1. Fluid Therapy in Dogs and Cats
CtVT 9th Edition pages
DRG 3rd Edition pages

2. Objectives
Develop familiarity with fluid therapy routes and delivery systems.
Discuss the different types of fluids available.
Explain how to determine and monitor patient hydration status.
Calculate and maintain a fluid infusion rate and drip rate.
Administer subcutaneous fluids to dogs and cats.

3. Where is Bodily Fluid Found?
Animals are made up of about ________ water
_____ of TBW is ICF
_____ of TBW is ECF
The _______________ is the primary barrier between ICF & ECF
ECF is found in two main locations:
1._____________ – main component found between cells/tissue spaces
2. ________________ - ____________ inside of the vein
The primary barrier between ISF & IVF is vascular endothelium

4. Indications for Fluid Therapy
Maintaining fluid __________
Replacing a fluid _______ &/or __________ losses
Correcting ____________ &/or __________ disorders
______________ patients
Treating _____________
decreased blood volume; specifically in volume of blood pressure.
Increasing __________ pressure
pressure in the blood exerted by proteins (albumin)

5. Routes of Fluid Administration
Subcutaneous
Absorption of fluid over _________
Why choose SC?
Correct or prevent ________ dehydration
Correct ____________ dehydration in patients that can not be hospitalized
Repeated fluid therapy for disease processes such as ________ disease in cats.
This can be done at home!
Example:

6. Routes of Fluid Administration
Subcutaneous
Fluid osmolality should match the ECF
Fluid type: _____________________
have the same ____________ pressure as the fluid in our cells/body
Caution: fluids containing ______________________ should never be given SQ due to pain and tissue damage such as

7. Routes of Fluid Administration
Subcutaneous
Fluid ______________ is given in any area with ample subcutaneous space typically between the scapulas
Avoid ________ an _________ areas
Technique is the same as for a SQ injection
Large volumes should be delivered in multiple locations
Possible complication:

8. Routes of Fluid Administration
Subcutaneous
___________ amount is the amount given from the fluid bag using a fluid administration set. Typically when administering SQ fluids to a _____.
Gather supplies:
Fluid ________
Fluid __________________ - choose _________ available
________ (large gauge)

9. Routes of Fluid Administration
Subcutaneous
____________ amount refers to a specific or exact amount given using a syringe.
Typically when administering SQ fluids to a ______
Gather Supplies
Fluid bag
Appropriate size ________
Needle

10. Fluid Administration Set

12. Routes of Fluid Administration
Intravenous
_______ administration of fluids with a quick effect
Patients requiring ________ attention
Exp. ____________, IV fluids increase intravascular fluid volume
Why choose IV?
Maintenance fluids in hospitalized patients
Fluid resuscitation/treating _________________
Maintaining BP in ___________________ patients
Correcting moderate to severe dehydration

13. Routes of Fluid Administration
Intravenous
All fluid types can be given IV
Usually given through an IVC using either a:
_______________ system
With or without a ____________
_________ pump

14. Intravenous Fluid Administration
Gravity-fed system
Fluid rate is manually adjusted using the _______ ________
Unit is ___________
Examples:
For high fluid rates, the line can be completely open and a _________________ is used
Beware: patient positioning can effect the flow of fluid!
Burette: safety device to prevent ________________in tiny patients
Placed in ____________ the fluid ____ and fluid ___________

15. Spike on fluid admin. set
Fluid bag
Spike on fluid admin. set
Injection port
_____________:
You can see the drops while manually setting fluid drip rates here!

16. Fluid Administration Sets
It is important to choose the correct fluid admin. set for your patient.
This is based on ___________:
___________ = micro drip set
___________ = macro drip set
Unit is _____________
Micro sets available:
Macro sets available:

17. Fluid Delivery Systems
Pump
A machine that _____________ delivers fluid over a set period of time.
Unit is ________________
mL/hr aka _______________

18. Fluid Delivery Systems
Pump
Used to administer ________ small amounts of fluid/medications over time
Example:
_____________ (________________ used to ______ fluid build up and pressure) a medication given over a period of time (20 to 30 min) if given too rapidly can cause CHF, tachycardia, severe vomiting etc.

19. Fluid Pump Info VTBI: Infusion Rate: VI:
_____________________– the ______ ___________ of fluids the __________ is to _________ over a designated amount of time (usually 24 hours).
____________________ the VTBI in the pump to keep the bag from completely emptying.
Infusion Rate:
How many ___________ to be infused each ____ to reach the VTBI.
________ ÷ ________ of infusion (hrs) = mL/hr infusion rate
Exp:
VI:
____________ – the amount that has been infused during a period of time that leads up to the VTBI
Always _______ the VI before pump use.

