Page 10 - 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

How to administer crystalloids the effects of hypertonic saline administration. The typical
y Standard crystalloid shock doses are essentially one hydroxyethyl starch dose for the dog is up to 20 mL/kg/24
complete blood volume. 26 hr (divide into 5 mL/kg boluses and reassess). For the cat,
y Shock rates are 80–90 mL/kg IV in dogs and 50–55 mL/ the dose range is 10–20 mL/kg/24 hr (typically, 10 mL/kg
kg IV in cats. in 2.5–3mL/kg boluses). 29–31 Titrate the amount of colloid

y Begin by rapidly administering 25% of the calculated infused to effect.
shock dose. Reassess the patient for the need to continue at
each 25% dose increment. Simultaneously administering crystalloids and colloids
y Monitor signs as described in the patient assessment y Use this technique when it is necessary to both increase
portion of this document. In general, if 50% of the intravascular volume (via colloids) and replenish interstitial
calculated shock volume of isotonic crystalloid has not deficits (via crystalloids).
caused sufficient improvement, consider either switching y Administer colloids at 5–10 mL/kg in the dog and 1–5
to or adding a colloid. mL/kg in the cat. Administer the crystalloids at 40–45
y Once shock is stabilized, replace initial calculated volume mL/kg in the dog and 25–27 mL/kg in the cat, which is
deficits over 6–8 hr depending on comorbidities such as equivalent to approximately half the shock dose. Titrate
renal function and cardiac disease. to effect and continually reassess clinical parameters to
adjust rate and type of fluid administered (crystalloid and/
or colloid).

Using hypertonic saline
hypovolemic
y To achieve the greatest cardiovascular benefit with the
least volume of infused fluids (typically reserved for large
patients or very large volume losses).
y To achieve translocation of fluids from the interstium to
hypotensive dehydrated
the intravascular space (e.g., for initial management of
hemorrhage).
FIGuRE 1 y In animals with hemorrhagic hypovolemic shock as a
fast-acting, low-volume resuscitation. Shock doses of
Patients may be hypovolemic, dehydrated, hypotensive,
or a combination of all three.

TABLE 5
When to administer colloids
y When it is difficult to administer sufficient volumes of Dehydration Assessment
fluids rapidly enough to resuscitate a patient and/or when Dehydration Physical exam findings*
achieving the greatest cardiovascular benefit with the least
volume of infused fluids is desirable (e.g., large patient, Euhydrated Euhydrated (normal)
emergency surgery, large fluid loss). Mild ( 5%) Minimal loss of skin turgor, semidry
y In patients with large volume losses where crystalloids are mucous membranes, normal eye
not effectively improving or maintaining blood volume
restoration. Moderate ( 8%) Moderate loss of skin turgor, dry
y When increased tissue perfusion and O2 delivery is mucous membranes, weak rapid pulses,
needed. 27 enophthalmos
y If edema develops prior to adequate blood volume Severe ( 10%) Considerable loss of skin turgor, severe
restoration. enophthalmos, tachycardia, extremely
y When decreased oncotic pressure is suspected or when the dry mucous membranes, weak/thready
total protein is  35 g/L (or albumin is  15 g/L). pulses, hypotension, altered level of
y When there is a need for longer duration of effect. consciousness 50
Preparations vary, and some colloids are longer lasting than
crystalloids (up to 24 hr). Use of colloids can prolong * Not all animals will exhibit all signs.
28
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