Lect 5 - Fluid Therapy - Basics Physiology & Applied Aspects

FLUID THERAPY-
BASIC PHYSIOLOGY &

APPLIED ASPECTS
Dr Kaustubh Garud (M.V.Sc. Med)
Animal science Scientist,
Department of Veterinary Nuclear Medicine
Learning objectives
• Applied Physiology of body fluids
• body fluid distribution
• Movement of fluid across compartments
• Dehydration
• Basics in fluid therapy
• Electrolyte disturbances
• Acid base disturbances
Distribution of body water
VARIATION:
• SPECIES
• AGE
• SEX
• NUTRITIONAL STATUS
• BODY COMPOSITION
• FAT – LOWER WATER CONTENT THAN LEAN TISSUE
LEAN ADULT
• NON-HERBIVORE < 70% WATER OF BODY WT.
• HIGER IN NEWBORN ---> REDUCES AS AGE ADVANCES
• FAT TISSUE = 10% OR LESS WATER CONTENT
• CATTLE = 70% WATER OF BODY WT.

Trans-cellular compartment
( <1% BW)
• CSF
• GI fluid
• Bile
• Glandular secretions
• Respiratory secretions
• Synovial fluid
Measurement of body fluid volumes
• Drying off the animals :/ • Other compounds (extracellular Volm)
• Antipyrin
• Blood volume measurement
• Dilution techniques • Thiouria
• Obtain fluid & determine concentration
• urea
• Volume = weight of compound injected /
• Sulphonamide
concentration after distribution • Insulin
• correction for losses
• Plasma volume measurements
• Heavy water (Deutrium oxide) • Evans blue dye – adsorbs on plasma
proteins
• Radioactive water (Tritium oxide) • Radiolabelling of Erythrocytes with
phosphorus
• Erythrocyte volume determination
• Compartmental assessment  difficult!
Data Generated by Dr L.D. Cowgill
Factors affecting Body water %
• Age : Young – 70-80%
• Pregnancy & lactation – increased TBW %
• Obesity – decreased TBW %
• Accumulation in body cavities  increased TBW %
• Ascites
• Fluid effusions
Normal water balance
• Maintenance requirement: 40-
60ml/kg/day
• Water in feed/food
Healthy individuals:
• Free water intake Input = Output
• Metabolic water
• Sensible losses  Urine O/P: 27-

40ml/kg/day
Zero Balance
• Insensible losses 
Faeces,respiration,cutaneous: 13-
20ml/kg/day
Solutes
• Not homogenously distributed through all body compartments

• Vascular endothelium & cell membranes – diff permeability
• Healthy vascular endothelium – impermeable to cellular components
• Number of osmotically active particles in each space determine the volume of fluid in
ICF & ECF compartment.
CATIONS ANIONS
• Na+ • Cl-
• K+ Non – electrolytes • HCO3-
• Organic molecules
• Ca2+ (ionised) • No electric charge • HPO42-, H2PO4-
• Mg2+ (ionised) • Urea, Glucose, lipids • Proteins
• others
Effective & in-effective osmoles
Electro-neutrality & Anion Gap
Sum of all cations = sum of all anion
Na+ + K+ + UC = Cl- + HCO3-+ UA
(Na+ + K+) – (Cl- + HCO3- ) = UA – UC =

ANION GAP
Normal Anion gap in Dogs –
12-24mEq/L
Vascular compartment
(ECF)
Interstitium
(ECF)
ICF
Assessment of dehydration
• Loss of pure water----> hypotonic, isotonic and hypertonic fluid losses
• History
• Route of fluid loss --> affected compartment --> possible fluid/electrolyte and acid base
derangements. Eg: urinary, gastric losses
• Vomiting (Eg Pyloric obstruction) --> loss of hydrogen, chloride, potassium and sodium
ions --> metabolic alkalosis
• Small bowel diarrhoea --> loss of bicarb, chloride, sodium and potassium --> metabolic
acidosis
Physical Total solids &