20. Fluid Pumps Benefits: Disadvantages: Administer a precise amount
Alarms when:
There are _____________ in the line
There is ________ in the line
The set fluid amount runs out
Disadvantages:
Must be _________ or _________
Does not always catch errors!

21. Routes of Fluid Administration
Intraosseous
Same principles as IV route
Large volumes/fluids given over time require IO catheter placement
Indications:
Patient with ______________
Examples:
veins are thrombosed & severe hypovolemia
wounds/burns/fractures & edema
obesity

22. IO Catheters Locations: Locally ____________ site first
Use aseptic technique and sterile gloves
________ needle, _______ needle or ___________ needle
Confirm placement with ______________ or __________
Suture in place
________________ hours max; or gain IV access
Potential complication: ______________

23. Fluid Administration Tips
Date ______ fluid bags the day they are opened
_________ the ____________ or ____ your ____ before removing the line from the patient.
_____________ the _______ of the fluid you gave and the ____________ given.
For IV fluids, chart the _______ rate (or ____ rate) too

24. Types of Fluid
1. Solutions that contain electrolytes in water and are characterized based on their ______________.
If given IV, will freely distribute ______ to the interstitial space within about an hour.
But, not ______ cells because ___________ cannot move freely across cell membranes.
They require _______ via active transport to move across a cell membrane
These fluids are called ________________
3 types: _______________, _______________, _____________
Classified as either Saline or __________ ____________ ___________.
have ______________ effects due to bicarbonate precursors (give to patients with severe ____________)

25. Types of Fluid
2. Solutions that contain ____________________________ suspended in crystalloid solution
When given IV, will remain in the _________________ space.
These are called _____________
2 types:
____________ - exp. plasma or albumin solutions
_____________ - hydroxyethyl starch (HES) or hetastarch

26. Isotonic Crystalloids
Osmolality is ___________ to blood osmolality
Provide _______ in equal proportion to electrolytes
Most ___________ used type of fluids!
_______________ and/or _____________ for ongoing losses
Daily maintenance
________________ (not always best choice)
Correct acid-base imbalances

27. Isotonic Crystalloids
Rare to choose saline- only for metabolic alkalosis/high alkalinity (exp. For saline use hypochloremia/low chloride due to vomiting)
BES/ balanced electrolyte solution - good for acidemia A
BES/ balanced electrolyte solution - good for ______________

28. Isotonic Crystalloids
0.9% Sodium Chloride or Saline
_______ to choose normal saline - only for metabolic ________________/high alkalinity
Exp. for normal saline use is ________________/low chloride due to vomiting
Rare to choose saline- only for metabolic alkalosis/high alkalinity (exp. For saline use hypochloremia/low chloride due to vomiting)
BES/ balanced electrolyte solution - good for acidemia

29. Hypotonic Crystalloids
Osmolality is _________ than blood osmolality
Provide ___________ than electrolytes
Indications:
Correct a free water _____
Rehydration or maintenance fluids in specific patients
_____________ – patients have decreased tolerance for sodium; is used to replace deficits or maintain hydration in these patients
___________ can cause a free water deficit, loss of water through the tissue replaces the water lost
Contraindications:
Rehydration or maintenance fluids in any other patient
___________ is the increase in intravascular fluid (increasing blood pressure and volume)

30. Hypotonic Crystalloids
_______% Saline (NaCl)
BES: Normasol-M & Plasma-Lyte 56
Sometimes combined with _________

31. Hypertonic Crystalloids
Osmolality is _________ than blood osmolality
Provide more __________ than water
High amount of ___________ & ____________
Promotes an increase in _______________ volume
Indications:
Resuscitation
______________ brain injuries/head trauma
_______________________- draws fluid from the cerebral interstitium (space between tissue)
Can cause reflex _____________ (decrease in heartrate)

32. Hypertonic Crystalloids
> 0.9 % Saline
Examples: __% Saline & __% Saline
Dose is very low compared to other crystalloids
Should be given ___________!

