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Fluid therapy in the critical (feline) patient

Introduction & cats

Tove Hultman, DVM

ECVECC Resident

Evidensia Södra Djursjukhuset

Massey University

Fluid in the body

- 60 % of BW is water

- Younger -> higher need

- Fat: 10% water

- Muscle: 75% water

Dogs: 80-90 ml/kg

Cats: 60 ml/kg

Loss of 15% body water is often fatal

Extracellular

Intracellular

1/3

Interstitiellt

2/3

IV

Feline triad of shock

Anemia -> Hb -> NO -> Vasodilation -> arterial underfilling -> RAAS -> volume overload

Cats and volume overload

50-60 ml/kg

Hypothermia -> norepinephrine low affinity for adrenergic receptors -> vasodilation ->rewarming -> vasoconstriction

Anemia -> Hb -> NO -> Vasodilation -> arterial underfilling -> RAAS -> volume overload

Cats and volume overload

50-60 ml/kg

Hypothermia -> norepinephrine low affinity for adrenergic receptors -> vasodilation ->rewarming -> vasoconstriction

Anemia -> Hb -> NO -> Vasodilation -> arterial underfilling -> RAAS -> volume overload

Cats and volume overload

50-60 ml/kg

Hypothermia -> norepinephrine low affinity for adrenergic receptors -> vasodilation ->rewarming -> vasoconstriction

Things to ask yourself

Prescribing fluids

  • Volume status?
  • Fluid responsiveness?
  • How quick?
  • How much?
  • What type of fluid?
  • When should we stop?

Colloids

Crystalloids

Types of fluids

Isotonic

Isotonic crystalloids - "replacement fluids"

Can be used for boluses & replacement.

LRS

Plasmalyte

NaCl 0.9%

  • Buffer: Acetate + Gluconate
  • Na: 140 mEq/l
  • Cl: 98 mEq/l
  • K: 5 mEq/l
  • Mg: 3 mEq/l
  • Ca: 0 mEq/l

  • DKA
  • Hypercalcemia

  • Buffer: Lactate (uses H+ when metabolised)
  • Na: 130 mEq/l
  • Cl: 109 mEq/l
  • K: 4 mEq/l
  • Ca: 2.7 mEq/l

  • Replacing losses
  • Maintenance

  • No buffer
  • High in cloride
  • hypercloremic metabolic acidosis
  • Na: 154 mEq/l
  • Cl: 154 mEq/l

  • Pyloric outflow obstruction
  • Addison
  • Hypercalcemia

Hypotonic

Hypotonic fluids

Never for boluses! Will cause cellular swelling and edema.

  • Osmolarity much lower
  • "Maintenance fluids"
  • Lower osmolality than plasma

D5W

0.45% NaCl

Dextrose 5% in sterile water

Na: 77 mEq/l

Cl: 77 mEq/l

  • For pure maintenance
  • To treat hypernatreamia

Hypertonic NaCl

  • Much higher osmolarity
  • Will drag fluid into the IV space
  • Will redistribute -> isotonic to follow

Hypertonic

  • Increase preload
  • Improve cardiac output
  • Inotropic effect
  • Immune modulatory effect (works with neutrophils)
  • Intracanial hypertension
  • Low volume resuscitation

Typical dose 3-5 mL/kg over 10-15 min

Hydroxythylated starch

  • Larger molecules -> will pull water into IV space
  • If used, usually for hypovolemia or low albumine to increase COP

Side effects

- Coagulopathy (increase in APTT)

- Humans: AKI & Direct renal toxicity

What about syntetic colloids?

Natural colloids

  • FFP
  • pRBC
  • Whole blood
  • Albumine

Natrual colloids

Rehydration

  • If cardiovascular stable -> correct fludis over 6-24 hours
  • Isotonic replacement fluids
  • Calculate the deficit, maintenance needs and ongiong losses
  • If unstable -> shock therapy

Rehydration vs resuscitation

BW (kg) x percentage dehydration = deficit (L)

Shock fluid therapy

Shock therapy

  • Isotonic crystalloids
  • Preferebly not 0.9% NaCl
  • Dose:

Dogs: 10 - 20 ml/kg over 10-20 minutes

Cats: 5-10 ml/kg over 5-10 min

Perfusion parameters

Perfusion parameters

  • Mentation
  • Mucus membranes
  • CRT
  • Temperature
  • Pulse quality
  • Heart rate

Shock & suspected TBI

TBI & shock

  • Resuscitate with a hyperosmolar fluid
  • Either hypertonic saline (or 0.9% NaCl)

Hypertonic saline

Hypertonic saline

- Will pull water into the IV space

- Increases cardiac contractility

- Mild peripherial vasodilation

- Decrease in intracranial pressure

- Might help decrease endothelial swelling and inflammation

Hypotensive resuscitation

Ongoing hemorrhage?

Goal

MAP: 60-65 mmHg

Doppler/systolic: 85-90mmHg

Until bleeding under control

Volume overload

Volume overload

Volume overload

Daily fluid plan

Daily fluid plan

Dehydration

BW x % dehydration x 1000 (ml)

Mainteinance

BW^0.75x70 (for 24 hrs)

Ongion losses

Estimation depending on severity

Volume assessment

POCUS in cats

POCUS for volume assessment in cats

Title

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