body water is distributed among three types of

compartments: intracellular, intravascular, and interstitial

– Intracellular fluid (ICF) = fluid within the cell (two-thirds of body water)

– Extracellular fluid (ECF) = fluid within the blood vessels and in the tissue spaces between the blood vessels and cells (one-third of body fluid)

Body 100%

Water 60% Tissues 40%

Intracellular 40%

Extra cellular 20%

Interstitial space 15%

Intravascular space 5%

Basics of Body FluidBasics of Body Fluid• To establish equilibrium, body water moves

along its concentration gradient

Extracellular fluid shifts between the intravascular space (blood vessels) and the interstitial space (tissues) to maintain a fluid balance with the ECF compartment.

Fluid exchange occurs only across the capillary walls.

Basics of Body FluidBasics of Body Fluid

• Body water contains solutes (substances that dissolve in solvent; particles).

– Primary ions in the body are sodium, potassium, chloride, phosphate, and bicarbonate

NaCl

HCo3

K & phos

Tonicity of FluidsTonicity of Fluids• Tonicity refers to the osmotic pressure of a

solution based on the number of particles per kilogram of solution (osmolality)

• An isotonic solution has the same osmotic pressure as blood and extracellular water

• A hypotonic solution has osmolality lower than that of blood.

• A hypertonic solution has osmolality higher than that of blood.

Types of fluid therapyTypes of fluid therapy• Fluid therapy in animals may involve:

Crystalloids: are diffusible substances that dissolve in solution.

Colloids: non diffusible substances

Whole blood and blood products

Crystalloids:Are group of Na based electrolyte fluids.

They enter ECF and from there equilibrate with other fluid compartments in the body to restore fluid balance.

1- Isotonic Sodium Chloride 0.9% (Saline):• This solution contain Na& Cl, no K• It is indicated in fluid and electrolyte losses,

particularly when plasma K levels are increased due to underlying disease an d additional administration of K must be avided during fluid therapy.

2- Ringer solution:Na, Cl and some KIn water and electrolyte losses when thre is also

some K deficit as vomiting.

3- Ringer lactate :Contains Na, Cl, K and lactate

4- Sodium bicarbonate 1.3, 5, 8.4%:Contain NaHCo3 and used in acidosis.

5- Dextrose saline 5%:Contain Na, Cl and glucoseUsed in water, electrolytes loss and hypoglycaemiaDextrose 5%:Small amount of glucoseNo electrolytePimary water loss& hypoglycaemia.

6- Rintose:• Rintose is a unique preparation containing balanced

electrolyte solution and dextrose

• specially recommended for diarrhoea, ketosis, dehydration and debility in animals

and as a supportive therapy.

Composition of Rintose:• Each 100ml of Rintose containsDextrose: 20gmSodium Chloride: 0.600 gmPotassium Chloride: 0.040 gmCalcium chloride: 0.027gmSodium Lactate: 0.312 gm

Composition - Similar to plasmaElectrolytes(Meq

/L)PlasmaRintose

Na140131

K45

Cl100112

Hco32428

For Cattle/Buffalo/Horses: 500-2000ml/day .

Sheep/Goat: 100-200 ml/day for 2-3 days.

Calves: 100-500ml/day for 2-3 days.

Comparison of Rintose with other infusion fluids: -Electrolytes in MEq/L

FluidNa+K+ClHco3Dextrose

Normal Saline)154(--)154(----

Dextrose-20%

Dextrose-10%

--

--

--

--

--

--

--

--

)20%(

)10%(Dextrosesaline

)154(--)154(--)5%(

Ringer Soln.)103()4()113(--Lactated Ringer)130()4()113()27(--Plasma

Rintose

)140(

)131(

)4(

)5(

)100(

)112(

)24(

)28()20%(

Oral fluid therapyOral fluid therapySuper- lyte50 -100g/1-2 L water/ calves

Vit-LyteAs super- lyte

Lectade1 sachet / Lwater/2-3 times/ daily

Deit Scour100 g/1 Lwater/2-3 times/ daily

Rehydran1 sachet/200ml/water/ times /daily

ColloidsColloidsColloids:Colloids:Are groups of fluids containing large Are groups of fluids containing large

molecules deigned to remain in the molecules deigned to remain in the intravenous space longer than intravenous space longer than crystalloid fluids.crystalloid fluids.

This means that colloids are able to This means that colloids are able to expand and maintain the vascular expand and maintain the vascular volume more effectively and are volume more effectively and are commonly termed commonly termed plasma plasma expanders.expanders.