33. Fluid Additives Potassium (K) Vitamin B Complex
Expressed in ________________ (mEq) not mg
Added to treat _______________
Normal potassium =
Exp. KCl 2 mEq/mL
GI and urinary losses ___________ K
MAX dose = _____ mEq/kg/hr
Vitamin B Complex
Give to help energy metabolism in anorexic patients

34. Fluid Additives Dextrose Added to treat ___________
Seen in neonates, starvation, insulin overdose, insulinoma (pancreatic tumor produces excess insulin) & pregnancy
Normal blood glucose = ___________
Ex. 50% dextrose
>2.5% dextrose must go _______
>5% dextrose should be given through a _____________
Hypertonic and can cause _____________

35. Fluid Additives: Dextrose
If I want to add 50% dextrose to a 1000 mL bag and make a 2.5% dextrose & LRS solution, how much stock solution should I add?
Formula
__________________(DC) % x ___________ mL (DV) ÷ ____________________(SC)% of dextrose = ___mL to be added to fluids
Put it together
___% DC x _____ mL DV ÷ ___% SC = ___ mL to add to fluid bag

36. Fluid Additives Sodium Bicarbonate
Added to fluids to correct metabolic ____________
___________ = metabolic acidosis
To correct ____________ imbalance (DKA, renal failure)
Given when pH is less than 7.1 in extreme cases
Normal blood pH =
Best with only ______ due to BES having bicarbonate precursors
Added to fluids to correct severe ______________
Normal blood potassium levels =
Given when _____ is >10 mEq/L

37. Fluid Tips Warm fluids before/during administration
Label bags appropriately
Protect from light?
Check expiration dates!

38. Daily Maintenance Fluids
Provided for _____________ animals that can not/will not drink enough water on their own to maintain __________.
Calculated to make up for water lost through:
Used when:
Dehydration has been corrected
Ongoing losses are no longer occurring
Fluid choice: ____________ _____________

39. Daily Maintenance Fluid Protocol
This is read as: in a __ hour period, we should give _____ milliliters of fluid for every kilogram of body weight
For each patient, be able to calculate:
Total amount needed for _____ hour period
Amount of fluid needed every _______

40. Daily Maintenance Fluids
Total amount needed in 24 hour period
Multiply the patient’s weight by the given fluid dose
Unless otherwise stated:
For cats, use the ___ end
For dogs, use the ___ end
Ensure _______ units are the same as the ______ units
40 lb dog

41. Daily Maintenance Fluids
Infusion Rate (total amount needed every hour in mL)
Divide the total fluid needed (mL) by 24 hours
40 lb dog
40 lb / 2.2 lb/kg = kg
18.18 kg x 60 mL/kg/24 hr = 1,091 mL/24 hours

42. Daily Maintenance Fluids
Practice Problem:

43. Replacement Fluid Therapy
Provided for animals that are ____________
Dehydration = loss of __________________________
Patient may or may not have _________________ as well
Ongoing losses tend to be __________ losses i.e.
Quantify water losses
While normal urine loss _____________ is accounted for in the maintenance fluid rate, abnormal losses such as ________ must be accounted for.
A common method of quantification is weighing absorbable pads; _________________________

44. Replacement Fluid Therapy
How would dehydration effect PCV and total protein?
PCV & TP _________
The amount of ____________ to the ________ in whole blood gradually _________
Time period for rehydration is set by the ___________
Fluid choice: ___________________ for isotonic losses

45. Assessing Dehydration
Physical Exam Findings
_______ or ______ MM - ___ clinical sign seen
How can respiratory rate affect mucous membranes?
_________ causes MM to appear dry and tacky
________ skin turgor
How does BCS affect skin turgor?
_________ patients skin is _______ and tends to snap back quicker
Enophthalmos
____________________of the __________ due to loss of fluid volume in the surrounding tissues (sunken in orbit)

46. Assessing Dehydration
Dehydration __% is __________ in dogs and cats
5-8% = _____ dehydration
Delayed skin turgor; twist disappears _____
MM tacky/dry
Eyes _____ and sunken
8-10% = __________ dehydration
Eyes dull and sunken
__________ tissue perfusion: causes the heart to beat _______ to try to perfuse the tissue, _______ perfusion leads to ______ MM

47. Assessing Dehydration
Delayed skin turgor; twist _______
MM dry, possibly ________
Eyes dull, dry and ________ sunken
Decreased tissue perfusion: increased HR, pale MM, ____________ CRT, _______ pulse
12-15%
Patient is in shock; ________ may soon follow

48. Replacement Fluid Rate Formula:
Rehydration Protocol
Replacement Fluid Rate Formula:
First, determine the contribution of ____________
Second, determine _______________ by quantifying or estimating fluid losses over a period time increasing the fluid rate accordingly
Distinguish between ___________ urine loss and _____________ urine loss
Appropriate urine loss is 1-2 mL/kg/hr x 1-24 hours
Inappropriate urine loss is anything is excess of appropriate in that time period and will be added to the total ongoing losses
Lastly, determine the ____________ rate (as previously discussed)

