Page 5 - 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats

2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats *

Harold Davis, BA, RVT, VTS (ECC), Tracey Jensen, DVM, DABVP, Anthony Johnson, DVM, DACVECC, Pamela Knowles, CVT, VTS (ECC),
Robert Meyer, DVM, DACVAA, Renee Rucinsky, DVM, DAVBP (Feline), Heidi Shafford, DVM, PhD, DACVAA

Abstract

Fluid therapy is important for many medical conditions in veterinary patients. The assessment of patient history, chief complaint,
physical exam findings, and indicated additional testing will determine the need for fluid therapy. Fluid selection is dictated by the
patient’s needs, including volume, rate, fluid composition required, and location the fluid is needed (e.g., interstitial versus intravascular).
Therapy must be individualized, tailored to each patient, and constantly re-evaluated and reformulated according to changes in status.
Needs may vary according to the existence of either acute or chronic conditions, patient pathology (e.g., acid-base, oncotic, electrolyte
abnormalities), and comorbid conditions. All patients should be assessed for three types of fluid disturbances: changes in volume,
changes in content, and/or changes in distribution. The goals of these guidelines are to assist the clinician in prioritizing goals, selecting
appropriate fluids and rates of administration, and assessing patient response to therapy. These guidelines provide recommendations
for fluid administration for anesthetized patients and patients with fluid disturbances.

Introduction A variety of conditions can be effectively managed using three
These guidelines will provide practical recommendations for fluid types of fluids: a balanced isotonic electrolyte (e.g., a crystalloid
choice, rate, and route of administration. They are organized by such as lactated Ringer’s solution [LRS]); a hypotonic solution (e.g.,
general considerations, followed by specific guidelines for perianes- a crystalloid such as 5% dextrose in water [D5W]); and a synthetic
thetic fluid therapy and for treatment of patients with alterations colloid (e.g., a hydroxyethyl starch such as hetastarch or tetrastarch).
in body fluid volume, changes in body fluid content, and abnor-
mal distribution of fluid within the body. Please note that these General Principles and Patient Assessment
guidelines are neither standards of care nor American Animal The assessment of patient history, chief complaint, and physi-
Hospital Association (AAHA) accreditation standards and should cal exam findings will determine the need for additional testing
not be considered minimum guidelines. Instead these guidelines and fluid therapy. Assess for the following three types of fluid
are recommendations from an AAHA/American Association of disturbances:
Feline Practitioners (AAFP) panel of experts. 1. Changes in volume (e.g., dehydration, blood loss)
Therapy must be individualized and tailored to each patient 2. Changes in content (e.g., hyperkalemia)
and constantly re-evaluated and reformulated according to 3. Changes in distribution (e.g., pleural effusion)
changes in status. Fluid selection is dictated by the patient’s needs, The initial assessment includes evaluation of hydration, tissue
including volume, rate, and fluid composition required, as well perfusion, and fluid volume/loss. Items of particular importance
as location the fluid is needed (interstitial versus intravascular). in evaluating the need for fluids are described in Table 1. Next,
Factors to consider include the following: develop a treatment plan by first determining the appropriate
y Acute versus chronic conditions route of fluid administration. Guidelines for route of administra-
y Patient pathology (e.g., acid-base balance, oncotic pressure, tion are shown in Table 2.
electrolyte abnormalities) Consider the temperature of the fluids. Body temperature
y Comorbid conditions (warmed) fluids are useful for large volume resuscitation but

From the University of California Davis, Veterinary Medical Teaching Hospital, Davis, CA (H.D.); *This document is intended as a guideline only. Evidence-based support for specific recommendations
Wellington Veterinary Clinic, PC, Wellington, CO (T.J.); Department of Veterinary Clinical Sciences, has been cited whenever possible and appropriate. Other recommendations are based on practical
College of Veterinary Medicine, Purdue University, West Lafayette, IN (A.J.); WestVet Animal clinical experience and a consensus of expert opinion. Further research is needed to document
Emergency and Specialty Center, Garden City, ID (P.K.); Mississippi State University College of some of these recommendations. Because each case is different, veterinarians must base their
Veterinary Medicine, Mississippi State, MS (R.M.); Mid Atlantic Cat Hospital, Cordova, MD (R.R.); and decisions and actions on the best available scientific evidence, in conjunction with their own
Veterinary Anesthesia Specialists, LLC, Milwaukie, OR (H.S.). expertise, knowledge, and experience. These guidelines are supported by a generous educational
Correspondence: shafford@vetanesthesiaspecialists.com (H.S.) and arpest7@hotmail.com (R.R) grant from Abbott Animal Health.

AAFP, American Association of Feline Practitioners; AAHA, American Animal Hospital Association; BP, blood pressure; D5W, 5% dextrose in water; DKA, diabetic ketoacidosis; K, potassium; KCl, potassium
chloride; LRS, lactated Ringer’s solution
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