What can we add
Special additives in the crystalloid fluids described earlier may help impove patient recovery and reversal of disease signs. When additives to the fluid bag ,it is important to remember to withdraw and discard an amount of fluid equal to the amount of additive being supplemented. Some additives
May precipitate with some types of fluids, so read the product inserts before you add supplements to fluid bags. The following additives are commonly added to fluids.
Fifty percent dextrose. When a patient is prone to hypoglycemia, dextrose may be added to the fluids. Dextrose supplementation may be need by patients with increased metabolic needs ,such as anorexic patients with sepsis or hyperthyroidism. Dextrose is not added to the fluids as a calorie source , but serves as an energy source for the brain. Dextrose is typically added to fluids to make a 2.5 to 5 percent solution. if adding 50 percent dextrose to a 1000 ml bag of fluids to make a 2.5 percent solution , 50 ml of 50 percent dextrose must be add. If adding 50 percent dextrose to added . A solution containing 5 percent dextrose should be administered into a central vein via a large-bore catheter.
Potassium. Potassium is usually supplemented to anorexic and diuretic patients. Potassium is obtained from food and is easily lost in urine. Hypokalemia may result in lethargy, muscle weakness, and vomiting. Potaaium is given IV vai a slow drip to avoid cardiac problems. The normal serum potassium level is 3.5 to 5.5 meq/L . The term miliequivalents(mEq) is used to express the number of ionic charges of each electrolyte on an equal basis. It measures the chemical activity of ions. A milliequivalent is one one-thousandth of an equivalent, which is the weight of an element that will combine with 1 gof h+ . Milliquivalents are based on the molecular weight,valence number , and milligrams of element. When calculating the amount of potassium to give, use mEq/ml as a concentration of 2 mEq/ml . Table 19-2 can be used as a guide to potassium supplementation.
Sodium bicarbonate. Sodium bicarbonate is added to fluids to correct acidosis , as sodium bicarbonate has basic properties . Sodium bicarbonate is available in 8 percent and 5 percent concentrations. The amount of sodium bicarbonate added is based on the bicarbonate deficit is determined by subtracting the normal serum bicarbonate value from the patient’s serum bicarbonate value. The bicarbonate deficit . The bicarbonate administration include development of alkalosis and other electrolyte abnormalities. Replacement should be given slowly over several hours to avoid side effects
Calcium. Calcium is given to patients with hypocalcemia due to diseases such as milk fever, eclampsia,and endocrine disorders . Calcium may be in the from calcium gluconate or calcium chloride , or in combination with other eletrolytes such as magnesium, potassium , phosphorus, and dextrose. Calcium is available as calcium gluconate 10 per cent for injection, calcium gluconate 23 percent , calcium chloride 10 percent for injection
Vitamin. Water-soluble vitamins may be added to fluid because they are lost rapidly by anorexic or debilitated animals. Vitamin C and B complex are frequently added to fluids. In general, 0.5 ml of B complex is given per 250 ml of fluid. This dose may be doubled in severely debilitated animals. B vitamins can cause pain at the injection site if given SO, so proper restraint is important when administering fluids containing B vitamin.Vitamin C may also be added to the fluids. It is light sensitive and does not have as long a shelf life as some of the other vitamins.
How much do we give
When calculating fluid replacement therapy , keep in mind that animal require fluids for the following:
Rehydration
Maintenance
Replacement of ongoing fluid losses
Rehydration Volumes
Dehydeation in animals can cause many health problems . Things to remember with dehydration include:
Dehydration effects younger animals much more rapidly than older animals.
Older patients with chronic disease require more fluids than other animals
Animals need more fluids if they are active or if the weather is hot or humid .
Drugs such as corticosteroids and diuretics will alter fluid and electrolyte requirements.
Animal that have been anaesthetized may require additional water for a few days.
Clinically, the amount of fluid needed to correct dehydration deficits can be determined from the degree of skin turgor , capillary refill time (CRT) , and pulse rate and quality . These parameters were listed in tables 19-1
The amount of fluid needed to rehydrate an animal I based on the estimated percent of dehydration . To calculate this value , you take the estimated percent dehydration and multiply it times the weight of the animal in kilograms . this will give you deficit in liters. If you want the value in milliliters, take the estimated percent dehydration , multiply it times the animal’s weight in kilograms , and then multiply it by 1000. When you do thi calculation , the percent dehydration should be in decimal from (for example 10%’5%)
It is difficult to replace all hydration deficits in a 14-hour period .If all of the fluid loss due to dehydration is replaced in 24 ours , urinary out put may in crease in an atemp to compensate for the large volume of fluid being given.
