Today's Veterinary Practice

MAR-APR 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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49 MARCH/APRIL 2018 ‚óŹ TVPJOURNAL.COM FEATURES Fluid Therapy in Hospitalized Patients: Electrolyte Abnormalities and Fluid Balance FLUID THERAPY: PART 2 Bridget M. Lyons, VMD Lori S. Waddell, DVM, DACVECC University of Pennsylvania Fluid therapy is an essential component of the treatment plan for many hospitalized small animal patients. The choice of type and dose of fluid to use depends on the clinical status of the patient as well as available resources. Part 1 of this article, in the January/February 2018 issue, reviewed fluid distribution in the body, assessment of hydration, types of body fluid losses, types of fluids available, and calculation of fluid needs. This article focuses on fluid therapy in select cases of electrolyte abnormalities and fluid balance states, monitoring fluid therapy, and when and how to discontinue fluids. ELECTROLYTE ABNORMALITIES Hypernatremia Sodium abnormalities are common in small animal practice. Measured serum sodium reflects the amount of sodium relative to water in the extracellular space and does not necessarily reflect total body sodium. Pathophysiology and Clinical Signs Hypernatremia may result from free water loss or sodium gain. Water loss may result from pure water loss, as seen with diabetes insipidus, elevated body temperature, primary hypodipsia, and water restriction. Alternatively, it may occur with loss of fluids that are hypotonic relative to plasma, such as with vomiting, diarrhea, third-space loss, burns, diabetes mellitus, mannitol, diuretics, kidney injury, or postobstructive diuresis. 1,2 With pure water loss, water moves down its concentration gradient from the relatively hypotonic intracellular space to the extracellular space. Consequently, there is a relatively proportional volume loss, with approximately two-thirds lost from the intracellular space and one-third lost from the extracellular space. HOLDING WATER Water loss may result from pure water loss, as seen with diabetes insipidus, elevated body temperature, primary hypodipsia, and water restriction. Alternatively, it may occur with loss of fluids that are hypotonic relative to plasma, such as with vomiting, diarrhea, third-space loss, burns, diabetes mellitus, mannitol, diuretics, kidney injury, or postobstructive diuresis. shutterstock.com/Konstantin Zaykov

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