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tvpjournal.com | September/October 2015 | TOday'S VeTerinary PracTice canine PediaTricS: The VOmiTing PuPPy Peer reviewed 35 TREATMENT APPROACH Therapy for Hypovolemic Shock • Due to the life-threatening hypoglycemia, JP received an initial IV bolus of 0.5 g/kg dextrose (3 mL of 50% dextrose diluted in 7 mL of 0.9% saline over 1 minute). • Aggressive fluid therapy was indicated due to the extreme dehydration and hypovolemic shock (see Fluid Therapy Plan ). • A bolus of 120 mL (34 mL/kg) of warmed lactated Ringer's solution was administered over 15 minutes, followed by 33 mL/H (10 mL/kg/H) of lactated Ringer's solution with 5% dextrose and potassium chloride supplementation. • A colloid was administered in addition to the crystalloid. BG was measured every 6 H, with glucose supplementation adjusted as necessary to maintain normoglycemia. Therapy for Parvovirus & Sepsis JP was treated with symptomatic and supportive care (see Typical Supportive Therapies for Parvoviral Enteritis), including provision of warmth and zinc oxide barrier therapy to prevent moist dermatitis. Due to sepsis secondary to leukopenia, antibiotic therapy was initiated (IV initially; then PO once Fluid Therapy Plan 1. Expand intravascular volume and treat shock with IV bolus of fuids; JP received a 120-mL bolus (30 mL/kg). Volume resuscitate the patient appropriately based on clinical signs of improved: ` Pulse quality ` Heart rate ` Mentation ` General perfusion parameters. 2. Correct estimated dehydration: JP's estimated dehydration was 12%. The remaining defcit was corrected over 12 H. ` 3.5 kg (body weight) × 0.12 (dehydration) = 420 mL fuid defcit ` 420 mL (original defcit before fuid bolus) – 120-mL bolus fuid volume = 300 mL ` 300 mL (remaining defcit)/12 H = 25 mL/h 3. Provide for estimated ongoing loss: JP had frequent diarrhea and vomiting, with an estimated loss of 75 mL Q 24 H; therefore, 75 mL/24 H = 3.1 mL/h 4. Provide maintenance fuids; fuid requirements for puppies vary with age (Table 3). 6,7 For JP, fuid requirements were: ` 3.5 kg (body weight) × 80 mL Q 24 H = 280 mL Q 24 H ` 280 mL /24 H = 11.7 mL/h 5. Consider colloidal support (see Table 2): ` VetStarch (abbottanimalhealth.com): 2 mL/kg/H ` 3.5 kg (body weight) × 2 mL/kg/H = 7 mL/h Crystalloid fuid rate for the frst 12 hours—after the initial fuid bolus—was calculated by considering: Replacement (25 mL/H) + ongoing losses (3.1 mL/H) + maintenance (11.7 mL/H) = 39.8 mL/h Colloid volume was subtracted (39.8 mL/H – 7 mL/H), which equaled a crystalloid fuid rate of 33 mL/h. During the remaining period of hospitalization, and after the dehydration defcit had been replaced, fuid rate was decreased to refect only maintenance needs and ongoing losses. Table 3. Maintenance Fluid Requirements for Puppies 6,7 aGE FLUiD REQUiREMENT Neonates (0–2 weeks) 120–180 mL/kg Q 24 H Pediatric patients (3–6 weeks) 80–100 mL/kg Q 24 H Puppies (7 weeks–1 year of age) 60 mL/kg Q 24 H ` Crystalloid fluids, along with dextrose and potassium chloride supplementation as needed ` Colloidal support , such as VetStarch, hetastarch, or plasma ` a ntiemetics , such as maropitant, dolasetron, or metoclopramide ` Gastric protectants, such as famotidine or pantoprazole ` Parenteral antibiotic therapy while hospitalized (eg, ampicillin/sulbactam, cefoxitin) ` antidiarrheals, such as probiotics or metronidazole ` a nalgesics, such as buprenorphine and lidocaine ` Nutritional support , such as nasogastric tube feeding (if oral feeding refused) or mirtazapine Typical Supportive Therapies for Parvoviral Enteritis