Fluid therapy

Question 1

What is hartmanns solution ?

Answer 1

crystalloid - isotonic

Question 2

Name some isotonic crystalloids .

Answer 2

hartmanns
sodium chloride ( saline )

Question 3

TRUE/FALSE hartmanns is alkalinising and saline ( sodium chloride ) acidifying .

Answer 3

true

Question 4

TRUE/FALSE hypertonic saline is used in hypovolemic LA

Answer 4

true

Question 5

Approach to hypovolaemic patient

Answer 5

10-15ml/kg for dog,cow,sheep,horses
5-10ml/kg for cat
-over 10-15 min up to 3 x

• consider hypertonic saline for LA - 3ml/kg over 10 min

if doesn’t work - reconsider cause ( non-fluid responsive indicates poor vascular tone - sepsis) – could be distributive shock

Question 6

How to treat distributive shock?

Answer 6

-vasopressors - nor adrenaline
-oncotic support - plasma 20ml/kg over 4 hours or maintenance 1-2ml/kg/hr , feed protein

Question 7

How do we know when to stop fluid resuscitation ?

Answer 7

-improved perfusion
-mentation/TPMR improving
-blood pressure more than 60
-lactate improving less than 2 mmol/l within 6 hours
-POCUS

Question 8

TRUE/FALSE if patient both hypovolaemic and dehydrated - correct hypovolaemia first

Answer 8

true

Question 9

Approach to dehydrated patient

Answer 9

-calculate deficit using tables or prev healthy weight - either weight loss = amount lost L or e.g 5% deficit in 20 kg =1L

Question 10

What is the aim of fluid therapy ?

Answer 10

replace deficit over 24 hours

Question 11

What is the rate of transfusion equal to when correcting dehydration ?

Answer 11

rate = deficit + maintenance + ongoing losses

maintenance varies = (30x BW + 70 ) ml/day or 1.5-4ml/kg/hr
ongoing losses - either monitor precisely ( urine , faeces ) or monitor weight

Question 12

What is the risk of fluid overload and how can we stop this ?

Answer 12

• if over deficit or vessels leaking ( can’t retain fluid )
• cause interstitial odema - increases space between blood and tissues - perfusion poor
  -pulmonary odema lungs
  -acute kidney injury

-basic monitoring - weigth , resp rate and effort , auscultation , POCUS , check peripheral odema ( squeeze paws )
-ins and outs table