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PubMed1999

Fluid therapy in mature cattle.

Fluid therapy is practical and beneficial when properly administered to cattle. Mature cattle are more frequently alkalotic than acidotic, so nonalkalizing solutions are usually indicated. Exceptions include cattle with choke, carbohydrate engorgement, diabetes mellitus, and occasionally, renal disease, diarrhea, and fatty liver/ketosis. Many dehydrated cattle need supplemental potassium and calcium as well as sodium, chloride, and water. Intravenous administration is indicated in patients with obstructive gastrointestinal disease and those with severe dehydration. Oral or intraruminal administration is less expensive and, often, very effective.

Acidosis↗

PubMed1990

Fluid therapy in mature cattle.

Fluid therapy is practical and beneficial when properly administered to cattle. Mature cattle are more frequently alkalotic than acidotic, so nonalkalizing solutions are usually indicated. Exceptions include cattle with choke, carbohydrate engorgement, diabetes mellitus, and, occasionally, renal disease, diarrhea, and fatty liver/ketosis. Most dehydrated cattle need supplemental potassium and calcium as well as sodium, chloride, and water. Intravenous administration is indicated in patients with obstructive gastrointestinal disease and those with severe dehydration. Oral or intraruminal administration is less expensive and often very effective.

Acidosis↗

PubMedDate not supplied

[Use of maintenance fluid therapy in surgery].

OBJECTIVE: To analyze the use of various maintenance fluid therapy regimens, as well as their adequacy to hospital recommendations, in adult in-patients admitted to a general surgery ward during 1 year. MATERIAL AND METHODS: Data on solution type and volume, fluid therapy regimen, and duration in days were retrospectively collected for each administered solution from computerized medical orders within the Unit-Dose Drug Distribution Area. A database was developed including the composition of available solutions within our hospital, so that electrolytes, glucose and volumes administered may be calculated. RESULTS: Out of 354 patients undergoing fluid therapy 125 were selected to receive maintenance regimens. Fluid therapy was administered for more than 5 days in 31% of patients. The most commonly supplied fluids were 5% glucose (43%) and 0.9% saline + 1500 mL of 5% glucose + 60 mEq potassium chloride (CIK). Amongst patients receiving the recommended volume/day (84%) 50% received sodium and potassium more than twice as much the recommended amount, and 70% received glucose amounts not covering minimal daily requirements. Potassium was administered according to recommendations in 85% of patients. CONCLUSIONS: There is an excessive use of 0.9% saline and 5% glucose to the detriment of 1/3 glucosaline and 10% glucose, which translates as an excessive daily sodium and defective daily glucose provision. In our hospital we have recommended maintenance fluid therapy regimens, as well as fluids more appropriate for postoperative electrolyte replacement; however, their use is still deficient.

Adult↗

PubMed2000

Gamble and Darrow: pathfinders in body fluid physiology and fluid therapy for children, 1914-1964.

The development of body fluid physiology and fluid therapy in pediatrics has special importance in the history of medicine because this development introduced physiology into clinical practice. James Gamble and Dan Darrow were leaders in this enterprise. Gamble was part of the group John Howland attracted to Johns Hopkins to establish the first organized program for clinical investigators in pediatrics. This group initiated fluid therapy as effective treatment for diarrheal dehydration and, led by Gamble, developed the discipline of body fluid physiology. Gamble was the first to describe the nature of extracellular fluid (ECF) to clinicians, using the new terminology for characterizing electrolytes in solution. In doing so, he became the teacher of body fluid physiology to a generation of medical students. Inexplicably, in his later years he failed to adopt yet newer terminology defining cations, anions, and acid-base status. This failure compromised his legacy. Dan Darrow extended our understanding of how body fluids react to hyper- and hyponatremia and to potassium deficiency. He was the first to add potassium to parenteral fluid therapy. In doing so, he broadened clinicians' understanding of body fluids but changed the emphasis of fluid therapy from rapid ECF restoration to replacement of estimated deficits. Unfortunately, this change in concept, taught by his successors as deficit therapy, slowed the adoption of oral rehydration therapy for treating diarrheal dehydration. The lapses noted for each of these men, now seen in hindsight, pale in comparison to their contributions. Pediatrics, medicine, and surgery are all indebted to the research of each, which emphasized the value of basic physiology in clinical practice.