Maintenance Fluid Volumes
Maintenance Fluid is the volume of fluid needed by the animal on a daily basis to maintain body function . Maintenance volumes can be divided into sensible and insensible losses. Sensible losses,which are body water lost in urine and feces, can be measured. Insensible body water losses are normal but not easily measured;such losses occur through sweating, ventilation ,and mucous membrane evaporation
Many different values are used for the determination of maintenance fluid volumes; therefore ,consulting with the veterinarian about the preferred volume is necessary . One value typically used is 50 ml/kg/day in adult animals and 110 ml/kg/day in young animals. These values include both sensible and insensible body water losses
Ongoing fluid loss volumes
Animals that are losing additional fluid amounts due to vomiting or diarrhea need to have this fluid loss replaced .This number is determined by estimayion. If you have a vomiting dog in the clinic, you can estimate the amount of fluid loss by monitoring the quantity and frequency of vomiting episode. This number is then added to the other numbers described earlier.
Page 309
How fast do we give it ?
The rate of fluid replacement parallels the severity of dehydration . in a clinical setting,the rate fluid replacement tends to be based on the clinical judgment, but some general rules apply.
Fluids should be replaced rapidly at first , especially in cases of shock, and then tapered to a maintenance dose
Rate of replacement of the deficit depends on the cardiovascular and renal status of the patient . If these wo systems are not functioning roperly , the rate of replacement may have to be decreased are not overload these system.
Fluid in put should not necessarily equal output initially; transient imbalance is frequently the optimal course of therapy .Hour-by-hour evaluation is necessary to adjust fluid rates until the patient is stable
Ideally ; fluids should be give over a 2-hour period . Fluids are administered by fluid administration sets that the deliver a constant number of drops/ml of fluid.
Nan make
WHAT DO WE USE TO GIVE IT?
Fluids are administered by fluid bags and bottles attached to administration sets or by fluid infusion pumps. Fluid bags and bottles deliver fluids by gravity, and the rate can be adjusted by the diameter of the administration line delivering the fluids. Administration sets may have roller clamps that can be adjusted to increase or decrease the amount of fluid delivered. Administration sets may also have screw clamps or slide clamps to control the diameter of the administration line. Infusion pumps are machines on which flow rates are set and the total amount to be given is entered. These pumps then give the desired amount of fluid at the desired rate. They can be readjusted when fluid delivery is either too fast or to slow.
KEEPING WATCH
Fluid administration should be monitored to make sure the animal is not getting too much or too little fluid for its needs. Additionally, fluid needs change with the changing health status of the animal. Physical finding such as nasal secretions (increased serous secretions indicate too much fluid), heart rate (tachycardia indicates too much fluid), lung sounds (harsh lung sounds indicate edema from too much fluid), and demeanor of the animal (restlessness may indicate too much fluid) should be monitored regularly. Laboratory values such as hematocrit and total protein can be measured in the clinic to make sure the animal’s hydration status is satisfactory.
The amount of fluid given can be monitored in a variety of ways. Fluid bags and bottles have milliliter increments on them that should be monitored to make sure the animal is receiving the correct amount of fluid over time. White tape may be applied to the bags/bottles to keep track of fluid volume delivered per hour, which is extremely helpful if more than one person is monitoring the fluids. Some administration sets have volume control chambers to allow easier measurement of fluid volumes. Some chambers can be filled with the exact amount of fluid to be delivered for that treatment; when the chamber is empty, the animal has received that volume. Examples of fluid bags and administration sets are shown in Figure 19-2A, B and C.
After the patient has been rehydrated and seems to be improving, the fluid plan is readjusted and only maintenance fluids may be given. Eventually all fluid administration will be stopped, but abruptly stopping fluid may lead to the redevelopment of dehydration due to the increased urine production still being performed by the kid
เราสามารถเพิ่มอะไรสารพิเศษในของเหลว crystalloid ที่อธิบายไว้ก่อนหน้านี้อาจช่วยกู้คืนผู้ป่วย impove และการย้อนกลับของสัญญาณโรค เมื่อวัตถุเจือปนกับน้ำถุง เป็นสิ่งสำคัญอย่าลืมถอน และยกเลิกเป็นจำนวนเงินเท่ากับจำนวนการบวกการเสริมน้ำมัน สารบางอย่างอาจ precipitate ด้วยของเหลว อ่านแทรกผลิตภัณฑ์ดังนั้น ก่อนที่คุณเพิ่มเสริมถุงของเหลวบางชนิด สารต่อไปนี้โดยทั่วไปบวกกับของเหลวห้าสิบเปอร์เซ็นต์ขึ้น เมื่อผู้ป่วยมีแนวโน้มที่จะ hypoglycemia ขึ้นอาจเพิ่มของเหลวที่ ขึ้นแห้งเสริมอาจต้องตามผู้ป่วยเพิ่มขึ้นเผาผลาญความต้องการ เช่นผู้ป่วย sepsis หรือเกี่ยวกับ anorexic ขึ้นไม่เพิ่มของเหลวที่เป็นแหล่งแคลอรี่ แต่ทำหน้าที่เป็นแหล่งพลังงานที่มีสมอง โดยทั่วไปมีเพิ่มขึ้นลงของเหลวจะทำให้โซลูชัน 2.5-5 เปอร์เซ็นต์ ถ้าเพิ่มขึ้น 50 เปอร์เซ็นต์ถุง 1000 มล.ของเหลวเพื่อให้แก้ไขปัญหาร้อยละ 2.5, 50 ml ของขึ้น 50 เปอร์เซ็นต์ต้อง เพิ่ม ถ้าเพิ่มขึ้น 50 เปอร์เซ็นต์เพื่อเพิ่ม โซลูชันประกอบด้วย 5 เปอร์เซ็นต์ขึ้นควรจะบริหารในหลอดเลือดดำส่วนกลางผ่านทางตัวกระบอกสูบขนาดใหญ่พัฒนาโปรแกรมฐานข้อมูลPotassium. Potassium is usually supplemented to anorexic and diuretic patients. Potassium is obtained from food and is easily lost in urine. Hypokalemia may result in lethargy, muscle weakness, and vomiting. Potaaium is given IV vai a slow drip to avoid cardiac problems. The normal serum potassium level is 3.5 to 5.5 meq/L . The term miliequivalents(mEq) is used to express the number of ionic charges of each electrolyte on an equal basis. It measures the chemical activity of ions. A milliequivalent is one one-thousandth of an equivalent, which is the weight of an element that will combine with 1 gof h+ . Milliquivalents are based on the molecular weight,valence number , and milligrams of element. When calculating the amount of potassium to give, use mEq/ml as a concentration of 2 mEq/ml . Table 19-2 can be used as a guide to potassium supplementation.Sodium bicarbonate. Sodium bicarbonate is added to fluids to correct acidosis , as sodium bicarbonate has basic properties . Sodium bicarbonate is available in 8 percent and 5 percent concentrations. The amount of sodium bicarbonate added is based on the bicarbonate deficit is determined by subtracting the normal serum bicarbonate value from the patient’s serum bicarbonate value. The bicarbonate deficit . The bicarbonate administration include development of alkalosis and other electrolyte abnormalities. Replacement should be given slowly over several hours to avoid side effectsCalcium. Calcium is given to patients with hypocalcemia due to diseases such as milk fever, eclampsia,and endocrine disorders . Calcium may be in the from calcium gluconate or calcium chloride , or in combination with other eletrolytes such as magnesium, potassium , phosphorus, and dextrose. Calcium is available as calcium gluconate 10 per cent for injection, calcium gluconate 23 percent , calcium chloride 10 percent for injectionVitamin. Water-soluble vitamins may be added to fluid because they are lost rapidly by anorexic or debilitated animals. Vitamin C and B complex are frequently added to fluids. In general, 0.5 ml of B complex is given per 250 ml of fluid. This dose may be doubled in severely debilitated animals. B vitamins can cause pain at the injection site if given SO, so proper restraint is important when administering fluids containing B vitamin.Vitamin C may also be added to the fluids. It is light sensitive and does not have as long a shelf life as some of the other vitamins.How much do we give When calculating fluid replacement therapy , keep in mind that animal require fluids for the following:Rehydration MaintenanceReplacement of ongoing fluid lossesRehydration VolumesDehydeation in animals can cause many health problems . Things to remember with dehydration include:Dehydration effects younger animals much more rapidly than older animals.Older patients with chronic disease require more fluids than other animalsAnimals need more fluids if they are active or if the weather is hot or humid .Drugs such as corticosteroids and diuretics will alter fluid and electrolyte requirements.Animal that have been anaesthetized may require additional water for a few days.Clinically, the amount of fluid needed to correct dehydration deficits can be determined from the degree of skin turgor , capillary refill time (CRT) , and pulse rate and quality . These parameters were listed in tables 19-1 The amount of fluid needed to rehydrate an animal I based on the estimated percent of dehydration . To calculate this value , you take the estimated percent dehydration and multiply it