Veterinary Fluid Administration and Shock Therapy Quiz

Fluid Administration and Shock Therapy in Veterinary Medicine

• In veterinary medicine, intravenous or intraosseous access is necessary for expanding the vascular space, with intraosseous cannulation being suitable for small puppies and kittens.
• Isotonic crystalloids equilibrate quickly with interstitial fluids, with only 10-25% remaining in the circulation after 1 hour, necessitating high volumes for shock therapy.
• Goal-directed therapy involves giving 10-20ml/kg of isotonic crystalloid over 15 minutes and then reassessing perfusion parameters, helping to avoid excessive fluids and identify non-responders.
• Hartmann's solution is often preferred for shock therapy in veterinary medicine due to its alkalinizing properties, although it is contraindicated in severe liver disease and conditions where fluid accumulation may be an issue.
• Crystalloids are cheap, physiological, and widely available, but they only transiently expand the vascular compartment and do not provide a replacement for albumin, which is important in hypoalbuminemic patients.
• Colloids contain large molecules that do not cross the vascular endothelium, and they have a high oncotic pressure that acts to expand and maintain intravascular volume, with smaller volumes required than crystalloids for shock therapy.
• There are various common colloids used in veterinary medicine, such as Haemacel and Pentastarch/Tetrastarch 6%, each with different molecular sizes and duration of action.
• There is no definitive evidence showing the superiority of crystalloids over colloids, and recent controversy exists surrounding the withdrawal of colloids in human medicine due to renal complications.
• Hypertonic saline, with a high osmotic gradient, draws interstitial fluid into the vascular space, making it valuable in hypovolemic patients with head trauma, but it must be followed by crystalloids to repay the debt.
• Blood products are not a first-line treatment for shock in veterinary medicine, as they cannot be administered fast enough while avoiding potential transfusion reactions, but may be required to maintain a PCV of greater than 20-25% after initial resuscitation.
• Hypotensive resuscitation may be indicated in ongoing internal hemorrhage to restore blood pressure to acceptable limits without "popping the clot," with definitive volume restoration delayed until bleeding is surgically managed.
• Additional shock therapies, such as vasopressors/inotropes, bicarbonate, and glucocorticoids, may be used in severe cases, but physical findings and blood lactate levels are essential for monitoring and assessing oxygen delivery to tissues.