QUARTERLY BEAT / DECEMBER 2024
QUARTERLY BEAT / DECEMBER 2024
Patients who are at an increased risk for fluid overload need to be monitored extremely closely while on IV fluid therapy, and rates adjusted accordingly. Remember to take into account volumes from IV medications (including CRIs), IV flushes, enteral fluids and liquid diets, subcutaneous fluids, etc. as these will also provide fluid volume to the patient. MONITORING AND ADJUSTMENTS It is imperative to monitor patients regularly while on IV fluid therapy, especially patients on high fluid rates and/or patients with comorbidities such as cardiac or renal disease. Key parameters to monitor include: mentation, temperature, heart rate, respiratory rate, mucous membrane palpation and color, capillary refill time, skin turgor, blood pressure, electrolytes, acid-base balance, urine specific gravity, creatinine, blood urea nitrogen, packed cell volume/total protein, fluid ins and outs, and body weight. Clinical signs that a patient may be experiencing fluid overload include: polyuria (in the absence of renal impairment or diuretic administration), gaining unintended weight, edema (e.g., subcutaneous, pulmonary), shivering, restlessness, pulmonary crackles, tachypnea, cough, labored breathing, chemosis, or clear nasal discharge. Fluid overload is life-threatening! CONCLUSION The key to quality IV fluid therapy and achieving the best possible outcomes is to tailor IV fluid therapy to the individual patient’s needs by obtaining a good patient history, performing a thorough physical exam, performing diagnostics, careful calculations, frequent monitoring, and ongoing adjustments as indicated to help avoid adverse effects such as electrolyte derangements or fluid overload. It is imperative to take into account a patient’s individual circumstances and not to rely on the numbers alone.
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Figure 4. The Medical Math Practice Problem is an excerpt from: de Kock, Danelia. Chapter 11. Medical Mathematics for Veterinary Professionals + tables. VetpocketTM 2020, page 239.
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REFERENCES
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1. Pardo M, Spencer E, Odunayo A, et al. 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2024 Jul 1:60(4):131-163. 2. Davis H, Jensen T, Johnson A, et al. 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats . J Am Anim Hosp Assoc 2013 May-Jun;49(3):149-59. 3. Langston C, Gordon D. Effects of IV Fluids in Dogs and Cats with Kidney Failure . Front Vet Sci 2021;8:659960. Published 2021 Apr 20. 4. de Kock D. Medical Mathematics for Veterinary Professionals + tables. VetpocketTM 2020. 5. Please note that the opinions in this blog are expressed by the speaker and not directly endorsed by VETgirl.
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ABBREVIATIONS
AAHA: American Animal
IV: intravenous kg: kilogram L: liter lb: pound
Hospital Association
BWkg: body weight in kilogram CRI: Constant rate infusion
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