Fluid Treatment Options

Question 1

Types of IV fluids

Answer 1

Replacement fluids
Maintenance fluids
Colloids

Question 2

Types of replacement fluids

Answer 2

Hypotonic
Isotonic
Hypertonic
Parenteral nutrition

Question 3

Hypotonic Replacement Fluids

Answer 3

5% dextrose - isotonic when given but become hypotonic quickly
□ Glucose removed from blood vessels into cell for respiration
□ Similar to giving sterile water IV
Best to avoid this

Question 4

Isotonic Replacement Fluids

Answer 4

HARTMANN’s (appropriate in most cases)
□ Has neutral pH
□ Don’t give Hartmann’s to patients with hyper/hyponatraemia
0.9% NaCl
□ Can be quite acidic
5% dextrose in 0.9% NaCl
□ Fluid from interstitial space ‘sucked’ into IV space
□ DO NOT give to dehydrated patient

Question 5

Hypertonic Replacement Fluids

Answer 5

Hypertonic saline
* DO NOT give to dehydrated patient

Question 6

Maintenance fluids

Answer 6

○ Composition more like that in cells than in plasma
○ Higher in K+ and lower in Na+
DO NOT USE AS BOLUS

Question 7

Colloid Examples

Answer 7

○ Artificial colloids
Gelatins
Dextrans
Hydroxyethyl starches
○ Natural colloids
Plasma variants
Whole blood

Question 8

When is Hartmann’s appropriate?

Answer 8

In the majority of cases

Question 9

When is should you NOT use 0.9% NaCl solution

Answer 9

Acidosis

Question 10

What should you give in hypochloramia metabolic alkalosis?

Answer 10

0.9% NaCl

Question 11

When is Hartmann’s NOT appropriate

Answer 11

Hyper/hypo-natremia

Question 12

Benefits of hypertonic saline

Answer 12

Useful if have limited time period for resuscitation
Physiological benefits
Immune-modulatory effects
Useful in trauma/septic shock
May be useful in traumatic brain injury

Question 13

Physiological effects of hypertonic saline

Answer 13

○ Vasodilation
Arteriolar vasodilation
Improved microcirculatory perfusion
○ Cardiac contractility
Positive inotropic effect
Volume expansion and decreased afterload

Question 14

Immuno-modulatory effects of hypertonic saline

Answer 14

○ Increases in cell mediated immune function
○ Reduced anti-inflammatory cytokine production
○ Inhibition of neutrophil action
○ Altered pulmonary macrophage activity

Question 15

Adverse effects of hypertonic saline

Answer 15

• Hypernatremia - rare in recommended doses
  ○ Causes neurological signs:
  Tremors
  Altered mentation
  seizures
• Overly fast administration can cause:
  ○ Bradycardia
  ○ Hypotension
  ○ Bronchoconstriction
  Inappropriate in dehydrated patients

Question 16

Entral fluids

Answer 16

• Reliant on some GI motility and GI perfusion
  ○ GI perfusion is often one of the first things to shut down in hypovolemic animal
• Only useful in patients with NO GI obstructions
  ○ OR
• Fluid deficit of <5%

Question 17

Types of Entral fluids with examples

Answer 17

• Hypotonic
  ○ Fluid is going to get absorbed into body
  ○ E.g. water
• Isotonic
  ○ Fluid is going to stay within GIT
  ○ Useful if managing pelvic flexure impactions in horses
  ○ E.g. balance electrolyte solution
• Hypertonic
  ○ Draws water into GIT from body
  ○ Risk of dehydrating patient
  ○ E.g. magnesium sulphate

Question 18

Fluids per rectum

Answer 18

• Useful in animals when you can’t obtain or maintain IV access
• Use in conjunction with IV to reduce therapy costs
  ○ E.g. anterior enteritis
• Useful in dysphagic animals (can’t swallow)
• Electrolytes are not well absorbed via rectum
  ○ JUST WATER is the best option for this route of administration