This manuscript will review crystalloid (hypo-, iso-, and hyper-tonic) and colloid (synthetic and natural) fluids that are available for intravenous administration with a focus on their electrolyte, ...acid-base, colligative, and rheological effects as they relate to each solution's efficacy and safety. The goal is for the reader to better understand the differences between each fluid and the influence on plasma composition, key organ systems, and their implications when used therapeutically in animals with critical illness.
This manuscript will review intravenous fluid therapy in traumatic brain injury. Both human and animal literature will be included. Basic treatment recommendations will also be discussed.
Practical relevance:
Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy ...requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses.
Clinical challenges:
A number of metabolic derangements can occur with DKA, requiring a comprehensive diagnostic evaluation, elimination of ketones, careful correction of glucose, electrolyte and acid base abnormalities, and close monitoring.
Audience:
Any veterinarian that cares for cats in urgent and emergency situations should understand the pathophysiology of DKA in order to address an individual’s clinical signs and metabolic derangements.
Evidence base:
This review draws evidence from the peer-reviewed literature as well as the author’s personal clinical experience.
Elke Rudloff
2017; 19: 1167-1174 Readers should note that the version of the article that appeared in print in November 2017 and online until June 2018 has been amended. The version now appearing ...online is the correct one. For information, the following amendment has been made to the original published version. In the fifth paragraph of 'Correction of electrolyte imbalances' box on page 1172, the unit for potassium supplementation should be mEq/kg/h and not mEq/h, as stated. The sentence has therefore been amended to 'Potassium supplementation is calculated according to the serum level and, in general, the rate should not exceed 0.5 mEq/kg/h.'
OBJECTIVE: To provide recommendations for reviewing and reporting clinical in‐hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational ...definitions for CPR terminology. DESIGN: Consensus guidelines. SETTING: International, academia, referral practice, general practice, and human medicine. METHODS: An international veterinary Utstein task force was convened in April 2013 in San Francisco to determine the scope of the project, the variables to be reported, their definitions, and a reporting template. Factors that were essential for meaningful data reporting and were amenable to accurate collection (ie, core variables) and additional variables useful for research projects and hypothesis generation (ie, supplemental variables) were defined. Consensus on each item was either achieved during that meeting or during the subsequent online modified Delphi process and dialogue between task force members. RESULTS: Variables were defined and categorized as hospital, animal, event (arrest), and outcome variables. This report recommends a template for standardized reporting of veterinary in‐hospital CPR studies involving dogs or cats. Core elements include the suspected cause(s) and location of arrest, first rhythm identified, the occurrence of return of spontaneous circulation (ROSC) of more than 30 seconds (any ROSC) or more than 20 minutes (sustained ROSC), survival to discharge, and functional capacity at discharge. If CPR is discontinued or the patient is euthanized by owner request, a reason is reported. The task force suggests a case report form to be used for individual resuscitation events. CONCLUSIONS: The availability of these veterinary small animal CPR reporting guidelines will encourage and facilitate high‐quality veterinary CPR research, improve data comparison between studies and across study sites, and serve as the foundation for veterinary CPR registries.
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Objective: To review the human and veterinary literature on the physiological role and effects of therapeutic albumin supplementation.
Data sources: Data from human and veterinary literature was ...reviewed.
Human data synthesis: Hypoalbuminemia often occurs in a variety of critical illnesses, and contributes to the development of life‐threatening complications, including pulmonary edema, delayed wound healing, feeding intolerance, hypercoaguability, and multiple organ dysfunction. Serum albumin concentration has been used as a prognostic indicator in cases of chronic hypoalbuminemia. The use of albumin replacement therapy in humans is sometimes controversial, but may be associated with improved morbidity and decreased mortality.
Veterinary data synthesis: Unlike human literature, there is a paucity of controlled clinical studies in the literature regarding albumin supplementation in veterinary patients. Rather, the majority of published studies were performed in experimental animals or via retrospective analyses. One recent study evaluated the use of plasma to improve albumin concentration in dogs with hypoalbuminemia. Other older studies investigated wound healing in dogs with experimentally induced hypoalbuminemia. As in human medicine, serum albumin concentration may be helpful as a prognostic indicator in critically ill dogs.
Conclusion: Albumin is one of the most important proteins in the body because of its role in maintenance of colloid oncotic pressure, substrate transport, buffering capacity, as a mediator of coagulation and wound healing, and free‐radical scavenging. Albumin replacement in veterinary medicine is difficult, but until prospective clinical trials determine the efficacy of albumin replacement are conducted, a suggested clinical guideline would be to maintain albumin concentration at or above 2.0 g/dl utilizing fresh frozen plasma.
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Objective
To review and summarize the pharmacokinetics and pharmacodynamics of hydroxyethyl starch (HES), as well as reported risks and benefits of HES infusion, and to provide administration and ...monitoring recommendations for HES use in dogs and cats.
Data Sources
Veterinary and human peer‐reviewed medical literature, including scientific reviews, clinical and laboratory research articles, and authors’ clinical experience.