Colloids are used in cases of Colloids are used in cases of shock where C .V . Function shock where C .V . Function needs to be improved rapidly needs to be improved rapidly as in case of:as in case of:

HaemorrhageHaemorrhageShockShockSever dehydrationSever dehydration

Types of ColloidsTypes of ColloidsNaturalNatural

PlasmaPlasmaAlbuminAlbumin

SyntheticSyntheticDextransDextransHydroxyethyl starchHydroxyethyl starchGelatinsGelatins

Clinical situations requiring Clinical situations requiring fluid therapyfluid therapy

Replace like with likeReplace like with likeBlood loss Blood loss replace deficit replace deficit

with bloodwith bloodWater loss Water loss replace deficit replace deficit

with waterwith waterWater &electrolyte Water &electrolyte replace replace

deficit with Water &electrolytedeficit with Water &electrolyte

Calculating Fluid VolumeCalculating Fluid VolumeMust consider that animals require fluids Must consider that animals require fluids

for the following:for the following:RehydrationRehydrationMaintenanceMaintenanceOngoing fluid lossOngoing fluid loss

Make sure the units of measure are the Make sure the units of measure are the same when performing these calculationssame when performing these calculations

Make sure the volumes make sense; we Make sure the volumes make sense; we don’t give 20 liters to a 4-pound catdon’t give 20 liters to a 4-pound cat

Rehydration fluid therapyRehydration fluid therapy

Rehydration fluid therapy=Rehydration fluid therapy= % of % of dehydration x Bwt.dehydration x Bwt.

Detection the degree of Detection the degree of dehydration depends up on:dehydration depends up on:

% %of of dehydratiodehydrationn

Sunken Sunken eyeeye

Skin fold Skin fold testtest

Mucous Mucous membranmembranee

4-64-6" -" -not not detecteddetected " "

Barely Barely detecteddetected

MoistMoist

6-86-8“ ++“ ++slight slight detecteddetected""

2-42-4 secsec . .MoistMoist

8-108-10++++++" " less less than than 0.5cm0.5cm””

66 - -1010 secsec . .tackytacky

10-1210-12““Coldness of Coldness of

extremitiesextremities””

" ++++" ++++0.5-10.5-1 cmcm""

20-4520-45 secsec . .DryDry

Maintenance fluid therapy=Maintenance fluid therapy= 50ml/kg50ml/kg

Ongoing fluid therapy:Ongoing fluid therapy: varies from 1-4 litres varies from 1-4 litres depending on the severity of diarrhoeadepending on the severity of diarrhoea

Amount of bicarbonate required=Amount of bicarbonate required= Bwt. x Bwt. x base deficit (mmol)x0.5 “factor”base deficit (mmol)x0.5 “factor”

Amount of bicarbonate =Amount of bicarbonate = Mmol/l

12 = gm

Base deficit determined from Base deficit determined from clinical examination:clinical examination:

Standing, strong suck reflexStanding, strong suck reflex55

Standing, weak suck reflexStanding, weak suck reflex1010

Sternal recumbencySternal recumbency1515

Lateral recumbencyLateral recumbency2020

Example 1Example 1::A calf (weighted 45 kg) is presented with A calf (weighted 45 kg) is presented with diarrhoea and sternal recumbencydiarrhoea and sternal recumbency

Clinical examination revealed thatClinical examination revealed that respiratory rate (44 beats/ min)respiratory rate (44 beats/ min)An irregular heart rate (76 beats/ min)An irregular heart rate (76 beats/ min)

Low normal rectal temperature 38.4Low normal rectal temperature 38.4Skin fold test returned after 7 secondsSkin fold test returned after 7 seconds..

Fluid therapy required for this Fluid therapy required for this calfcalf::

Rehydration fluid therapy=Rehydration fluid therapy= 8% X45= 3.6 8% X45= 3.6 LL

Ongoing losses are estimated as equal to Ongoing losses are estimated as equal to the replacement requirments=the replacement requirments= 3.6 L3.6 L

Maintenance fluids=Maintenance fluids= 50x 45=2250 ml= 50x 45=2250 ml= 2.5L 2.5L

Total fluid therapy=Total fluid therapy= 3.6+3.6+2.5=9.7 L3.6+3.6+2.5=9.7 L

Animal shows signs of acidosis “harried Animal shows signs of acidosis “harried respirator rates”respirator rates”

Amount of required Sod. Bicarbonate=Amount of required Sod. Bicarbonate= 45 x 45 x (base deficit) 15x 0.5= 337.5 mmol(base deficit) 15x 0.5= 337.5 mmol

Amount of required Sod. Bicarbonate= Amount of required Sod. Bicarbonate= 28 28 gmgm

Amount of required Sod. Bicarbonate= Amount of required Sod. Bicarbonate= 2 2 liters of sod. Bicarbonate 1.3%liters of sod. Bicarbonate 1.3%

Example 2Example 2:: An adult 14-lb cat with 3% dehydration An adult 14-lb cat with 3% dehydration

comes into the clinic. It is estimated that comes into the clinic. It is estimated that the cat vomited 100 ml of fluid overnight.the cat vomited 100 ml of fluid overnight.

