Today's Veterinary Practice

MAR-APR 2018

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57 MARCH/APRIL 2018 ● TVPJOURNAL.COM FEATURES accompany these changes. If cage-side ultrasonography is available, serial monitoring of left atrial size can be extremely useful in identifying pending fluid overload before the onset of clinical signs. In addition, electrolytes such as sodium, potassium, and chloride should be checked at least once daily in stable patients, and more frequently if indicated by patient stability or electrolyte fluctuations. If available, point-of-care panels that include electrolytes and acid– base status are useful because acid–base abnormalities are frequently concurrent with other abnormalities and electrolyte disorders that require fluid therapy. DISCONTINUING FLUIDS Determination of when to discontinue fluids is based on the patient's individual needs. Patients that begin eating and drinking can have their fluids tapered, which involves a gradual decrease of hourly fluid rate over 24 to 48 hours to ensure that they can maintain hydration without further intervention. Patients that receive high rates of IV fluids may experience renal medullary washout, which impairs urine concentrating ability for several days after fluids are discontinued, so abrupt discontinuation is not recommended. 7 Medullary washout is of greatest concern in patients that are undergoing postobstructive diuresis or are receiving high rates of IV fluids for other reasons (eg, conversion of anuria to polyuria). The duration of a fluid taper in these patients may last between 2 and 5 days. Once the decision has been made to taper IV fluids, the fluid rate can be decreased by 10% to 20%. The patient's weight and hydration status should be monitored carefully to ensure the patient can compensate for this reduction in fluid rate. If the reduction is tolerated, the fluids can be decreased by an additional 10% to 20% in 6 to 12 hours, then continue to be similarly decreased every 6 to 12 hours until they are discontinued. In patients that are not drinking enough to compensate for fluid losses, IV fluids may need to be transitioned to enteral water via a feeding tube or SC fluids, depending on the primary disease process. References 1. DiBartola SP. Disorders of sodium and water: hypernatremia and hyponatremia. In: DiBartola SP, ed. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. 3 rd ed. St Louis, MO: Elsevier; 2006:47-79. 2. Burkitt Creedon JM. Sodium disorders. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2 nd ed. St. Louis. MO: Elsevier; 2015:263-268. 3. DiBartola SP, de Morais HA. Disorders of potassium: hypokalemia and hyperkalemia. In: DiBartola SP, ed. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. 3 rd ed. St Louis, MO: Elsevier; 2006:91-121. 4. Greene RW, Scott RC. Lower urinary tract disease. In: Ettinger SJ, ed. Textbook of Veterinary Internal Medicine. Philadelphia: WB Saunders; 1975: 1572. 5. Hughes D, Boag A. Fluid therapy with macromolecular plasma volume expanders. In: DiBartola SP, ed. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice. 3 rd ed. St Louis, MO: Elsevier; 2006:647-664. 6. Woodcock TE, Woodcock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesthes 2012;108(3):384-394. 7. Silverstein DC, Santoro-Beer K. Daily intravenous fluid therapy. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2 nd ed. St. Louis. MO: Elsevier; 2015:316-320. Bridget M. Lyons Bridget M. Lyons, VMD, is a resident in emergency and critical care at the University of Pennsylvania. She graduated from the University of Pennsylvania School of Veterinary Medicine and completed a small animal rotating internship at the Animal Medical Center. Her research interests include sepsis and the role of the microbiome in critical illness. Lori S. Waddell Lori S. Waddell, DVM, DACVECC, is clinical professor of critical care medicine at the University of Pennsylvania, working in the intensive care unit. She graduated from Cornell University's College of Veterinary Medicine and completed an internship at Angell Memorial Animal Hospital in Boston, Massachusetts. After her internship, she briefly worked as an emergency clinician in private practice before completing a residency in emergency and critical care at the University of Pennsylvania's Veterinary Hospital. Her current areas of interest include fluid therapy, acid–base disturbances, and coagulation in critically ill patients. Patients that begin eating and drinking can have their fluids tapered, which involves a gradual decrease of hourly fluid rate over 24 to 48 hours to ensure that they can maintain hydration without further intervention. Patients that receive high rates of IV fluids may experience renal medullary washout, which impairs urine concentrating ability for several days after fluids are discontinued, so abrupt discontinuation is not recommended.

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