Page 433 - WSAVA2018
P. 433

type and amount of fluid deficit present. Areas to be
considered include:
· Patient eating and drinking status It is important to establish if the patient has been eating and drinking normally. If the patient is anorexic or has had re- duced food intake this should be noted. The drinking status should also be recorded; this may include lack or fluid intake or excessive fluid intake (polydipsia)
· Gastrointestinal Losses If the patient has had any vomiting or diarrhoea, the frequency, amount and consistency should be noted. When devising a fluid therapy plan any ‘on-going’ losses should be taken into account; vomiting and diarrhoea are an on-going loss until the condition is resolved.
· Trauma Haemorrhage should be duly noted and attended to, along with a history of when the trauma occurred, circumstances, patient status.
· Urinary status Notation of the patient’s urinary status should be made. This includes reduced or increased urine output, colour and consistency of the urine.
· Abnormal discharges Any abnormal discharge should be recorded (for example, an open pyometra or weeping large sore). A history should be taken of how long the discharge has been present, amount and consistency of discharge.
Physical Examination
Although they are not always accurate, clinical signs are a useful means of assessing dehydration. It should be noted however that clinical signs will not become apparent until the animal is at least 5% dehydrated.
To assess hydration, feel the mucous membranes and perform the ‘skin tenting’ test. Mucous membranes should normally be moist. Dry, tacky mucosa is an indication that hydration is not adequate.
sufficiently rapid via the oral route for those cases where the fluid loss has been extensive and the blood flow is inadequate.
Subcutaneous
Fluids are usually administered in the subcutaneous tissues over the dorsal neck and cranial trunk. In the absence of vasoconstriction and/or hypovolemia the rate of absorption is approximately six to eight hours. Fluids should be administered at body temperature to decrease the discomfort to the patient and improve absorption. Only isotonic fluids should be administered by this route. Potassium supplementation up to 40 mmol/L may be added to the fluids. The rate and volume of administration will vary from patient to patient. Skin necrosis and infection are complications associated with this route of fluid administration.
When administering subcutaneous fluids try to
massage the area being injected. This will help prevent formation of a lump. If large amounts of fluid are being administered subcutaneously, divide the total amount into smaller injections and change sites. E.g. if a 100mls is being given, give four separate injections of 25mls.
Intravenous
This is the route of choice when vascular volume restoration is desired. Fluid absorption is rapid. In addition to isotonic solutions, hyper- and hypotonic solutions may be administered via this route. The rate and volume administered will vary from patient to patient and be based upon the patient condition and desired end-point.
Intravenous catheter placement and fluids are discussed in more detail further in this text.
Intraosseous
Fluids are administered via the bone marrow. Like intravenous administration, fluid absorption is rapid. This route is indicated when it is difficult to gain venous access using standard techniques, for example neonate patients or patients with collapsed circulation.
The veins in the bone marrow drain into the systemic venous system and enable quick effective absorption of fluids
Sites for placement of an intraosseous catheter in the cat or dog include:
· Tibial crest
· Inter-trochanteric fossa of the femur · Wing of ilium
· Tibial tuberosity
· Greater tubercule of the humerus
To perform ‘skin tenting’, gently lift the skin of the animal, twist and observe how long it takes before skin returns to its normal position.
Clinical sings of dehydration per percentage:
5%
5 – 8%
10 – 12% 12 – 15%
Slight decrease in skin turgor, slightly tacky MM
Delay in skin ‘tent’ to normal, tacky and dry MM, increased CRT, eyes may appear slightly sunken
Tenting of skin, dry and tacky MM, increased CRT, tachycardia, sunken eyes, cold extremities
Severe dehydration, clinical signs of shock are apparent, life threatening, hypothermic, weakness
Blood work may indicate increase in PCV, TPP and BUN
Routes of Administration
Oral
The oral route is the most physiological. This route should not be used in the presence of vomiting or if contraindicated due to illness or surgical procedure. This route is also inadequate for animals that have had acute or extensive fluid losses. Fluid absorption is not
Your Singapore, the Tropical Garden City
        431
            

























































   431   432   433   434   435