Step 1:Step 1: Convert 14 lb to kg using the conversion Convert 14 lb to kg using the conversion

factor 2.2 lb = 1 kgfactor 2.2 lb = 1 kg14 lb x 2.2 lb/kg = 6.4 kg14 lb x 2.2 lb/kg = 6.4 kg

Rehydration fluid is based on the estimated Rehydration fluid is based on the estimated percent of dehydration percent of dehydration % dehydration x weight in kg =% dehydration x weight in kg = deficit in litersdeficit in liters

Step 2: Calculate replacement for Step 2: Calculate replacement for dehydrationdehydration3% = 0.033% = 0.030.03 x 6.4 kg = 0.192 l0.03 x 6.4 kg = 0.192 l0.192 l x 1,000 ml/l = 192 ml0.192 l x 1,000 ml/l = 192 ml192 ml x 0.8 (80% of dehydration value 192 ml x 0.8 (80% of dehydration value

replaced in 24 hours) = 154 ml to replace on replaced in 24 hours) = 154 ml to replace on first dayfirst day

Maintenance fluidMaintenance fluid is the volume of fluid is the volume of fluid needed daily to maintain body functionneeded daily to maintain body function

Maintenance fluids can be dosed at 50 Maintenance fluids can be dosed at 50 ml/kg/day in adults and 110 ml/kg/day in ml/kg/day in adults and 110 ml/kg/day in young animalsyoung animals

Step 3Step 3: : Calculate maintenance volumeCalculate maintenance volume6.4 kg x 50 ml/kg/day = 320 ml per day6.4 kg x 50 ml/kg/day = 320 ml per day

Ongoing fluid loss is an estimation Ongoing fluid loss is an estimation based on the additional loss of fluid based on the additional loss of fluid due to vomiting or diarrheadue to vomiting or diarrhea

Step 4:Step 4: Take estimated volume lost in Take estimated volume lost in fluid and add to the other volumesfluid and add to the other volumes

Final step:Final step: Take all values and add Take all values and add togethertogether320 ml + 192 ml + 100 ml = 320 ml + 192 ml + 100 ml = 612 ml612 ml

How and How Quickly Is It How and How Quickly Is It GivenGiven??

Rate of fluid replacement parallels Rate of fluid replacement parallels the severity of dehydration.the severity of dehydration.

Ideally, fluids are given over a 24-Ideally, fluids are given over a 24-hour period.hour period.

Fluids are stored and given by fluid Fluids are stored and given by fluid bags or bottles attached to bags or bottles attached to administration setsadministration sets

Routes of Fluid Routes of Fluid AdministrationAdministration

The route of administration of fluid therapy depends upon:

type of disease condition of the patientseverity of dehydration Type of electrolyte/Acid-base

balance.

Routes of Fluid Routes of Fluid AdministrationAdministration

Route of Route of administratioadministrationn

Advantages Advantages DisadvantageDisadvantages s

OralOralSafest routeSafest routeEasy Easy

Less rapid Less rapid absorptionabsorptionPossible Possible aspirationaspirationCannot use for Cannot use for vomiting vomiting animalsanimals

SubcutaneousSubcutaneousRelatively easy Relatively easy to administerto administerAbsorption Absorption distributed over distributed over timetime

Possible Possible infectioninfectionMust use Must use isotonic fluidsisotonic fluidsSlower Slower absorptionabsorption

Routes of Fluid Routes of Fluid AdministrationAdministration

Route of Route of administrationadministration

Advantages Advantages Disadvantages Disadvantages

IntravenousIntravenousPrecise Precise amount given amount given is available is available rapidly rapidly Various Various tonicities of tonicities of fluid can be fluid can be usedused

Possible fluid Possible fluid overload and overload and vessel damagevessel damageRequires close Requires close monitoringmonitoringMust be Must be sterilesterile

Intraperitoneal Intraperitoneal Relatively Relatively rapid rapid absorptionabsorptionCan be used Can be used when IV when IV access is not access is not availableavailable

Possible Possible infectioninfectionCannot use Cannot use hypertonic hypertonic solutionssolutions

Routes of Fluid Routes of Fluid AdministrationAdministration

Route of Route of administratioadministrationn

Advantages Advantages Disadvantages Disadvantages

Rectally Rectally Good Good absorptionabsorptionRapid Rapid absorptionabsorption

Not Not frequently frequently used used

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