49. Rehydration Protocol Dehydration + Ongoing losses + Maintenance
= Replacement Fluid Rate
Formula for Dehydration:
Answer is in total ____________ needed for rehydration
6% dehydration, 20 kg dog

50. Rehydration Protocol Dehydration + Ongoing losses + Maintenance
= Replacement Fluid Rate
Formula for Ongoing losses:
Ongoing losses volume is doubled, and added to the final amount of dehydration.
66 mL of diarrhea & urinated 462 mL in last 12 hours

51. Rehydration Protocol Dehydration + Ongoing losses + Maintenance
=Replacement Fluid Rate
Formula for Maintenance:
Maintenance fluids for the specified period of time is included.
DVM request IV LRS over the next 8 hours

52. Rehydration Protocol Replacement Fluid Rate Formula:
Dehydration + Ongoing losses + Maintenance
= Replacement Fluid Rate
Total volume is given over the specified period of time.
_________ amount needed for _________ in 8 hours (hours can vary, 8 hours for this example)

53. Calculating Drip Rate Find total amount needed every _________
Divide the infusion rate by 60 minutes/hour
40 lb dog
40 lb / 2.2 lb/kg = kg
18.18 kg x 60 mL/kg/24 hr = 1,091 mL/24 hours
1,091 mL/24 hours = 45.5 mL/1 hour

54. Calculating Drip Rate Find total amount needed every _________
Divide the mL/min rate by 60 seconds/minute
40 lb dog
40 lb / 2.2 lb/kg = kg
18.18 kg x 60 mL/kg/24 hr = 1,091 mL/24 hours
1,091 mL/24 hours = 45.5 mL/1 hour
45.5 mL/hr / 60 min/hr= mL/min

55. Calculating Drip Rate Drip Rate:
Multiply the amount of fluid given every second by your chosen _________.
40 lb dog
40 lb / 2.2 lb/kg = kg
18.18 kg x 60 mL/kg/24 hr = 1,091 mL/24 hours
1,091 mL/24 hours = 45.5 mL/1 hour
45.5 mL/hr / 60 min/hr= mL/min
mL/min / 60 sec/min = mL/sec

56. Calculating Drip Rate
Finding the magic number- the final answer must be a ___________ number so that we can actually count it.
Multiply gtt/sec by 2 to see if you get a whole number.
If ________, then give that amount, every 2 seconds
If ______, continue increasing your magic number until you do
Multiply the ________ gtt/sec by 3, then 4, then 5, etc.
DO NOT __________ your original gtt/sec number
The whole number you get is the number of ________.
The magic number is the number of ___________.

57. Resuscitation Fluid Therapy
Given to patients requiring an increase in _______________ fluid.
Patient examples:
Hypovolemic
Severely hypotensive
Decreased oncotic pressure
Fluid choices: _________ crystalloids, ___________ crystalloids, and _____________

58. Colloids
These fluids are made of large (high molecular weight) molecules, suspended in an isotonic crystalloid.
Natural examples:
Synthetic examples:
Brand names:
These fluids do no readily pass through the vascular endothelium, and also promote an increase in IVF.
Stay in vessels for ____ hours
Potential complications:

60. Resuscitation “Shock” Protocol
Dogs Cats
_______ crystalloids: mL/kg mL/kg
_________ crystalloids: 3-6 mL/kg mL/kg
__________: mL/kg mL/kg
Colloids - adds _______ mL of fluid for each __ mL given
Give with crystalloids to reduce negative side effects
The total dose is calculated, but only ___ is given as a _____.
Reassess patient over the next ________ minutes

61. Monitoring Patients on Fluids
Best way to monitor acute changes in total body water is by taking _______ body weights.
Using just YOU & your stethoscope:
HR, pulse quality, CRT, MM color, warmth of extremities
Respiratory rate and pattern
Monitor for edema
____________ edema from back up into the left side of the heart
Using equipment/advanced techniques:
BP, Central Venous Pressure, blood work

62. Complication from Fluid Therapy
Over-hydration/fluid overload/hypervolemia
How would this occur?
Excessive _________ given
Excessive _______ given
Patient is ________ ____________
______________ cardiac or renal function

63. Signs of Fluid Overload
Weight gain
Hypertension
Serous nasal discharge
Chemosis
__________ of the __________
Pitting edema
Dyspnea/tachypnea
Harsh lung sounds/crackles
Decreased PCV and tP from _____________
AAHA Guidelines: