Critical Care
Scientific Proceedings: Companion Animals Programme
Fluid Therapy: Theory and cases
Laura J. Ruys, DVM, Spoedkliniek voor Dieren Amsterdam, Weesperzijde 147, 1091 ET Amsterdam, NL
lauraruys@gmail.com
Introduction:
The most important organs con-
cerned with body fluids are the kid-
neys. A healthy kidney can regulate
the volume and composition of
body fluids with a finesse envied by
the finest fluid therapist, supported
by the most modern clinical labo-
ratory. In hypovolemia and dehydra-
tion, the most important aim is not so much to treat
abnormalities of plasma composition, unless they are
extreme, but to restore euvolemia and so the ability of
the kidney to correct further disturbances(1). This
phenomenon is for veterinarians both reassuring and
1
frustrating. In dehydrated and hypovolemic patients
with healthy kidneys, fluid therapy can be very successful,
and over- and undercorrection may be forgiven. In many
critical patients, however, renal function, as well as the
function of other important organ systems such as heart
and lungs, may be impaired. Trauma patients may suffer
from head trauma and internal hemorrhages. In these
cases, and many more, giving adequate fluid therapy is
quite a challenge. Fluid therapy is regarded by many as
the major life-saving development of the 20th century. In
the last decades, diagnostic techniques have come into
range of the practice laboratory and knowledge about
physiology has increased. The questions that rise among
veterinarians have remained, however: How much, how
Abstracts European Veterinary Conference Voorjaarsdagen 2008 | 83

1 Scientific Proceedings: Companion Animals Programme
fast and what kind of fluid should I give?. These questions
are very hard to answer before answering two other
questions: Where are fluids needed and where do given
fluids go?
Distribution of body fluids:
For the distribution of body fluids, the following values
are commonly used:
60% of the body weight consists of water. Two thirds
of this water is intracellular (including red and white
blood cells), one third is extracellular. Three quarters of
the extracellular fluid is interstitial fluid, one quarter is
plasma (intravascular).
Blood volume:
Dog: 8-9% of body weight
Cat: 6-7% of body weight (1,2)
Hypovolemia is a state of decreased blood volume.
Severe hypovolemia (when more than 25% of the intra-
vascular volume is lost) leads to hypovolemic shock (3,4).
Shock is a condition defined as insufficient perfusion of
the tissues, leading to tissue hypoxia, and characterized
by an altered mental status, cool extremities, tachycardia
or severe bradycardia, mucous membrane pallor, prolon-
ged or absent capillary refill time (CRT), reduced or ab-
sent peripheral pulses and arterial hypotension. In early
stages of shock and in septic disease, dogs may exhibit
pounding pulses, bright red mucous membranes and a
rapid CRT (5). Is cats, this stage is not clearly recognized.
Dehydration is a condition in which the body contains an
insufficient volume of water for normal functioning and
affects the intracellular and interstitial fluid compart-
ments. Severe dehydration can lead to hypovolemic
shock. The percentage of dehydration can be estimated
based on patient history and the following clinical
findings(6,7):
< 5%: Not detectable, history of vomiting, diarrhea or
lack of water intake
6-8%: Mild to moderate degree of decreased skin
turgor. Dry oral mucous membranes
10-12%: Marked degree of decreased skin turgor
Eyes sunken in orbits. Dry mucous membranes.
Possibly signs of shock
12-15%: Collapse/ shock
Where are fluids needed?
Before starting an aggressive fluid therapy, it is important
84 | Abstracts European Veterinary Conference Voorjaarsdagen 2008
Critical Care
to assess whether the patient is hypovolemic, dehydrated
or both, and whether other diseases are present that
could influence fluid tolerance (kidney disease, heart
disease, internal bleedings, lung disease). In hypovolemia,
faster fluid replacement is required than in dehydration.
After fluid therapy for hypovolemia, an animal can still
be dehydrated. Whether an animal becomes dehydrated
or hypovolemic or both, depends on the tonicity of the
fluid that was lost.
Tonicity refers to the ability of particles in solution to
induce water movement (8). The tonicity of fluid that is
lost, determines the redistribution of the remaining fluid
in the body and therefore determines which compartment
suffers the greatest losses. Loss of an extracellular fluid
with low tonicity (watery fluids with few solutes), as in
inadequate access to water, concentrates the solutes in
the remaining body fluids. Through osmosis, water will
shift from the intracellular space to the extracellular
space, until an equilibrium is reached. Both compartments
will share the losses equally. Loss of extracellular fluid
with higher tonicity, as in diarrhea, gives less osmotic
stimulus. With no supplementation of water from the
intracellular space, the loss in the extracellular space will
be more severe than in the first example, and the animal
is more likely to show signs of hypovolemia. As the
tonicity of the fluid that is lost increases toward the
normal tonicity of extracellular fluid, the volume deficit
of the extracellular compartment becomes progressively
more severe. In the case of isotonic losses, as in acute
hemorrhages, the entire loss is borne by the extracellular
compartment(8,9).
Where do fluids go?
The composition of the administered fluid, in conjunction
with the hydrostatic and colloid osmotic pressure in the
capillaries and tissues, determines how the fluids are
distributed.
Crystalloids are solutions with small molecular weight
particles (ions) that pass capillary membranes freely.
Most commonly used are isotonic crystalloids, such as
normal saline (0.9%) or lactated Ringers. Isotonic
crystalloids exert their effects primarily on the interstitial
and intracellular compartments. Colloids, such as
Hemohes or Voluven, contain molecules too large to
freely pass intact capillary membranes. For this reason,
colloids are thought of as intravascular volume replace-
ment fluids (6). When colloids are used in shock resus-
citation, it is always in conjunction with crystalloids (3).
Monitoring:
During shock resuscitation, the patient has to be moni-
tored carefully. Physical exams have to be performed
frequently to assess whether the desired endpoints are
reached. The following values can be aimed for:
Critical Care