Summary
HES solutions are the most frequently used synthetic colloid plasma volume expanders in human and veterinary medicine. The majority of research in human medicine has focused on the adverse effects of HES infusion, with emphasis on acute kidney injury and coagulation derangements. The studies often differ in or fail to report factors, such as the type, amount, interval, and concentration of HES administered; the patient population studied; or concurrent fluids administered. Currently, there is no definitive clinical evidence that the reported adverse effects of HES use in human medicine occur in veterinary species. There is little information available on HES administration techniques or simultaneous administration of additional fluids in human and veterinary medicine. The rationale for HES use in small animals has been largely extrapolated from human medical studies and guidelines. A controlled approach to intravenous fluid resuscitation using crystalloid and HES volumes titrated to reach desired resuscitation end point parameters is outlined for small animal practitioners.
Conclusion
The extrapolation of data from human studies directly to small animals should be done with the knowledge that there may be species variations and different pharmacokinetics with different HES solutions. Veterinary reports indicate that bolus and continuous rate infusions of 6% hetastarch solutions at moderate doses are well tolerated in feline and canine subjects. Further research in domesticated species is necessary to better define and expand the knowledge regarding use of HES solutions in small animal medicine.
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Objective
To compare the percent recovery of regular insulin prepared for administration as a continuous rate infusion (CRI) using 2 different concentrations, 3 and 45 U in 250 mL 0.9% saline.
Design
...In vitro experiment
Setting
Privately‐owned emergency and referral teaching hospital.
Animals
None
Intervention
Commercial 250 mL 0.9% sodium chloride IV fluid bags were injected with either 3 U (solution bag A) or 45 U (solution bag B) of regular insulin. The insulin concentration was measured in each bag. A fluid administration and extension set were connected to each bag and 50 mL was drained through the IV tubing. The insulin concentration was then measured from samples post washout.
Measurements and Main Results
Comparison of the concentration of insulin injected into the bag and concentration of insulin in the bag showed that there was a 29.7 and 37.3% recovery of insulin from solution bag A and solution bag B, respectively. Comparison of the concentration of insulin injected into the bag and concentration of insulin in the post 50‐mL washout samples showed that there was an 11.9 and 30.6% recovery of insulin from bags A and B, respectively.
Conclusions
Substantially more insulin was available after a 50‐mL washout from solution bag B compared to solution bag A. Insulin binding to the IV bag and fluid administration set is likely the cause of this difference.
Clinical Significance
Patients receiving lower concentrations of insulin as a CRI, such as might be prescribed for cats and small dogs may require longer time for resolution of hyperglycemia and ketonemia.
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Objective
To determine whether administration of antiemetic medication to dogs and cats with gastrointestinal foreign body obstruction (GIFBO) delays time to definitive care (surgery or endoscopy) ...and increases the risk of complications.
Design
Retrospective study (January 2012–July 2020).
Setting
Private referral center.
Animals
Five hundred and thirty‐seven (440 dogs and 97 cats).
Interventions
None.
Measurements and Main Results
Medical records of dogs and cats with GIFBO were reviewed for antiemetic administration at the onset of clinical signs, time from onset of clinical signs to first intervention and definitive care, GIFBO‐related complications, and length of hospitalization. Antiemetics were prescribed for 200 of 537 patients (158 dogs, 42 cats). Antiemetic administration was associated with an increased time between the onset of clinical signs and definitive care (3.2 days 95% confidence interval, CI, 2.8–3.5 vs. 1.6 days 95% CI, 1.4–2.0; P < 0.001) but not with GIFBO‐associated complications (P = 0.45). Antiemetic administration was associated with an increased length of hospitalization (1.6 days 95% CI, 1.4–1.7 vs. 1.1 days 95% CI, 1.1–1.2; P < 0.001). A longer duration of clinical signs prior to intervention was associated with GIFBO‐related complications (P < 0.001) regardless of antiemetic administration.
Conclusions
Antiemetic administration in patients with GIFBO was associated with increased time to definitive care and length of hospitalization but not GIFBO‐associated complications. Antiemetics are not inherently contraindicated in patients for whom GIFBO is a differential, but clients should be counseled to monitor for progression of clinical signs and follow‐up accordingly.
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10.
The role of aquaporin 4 in the brain Iacovetta, Christine; Rudloff, Elke; Kirby, Rebecca
Veterinary clinical pathology,
03/2012, Volume:
41, Issue:
1
Journal Article
Peer reviewed
Open access
:
Emerging evidence suggests that aquaporin (AQP) 4 water channels play an important role in water homeostasis in the brain. These water channels are most abundant in the cell membrane of astrocytes, ...but are also present within ependymal cell membranes and in osmosensory areas of the hypothalamus. Water transport through AQP4 depends on concentration gradients across the membrane, but the rate of transport is determined by the capacity of astrocytes to up‐ and down‐regulate AQP4 numbers, their location within the membrane, and the overall permeability of the channel. Other functions of brain AQP4 involve potassium uptake and release by astrocytes, migration of glial cells, glial scarring, and astrocyte‐to‐astrocyte cell communication. AQP water channels are involved in formation and control of edema in the brain and in multiple disease processes in the brain, such as seizures and tumors. There is abundant scientific literature on AQP4 describing its structure, function, location, and role in water homeostasis and edema in the brain. Investigation of AQP expression in the canine and feline brain should be pursued so that clinically relevant comparisons between findings in mice, rats, and people and animal patients can be made.
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