Fluid Therapy

Question 1

In a balanced fluid, which is higher: sodium or chloride?

Answer 1

Sodium
- if sodium and chloride are equal this is an unbalanced fluid

Question 2

What does a replacement fluid look more like in terms of the electrolytes: extracellular or intracellular fluid?

Answer 2

Extracellular- will be high in sodium and low in potassium

Question 3

When should you give a bolus of fluids?

Answer 3

When a patient is in hypovolemic shock
-dont bolus if you dont need to- can cause vascular damage

Question 4

Over what time period should you rehydrate a patient?

Answer 4

Over 12-24 hours- but can change based on clinic schedule etc
- should give faster if patient has renal injury/azotemia (especially if there is a prerenal component)
- push fluids slower if patient has heart disease (so you can stop easier and not overload the heart)

Question 5

What is the recommended maintenance rate?

Answer 5

-adults: 30-60 mL/kg/day (smaller dogs go towards lower end, larger dogs go towards upper end)
-neonates: 80-120 mL/kg/day

Question 6

What is the most important aspect of any fluid plan?

Answer 6

Continual monitoring and reassessment, so you can adjust or stop the fluids if needed

Question 7

What are some complications associated with fluid therapy?

Answer 7

-electrolyte imbalances
-fluid overload (pitting or organ edema)
-iatrogenic congestive heart failure
-phlebitis
-extra cost
-prolonged hospitalization

Question 8

Why is fluid overload such a concern?

Answer 8

Patient can be fluid overloaded and it can be hard to tell by looking at them
- signs of fluid overload don’t show up until very late

Question 9

What are some early/late signs of fluid overload?

Answer 9

Early: ileus, regurgitation, nausea, loss of appetite
Late: increased RR, chemosis, peripheral edema, new murmur, clear nasal discharge

Question 10

How can you use USG to monitor hydration status of patient on fluids?

Answer 10

Look for normal USG: 1.020-1.030
- if lower than this range, likely giving too much fluids

Question 11

When should IV fluid therapy be stopped?

Answer 11

When they are no longer needed
- patient can keep up with losses on their own (aka patient is eating- if eating they will be drinking as well)

Question 12

What 2 indicators tell the brain when thirst should be stimulated?

Answer 12

• osmolality (higher sodium in the blood) in early dehydration
• later on it is due to low blood pressure- stretch receptors not firing