Scientific Proceedings: Companion Animals Programme 1

Heart frequency: 60-100 (cat: 160-200)

Mucous membranes: pink, moist

Capillary refill time:1.5 s

Pulse quality: strong, regular

Blood pressure: systolic 100 mmHg, mean > 65 mmHg
Central venous pressure: 4-8 cmH2O
Urine production: > 1ml/kg/h

During long term fluid therapy, the patient has additio-

nally to be monitored for electrolytes, hematocrit (>25%),
albumin (>20 g/l), disappearance of initial clinical signs,
and at least twice a day for breathing pattern, respiration
rate and lung sounds(5).

References:
1. Michell AR, Bywater RJ, Clarke KW, Hall LW, Waterman AE. Regulation
of body fluids. In: Veterinary fluid therapy. Blackwell Scientific
Publications, 1989; 1-19
2. Wellman ML, DiBartola SP, Kohn CW. Applied physiology of body
fluids in dogs and cats. In: DiBartola SP. Fluid, electrolyte and acid-
base disorders in small animal practice. Missouri: Saunders Elsevier,
2006; 3-26.
3. Kirby R. Shock and resuscitation parts I and II. WSAVA-FECAVA-HVMS
World Congress 2004, Scientific Proceedings; 228-236.
4. Muir W. Trauma, physiology, Pathophysiology and clinical
implications. J Vet Emerg Crit Care 2006; 16(4) 253-263.
5. Kirby R, Rudloff E. The critical need for colloids: Maintaining fluid
balance. The Compendium 1997; 705-714.
6. DiBartola SP, Bateman S. Introduction to fluid therapy. In: DiBartola
SP. Fluid, electrolyte and acid-base disorders in small animal practice.
Missouri: Saunders Elsevier, 2006; 325-344.
7. Plunkett SJ. In: Emergency procedures for the small animal clinician.
Appendices. Saunders, 2007; 475
8. Goldkamp C, Schaer M. Hyernatremia in dogs. The Compendium
2007 Mar;29(3):148-160.
9. DiBartola SP. Disorders of sodium and water: hypernatremia and
hyponatremia. In: DiBartola SP. Fluid, electrolyte and acid-base
disorders in small animal practice. Missouri: Saunders Elsevier, 2006;
47-79.

Abstracts European Veterinary Conference Voorjaarsdagen 2008 | 85