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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice cO n S ider Thi S c a S e Peer r eviewed 95 fluids at a rate of 125 mL/ h : 20 kg (body weight) × 0.05 (dehydration) = 1000 mL fluid deficit 1000 mL (deficit)/8 H = 125 mL/H 2. Maintenance fluids: Lucky also needed to concurrently receive maintenance fluids at a rate of 42 mL/ h : 20 kg (body weight) × 50 mL Q 24 H = 1000 mL Q 24 H 1000 mL /24 H = 42 mL/H More information on the dosage of 50 mL Q 24 h can be found at aaha.org/ public_documents/professional/guidelines/ fluidtherapy_guidlines_toolkit.pdf. 3. Ongoing losses: Ongoing losses (eg, vomiting, urinary losses) were estimated at 30 mL/H. 4. Crystalloid fluid therapy: c rystalloid fluid rate for the first 8 hours—after the initial fluid bolus—was calculated: Replacement (125 mL/H) + maintenance (42 mL/H) + ongoing losses (30 mL/H) = approximately 200 mL/H Once the dehydration deficit had been replaced, the fluid rate was adjusted to reflect maintenance and ongoing losses. Based on blood glucose monitoring results, glucose supplementation (2.5%–5% dextrose supplementation) was adjusted to maintain normoglycemia. Patient Monitoring r eassessment of perfusion parameters showed improvement after the initial crystalloid and dextrose bolus, and Lucky was carefully and frequently assessed while receiving fluid therapy (Table 3). Blood glucose was measured Q 8 h in order to guide glucose supplementation. ADDITIONAL DIAGNOSTICS While the patient was stabilized, further diagnostics were pursued, including a complete blood count ( c B c ), serum biochemical profile, urinalysis (Table 4, page 96), and baseline and resting cortisol levels. c B c results revealed: • e osinophilia and lymphocytosis: May be due to glucocorticoid deficiency (eg, lack of a stress leukogram) 1 • Mild anemia: i n the face of dehydration, may be due to gastrointestinal bleeding or anemia of chronic disease. Biochemistry revealed: • h ypoglycemia: r arely seen in adult dogs secondary to anorexia; may be due to glucocorticoid deficiency, Figure 2. The effects of potassium and calcium on the action potential. Reprinted with permission from DiBartola SP (ed). Disorders of potassium. Fluid Therapy in Small Animal Practice, 2nd ed. Philadelphia: WB Saunders, 2000. Table 3. d aily m onitoring r ecommended for Patients with Hypoadrenocorticism t HE ra P y F r EQUE ncy (dependent on severity of clinical signs) Physical examination, including: Abdominal pain Capillary refill time a Heart rate and respiratory rate Lung auscultation Mentation a Mucous membrane color a Pulse quality Temperature Urine output Q 4–6 H b m onitoring, including: Blood glucose Electrolytes Packed cell volume Total solids Q 6–8 H b Blood pressure measurement a Q 6–8 H b E cg monitoring Continuous for 6–12 H, until the patient is stabilized, electrolytes are improved, and arrhythmias resolve a. Perfusion parameters include blood pressure measurement, capillary refill time, improved mentation, and mucous membrane color. b. In some very critical or dynamic patients, these parameters may need to be monitored more frequently, even Q 1 H.