Fluid therapy crystalloids

Has the goal arterial blood pressure been achieved If not, give additional fluid therapy hourly blending crystalloids and isooncotic colloids based on inadequate blood pressure response. 

The use of colloids has recently been advocated for the resuscitation of hypovolemic horses and for the treatment of severe hypoproteinemia (McFarlane 1999). Colloids have two advantages over crystalloids that makes them attractive for fluid therapy. Firstly, because of their persistence in the circulation, a three to six times lower volume of a colloid solution is required to produce the same resuscitative effect as a crystalloid solution (Rackow et al 1987). This is particularly useful in acute resuscitation of severely dehydrated horses or in the field where large amounts of crystalloids may be difficult to transport. Secondly, the administration of colloids can increase colloidal oncotic pressure, in contrast to the administration of large volumes of crystalloids, which decreases the colloidal oncotic pressure (Jones et al 1997,2001). 

The rehydration phase aims to replace extravascular fluid losses. Crystalloid fluids are a logical choice for rehydration as they readily diffuse into the interstitial fluid from the vasculature (Spalding Goodwin 1999, Vaupshas Levy 1990). Rehydration should take place over the first 12-24 h of therapy. The amount given should be based on the clinical estimate of the degree of dehydration and the response to fluid therapy. 

The volume to be infused and rate of delivery are only part of the therapeutic plan for fluid therapy, albeit the most important in acute resuscitation. The electrolyte and acid-base status of the horse should also be considered and fluids chosen to help to correct physiological imbalances. Unfortunately, it is not possible to predict electrolyte and acid-base disturbances accurately based on clinical signs. Seemingly similar clinical presentations may have a quite different pathophysiology (Brownlow Hutchins 1982, Svendsen et al 1979). The recent availability of relatively inexpensive, portable blood gas and electrolyte measuring equipment (Grosenbaugh et al 1998) has made determining the acid-base status possible in ambulatory equine practice and allows the field veterinarian to monitor and treat these disturbances. As stated earlier, in the absence of specific laboratory information, fluid therapy should probably be limited to isotonic polyionic crystalloid fluids, possibly with the addition of 10-20 mEq/1 potassium chloride in the maintenance phase. 

Crystalloids Crystalloids are replacement and maintenance fluid therapy. These include dextrose,... 

Crystalloids are IV fluids used for replacement and maintenance of fluid therapy. 

Because medications are not simply alternatives to crystalloids but rather are used when crystalloid therapy has been optimized, there is little reason to compare medication and fluid therapies from an economic perspective. Furthermore, there are no economic comparisons... 

Treat fluid and eleotrolyte losses aggressively, because massive fluid losses may cause circulatory collapse. Administer nornial saline or another crystalloid solution, 10- to 20-mL/kg boluses, with monitoring of central venous pressure or even pulmonary artery pressure to guide fluid therapy. 

The tonicity of crystalloid solutions is directly related to their sodium concentration. The most commonly used crystalloids include normal saline, hypertonic saline, and lactated Ringer s solution. Excessive administration of any fluid replacement therapy, regardless of tonicity, can lead to fluid overload, particularly in patients with cardiac or renal insufficiency. 

Most clinicians agree that crystalloids should be the initial therapy of circulatory insufficiency. Crystalloids are preferred over colloids as initial therapy for burn patients because they are less likely to cause interstitial fluid accumulation. If volume resuscitation is suboptimal following several liters of crystalloid, colloids should be considered. Some patients may require blood products to assure maintenance of 02-carrying capacity, as well as clotting factors and platelets for blood hemostasis. 

Therapeutic plasma exchange (TPE), or plasmapheresis (PP), is an extracorporeal therapy most frequently used in the treatment of hematologic disorders, and autoimmune neuropathies and vasculitides [37]. This modality occasionally is also employed in the treatment of poisoning. The apparatus involves central venous access and a blood circuit between the patient and a pheresis machine. Cytopheresis by centrifugation or filtration then separates the formed elements of blood from plasma. The cells are returned to the patient while the plasma (with the poison) is discarded. Fluid volume is typically replaced with crystalloid, colloid, or fresh frozen plasma (FFP) if clotting factor repletion is necessary. 

The primary therapy for hypovolemic shock is fluid replacement. The institutional cost of 1 L of most crystalloid solutions is less than 1. Assuming that such fluids are used, it is the associated costs of personnel and equipment that become the primary economic considerations in the resuscitation of patients with hypovolemic shock. However,... 

Hypotension usually responds to supine positioning and intravenous crystalloid fluids. Occasionally, pressor therapy is needed (p 16). 

---