BUN:Creatinine
exam/dehydration % hematocrit
• Is the patient suffering from shock syndrome – warranting immediate fluids?
• In the patient dehydrated.?
• Can patient consume adequate water to sustain normal fluid balance?
• What type of fluid should be given.?
• By what route.??
• How rapidly..??
• How much fluid.??
• When should therapy be discontinued.?!
What type of fluid??
• Crystalloids
• Replacement solutions
• Maintenance solutions
• Hypertonic solutions
• Dextrose in water
• Colloids
• Hb-based O2 carriers
• Intravenous nutrition
Crystalloids
• Water with Na or glucose base, with added electrolytes and buffer
• Effect on interstitial and intracellular compartment
• Replacement solutions
• Isotonic
• 20-25% of infused volm stays in vascular compartment 1 hr post administration
• Shock/haemorrhage/volume depletion/vomiting/diarrhoea/third space loss/excessive
urine loss
• Large volumes needed to replace intravascular volume deficit
Crystalloids
• Maintenance solutions
• Dissolved solutes – approximate solutes of ECF
• To fulfil electrolyte requirements of patients with normal daily electrolyte losses, those
are unable to maintain intake
• Hypotonic
• <10% of infused volume stays in vascular compartment, 1hr post administration
• 0.45% NS (Half strength), 0.45% NS + 2.5%Dextrose, Half strength RL
• Commonly supplied with potassium to balance them for patients electrolyte needs
Crystalloids
• Hypertonic solutions
• 3.5%, 7.2%, 23% NaCl
• To increase intravascular volume rapidly
• In patients who need low volume resuscitation (eg. cerebral trauma patients)
• 4-7ml/kg (dog) & 2-4ml/kg(cat) of 7% solution
@1ml/kg/min  offers similar effect of that offered by 60-70mls/kg of replacement
solution
• Dextrose in water
• Not to be used commonly – dextrose used up rapidly and water redistributes
• Can dilute electrolytes
• To treat hypernatremia
Colloids
• High molecular weight compounds
• Don’t readily leave intravascular space
• Expand i/vascular volm  hold and draw water within vasculature
• Use
• Hypovolemia  rapid volume expansion
• Surgical blood loss
• Low volume resuscitation protocols
• To improve colloidal oncotic pressure in patients with low albumin
(Plasma @50-60ml/Kg to raise Albumin by 1gm/dL)
• Hence, synthetic colloids are used.!
• 5-20ml/kg
• Hetastarch 6%, dextran, Hemacoel etc
Ringers’ Lactate
• Sodium 130 mEq/L, potassium 4 mEq/L, calcium 2.7 mEq/L, chloride 109 mEq/L,
and lactate 28 mEq/L
• Osmolarity of 273 mOsm/L
• Being most PHYSIOLOGICAL can be given in large amount without risk of
electrolyte imbalance
• Fluid of choice for DIARRHOEA (Hypokalemic metabolic acidosis), it corrects
acidosis due to bicarbonate produced from Lactate in liver with added supply of
Sodium ion.
• Fluid of choice for DIABETIC KETO-ACIDOSIS as it provides glucose free water,
bicarbonate with added advantage of K+ supply
RL - contraindecations
• In liver disease, shock, sever hypoxia, severe uremia – because of
impairment of lactate metabolism in these conditions.
• In decompensated congestive heart failure – Lactic acidosis takes place so
lactate cannot be utilized
• In vomiting – as here metabolic alkalosis takes place so bicarbonate may
worsen the problem
• Cannot be used with blood transfusion as citrate combines with calcium
that inactivates the anticoagulant
• Incompatible with certain drugs like Amphoterecin- B, Thiopental,
Ampicillin, Tetracycline due calcium binding which cause decrease in
bioavailability and efficacy.
Normal saline (0.9%)
• 154 mEq/L Sodium and Chloride
• Osmolality - 308 mOsmol/L
• Hypovolemic shock (being isotonic, chiefly distributed in extracellular fluid
resulting immediate increase in B.P.)
• Vomiting (effectively counterbalances metabolic alkalosis)
• Compatible with blood transfusion
• Initial fluid therapy in diabetic keto-acidosis and in treatment of hypercalemia
NS - contraindications
• Use with caution in patient with edema due to CHF, renal diseases, cirrhosis
• Dehydration with sever hypokalemia as it does not provide K+ and additionally causes
dilutional hypokalemia
Dextrose 5%
• 5gm of dextrose/100 ml water (170Kcal/L)
• Besides providing energy this goes to all compartment proportionally, so it correct
intracellular (true) dehydration more efficiently than others
• Fluid of choice for Diabetes insipidus (free water loss)
• For treatment and prevention of ketosis in starvation, vomiting diarrhea and high
grade fever
• For correction of hypernatremia of any origin
D5% - Contraindecations
• Cerebral edema due to hypotonicity
• Acute ischemic stroke – as hyperglycemia
• aggravates cerebral ischemic brain damage
• Hypovolemic shock – as it causes osmotic diuresis

• Blood transfusion – due to hypotonicity causes hemolysis of RBCs
• Hypernatremia and water intoxication- because only provides free water
• Severe hypernatremia – because may induce swelling of brain cells if given in large
amount
• Jaundice (hepatic encephalopathy)- may aggravate cerebral edema
Dextrose 25%
• Hypoglycemic coma
• Patient on fluid restriction (CHF, Oliguric renal failure, Cirrhosis)
• Hyperkalemia (with/without regular insulin) - 10 unit insulin/ 100 ml D25
• Hepatic jaundice
• In hyper alimentation
• Contraindications
• Sever dehydration with anuria
• Diabetic patients (unless there is severe hypoglycemia)
Potassium chloride
Data generated by Dr L D Cowgill
Routes of fluid administration
• Intravenous
• Subcutaneous
• Oral
• Intra-peritoneal
• Intraosseus/intramedullary
How rapidly fluids can be given?
• Shock doses of isotonic
crystalloids
• 80-90ml/kg/hr in dogs
• 40-60ml/kg/hr in cats
• Basal fluid administration rate

• 5-10ml/kg/hr
• Anaesthesia and surgery –

same as basal
• Half as bolus, and rest half as
CRI
Technical aspects
• Types of catheters
• Vein selection
• Accessibility
• Therapeutic goals
• Rick infection
• Risk of damage to catheter
• Risk of thrombosis
Complications of IV fluid therapy
• Extravasation
• Thrombosis
• Thrombophlebitis
• Infection
• Catheter embolism
• Air embolism
• Exsanguination
• Over hydration
Monitoring fluid therapy
• Physical and lab findings

• TS/PCV
• Urine O/P
• Central venous pressures

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FLUID THERAPY-

BASIC PHYSIOLOGY &

• CATTLE = 70% WATER OF BODY WT.

• Sensible losses  Urine O/P: 27-

• Not homogenously distributed through all body compartments

Na+ + K+ + UC = Cl- + HCO3-+ UA

(Na+ + K+) – (Cl- + HCO3- ) = UA – UC =

Physical Total solids &

• Hypovolemic shock – as it causes osmotic diuresis

• Basal fluid administration rate

• Anaesthesia and surgery –

• Physical and lab findings

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