Body Fluids↗

PubMed2003

Fluid therapy in horses with gastrointestinal disease.

Fluid therapy is essential to the successful management of horses with gastrointestinal disease. Affected horses can present in a wide spectrum of metabolic derangement depending on the extent and severity of the underlying disease process. Precise quantitation of fluid deficits and losses is usually not possible; thus, formulating a rational plan, applying diligent and ongoing monitoring, and making adjustments to meet individual demands provide the best approach to fluid therapy in these horses. Although restoration of fluid and electrolyte homeostasis can be complicated, it is probably best in most cases to keep the approach as simple as possible and resist the urge to "over" manage.

Acid-Base Equilibrium↗

PubMed1999

Fluid therapy and newer blood products.

A fluid therapy plan for a patient is developed prior to surgery and is designed to meet each patient's needs. The volume and type of fluid are dependent on the patient's physical status; the acid-base, fluid, and electrolyte status; the surgical procedure; and the expected losses occurring during the procedure. No one fluid regimen is ideal for all patients. All fluid regimens must be continually re-evaluated. A brief minor surgical procedure in a healthy surgical candidate requires little or no fluid administration. In cases of more extensive surgical procedures involving invasion of the abdomen or chest as well as in cases with trauma and major blood loss, much more volume and a specific balanced replacement fluid are required. Depending on the severity of the surgical case, administration rates of 5 to 15 mL/kg/h or greater of crystalloid may be required to maintain perfusion. These rates are merely guidelines, and resuscitation should continue until the desired end point is reached. Balanced replacement fluids may be used to replace blood loss at a ratio of 3:1 and are added to maintenance and replacement requirements. Blood loss of 20% to 25% of the calculated blood volume or hematocrit values less than 20% are indications for colloids or blood replacement at a ratio of 1:1. The optimal fluid therapy regimen for a patient may involve a combination of crystalloids as well as natural and synthetic colloids, using each type of fluid to obtain and maintain perfusion and oxygenation to the tissues.

Animals↗

PubMed1998

Fluid therapy. Crystalloids and colloids.

Appropriate fluid therapy requires an understanding of fluid dynamics and pathologic alterations during various disease states. In addition, it requires an understanding of the pharmacologic differences of available fluids. Crystalloid fluids and colloid fluids can be used in combination to treat a variety of volume-deficient states. Synthetic colloids are also used to treat hyponcotic states. Blood products are used to replace blood components and coagulation proteins. Frequent monitoring and reassessment are required to prevent volume overload and life-threatening edema.

Animals↗

PubMed1998

Fluid therapy in the cardiac patient.

Correcting fluid deficits and preventing fluid overload in patients with cardiac disease can be challenging. The purpose of the fluid therapy, the projected duration of the therapy, and the type of heart disease affecting the patient play important roles in the decision-making process. In addition, the distinction between patients who are not symptomatic (NYHA Class I) and those who are symptomatic (NYHA Classes II to IV) for their cardiac disease should be made early in fluid therapy planning.

Animals↗

PubMed1998

Oral fluid therapy in paediatric burns (5-10%): an appraisal.

Fluid therapy by the oral route is the accepted method of treatment for smaller burns in children (less than 10%). [Settle JAD. Burns - the first five days. Essex: Smith and Nephew Pharmaceuticals Ltd, 1986.] A phone survey was carried out of all the hospitals in the United Kingdom that manage burns, to record their oral fluid therapy practices for burns (5-10% BSA) in paediatric patients. Included in the survey was an assessment of the uniformity of the contents of the fluids, their palatability and acceptance by patients and any side-effects from this form of treatment. There appears to be no uniformity in policies regarding fluid therapy in children with this percentage of burns. Treatment ranged from a formula guided resuscitation therapy (as practised generally with large burns) to a 'drink as you like' policy. Fluids used varied from electrolyte to non-electrolyte containing solutions and fruit juices and were, therefore, markedly different in content. The electrolyte solutions were reported as being non-palatable unless flavoured with fruit juices. No complication was reported although one unit queried a possible case of fluid overload. Potential complications from this mode of therapy are discussed. The cost implications of using various fluid types are also presented.

Administration, Oral↗

PubMed1996

Hypertonic saline fluid therapy following brain stem trauma.

Intravenous hypertonic fluid therapy has been proposed to improve secondary ischemic injury after cerebrospinal trauma. We report the case of a 14-year-old boy with vasospasm of the intracranial vertebral arteries and ischemic brain stem damage following head trauma. The patient presented with severe tetraparesis and somatosensory (SSEPs) and brain stem auditory evoked potentials (BAEPs) impairment. The patient was treated with two subsequent hypertonic saline (HS) infusions, 2.7% and 5.4%, respectively, for a period of 48 sp, followed by standard hypervolemic therapy. After the first treatment with 2.7% HS, improvement of SSEPs without neurological improvement was apparent. Relative hypervolemia was subsequently maintained by administration of crystalloids and 20% albumin for 48 h. During standard hypervolemic therapy, no clinical and/or electrophysiological change occurred. The second infusion of 5.4% HS was concomitant with further amelioration of SSEPs and improvement of motor performance. Twelve hours after the second HS infusion, the neurological status returned to preinfusion levels, while SSEPs showed no further changes. BAEPs never changed during fluid therapy. No complication occurred secondary to the infusion of HS. This case report suggests that local improvement of brain stem perfusion following hypertonic fluid therapy accounts for or relevantly contributes to the neurological and SSEPs improvement of the patient.

Accidents, Traffic↗

PubMed1993

Management of severe ovarian hyperstimulation syndrome by ascitic fluid aspiration and intensive intravenous fluid therapy.

OBJECTIVE: To assess the value of intensive intravenous (IV) fluid therapy and ascitic fluid aspiration in the management of severe ovarian hyperstimulation syndrome. METHODS: Forty-two women with severe ovarian hyperstimulation syndrome were treated by ultrasonically guided transvaginal aspiration of ascitic fluid and IV fluid infusion. Ten women with the same condition treated conservatively constituted a comparison group. The main outcome measures included percentage change in hematocrit, creatinine clearance, and urine output before and after aspiration. The duration of hospital stay was compared between the groups. RESULTS: Marked improvement of symptoms and general condition followed soon after aspiration. Hematocrit readings decreased by 22%, creatinine clearance increased by 79.3%, and urine output increased by 220.7%. The average volume of aspirated fluid was 3900 mL. The average duration of hospital stay was 3.8 days in the treated women. In the comparison group, severe symptoms and electrolyte imbalance continued for an average of 9 days, and the average hospital stay was 11 days. CONCLUSION: Intensive IV fluid therapy and transvaginal aspiration of ascitic fluid are safe and effective in improving symptoms, preventing complications, and shortening the hospital stay in severe ovarian hyperstimulation syndrome.

Ascites↗

PubMed1991

Thermal skin injury: effect of fluid therapy on the transcapillary colloid osmotic gradient.

The effects of fluid therapy on interstitial colloid osmotic and hydrostatic pressures in thermally injured skin were investigated in anesthetized rats subjected to full-thickness scald burns to 40% of the body surface area and resuscitation for 3 hr by either lactated Ringer's or plasma. Interstitial fluid hydrostatic pressure (Pif) was reduced from -2 mm Hg to -20 to -40 mm Hg after injury, which will profoundly increase transcapillary filtration. Following the onset of fluid therapy, Pif increased to slightly positive values. In control, colloid osmotic pressure in plasma (COPp) was 20.6 +/- 0.4 mm Hg and in interstitial fluid (COPif) 13.7 +/- 0.3 mm Hg (means +/- SEM). The transcapillary oncotic pressure gradient (COPgrad = COPp-COPif) was 6.9 +/- 0.4 mm Hg. Following nonresuscitated thermal injury, COPp declined to 18-19 mm Hg (P less than 0.05) and COPif was reduced to 10.4 +/- 0.5 mm Hg (P less than 0.05). Fluid therapy by lactated Ringer's markedly reduced COPp (12.3 +/- 0.3 mm Hg; P less than 0.05), and COPgrad was almost abolished (2.6 +/- 0.7 mm Hg; P less than 0.05). In contrast, plasma infusion maintained COPp, whereas COPgrad increased significantly (11.1 +/- 1.2 mm Hg; P less than 0.05). Noncolloid saline solutions have been preferred for the initial fluid therapy for burns. The present study provides evidence that this will reduce both COPp and COPgrad, a situation in which edema formation will be favored.

Animals↗

PubMed1964