times the weight of the animal in kilograms . this will give you deficit in liters. If you want the value in milliliters, take the estimated percent dehydration , multiply it times the animal’s weight in kilograms , and then multiply it by 1000. When you do thi calculation , the percent dehydration should be in decimal from (for example 10%’5%)It is difficult to replace all hydration deficits in a 14-hour period .If all of the fluid loss due to dehydration is replaced in 24 ours , urinary out put may in crease in an atemp to compensate for the large volume of fluid being given.Maintenance Fluid VolumesMaintenance Fluid is the volume of fluid needed by the animal on a daily basis to maintain body function . Maintenance volumes can be divided into sensible and insensible losses. Sensible losses,which are body water lost in urine and feces, can be measured. Insensible body water losses are normal but not easily measured;such losses occur through sweating, ventilation ,and mucous membrane evaporationMany different values are used for the determination of maintenance fluid volumes; therefore ,consulting with the veterinarian about the preferred volume is necessary . One value typically used is 50 ml/kg/day in adult animals and 110 ml/kg/day in young animals. These values include both sensible and insensible body water lossesOngoing fluid loss volumesAnimals that are losing additional fluid amounts due to vomiting or diarrhea need to have this fluid loss replaced .This number is determined by estimayion. If you have a vomiting dog in the clinic, you can estimate the amount of fluid loss by monitoring the quantity and frequency of vomiting episode. This number is then added to the other numbers described earlier.Page 309How fast do we give it ?The rate of fluid replacement parallels the severity of dehydration . in a clinical setting,the rate fluid replacement tends to be based on the clinical judgment, but some general rules apply.Fluids should be replaced rapidly at first , especially in cases of shock, and then tapered to a maintenance doseRate of replacement of the deficit depends on the cardiovascular and renal status of the patient . If these wo systems are not functioning roperly , the rate of replacement may have to be decreased are not overload these system.
Fluid in put should not necessarily equal output initially; transient imbalance is frequently the optimal course of therapy .Hour-by-hour evaluation is necessary to adjust fluid rates until the patient is stable
Ideally ; fluids should be give over a 2-hour period . Fluids are administered by fluid administration sets that the deliver a constant number of drops/ml of fluid.
Nan make
WHAT DO WE USE TO GIVE IT?
Fluids are administered by fluid bags and bottles attached to administration sets or by fluid infusion pumps. Fluid bags and bottles deliver fluids by gravity, and the rate can be adjusted by the diameter of the administration line delivering the fluids. Administration sets may have roller clamps that can be adjusted to increase or decrease the amount of fluid delivered. Administration sets may also have screw clamps or slide clamps to control the diameter of the administration line. Infusion pumps are machines on which flow rates are set and the total amount to be given is entered. These pumps then give the desired amount of fluid at the desired rate. They can be readjusted when fluid delivery is either too fast or to slow.
KEEPING WATCH
Fluid administration should be monitored to make sure the animal is not getting too much or too little fluid for its needs. Additionally, fluid needs change with the changing health status of the animal. Physical finding such as nasal secretions (increased serous secretions indicate too much fluid), heart rate (tachycardia indicates too much fluid), lung sounds (harsh lung sounds indicate edema from too much fluid), and demeanor of the animal (restlessness may indicate too much fluid) should be monitored regularly. Laboratory values such as hematocrit and total protein can be measured in the clinic to make sure the animal’s hydration status is satisfactory.
The amount of fluid given can be monitored in a variety of ways. Fluid bags and bottles have milliliter increments on them that should be monitored to make sure the animal is receiving the correct amount of fluid over time. White tape may be applied to the bags/bottles to keep track of fluid volume delivered per hour, which is extremely helpful if more than one person is monitoring the fluids. Some administration sets have volume control chambers to allow easier measurement of fluid volumes. Some chambers can be filled with the exact amount of fluid to be delivered for that treatment; when the chamber is empty, the animal has received that volume. Examples of fluid bags and administration sets are shown in Figure 19-2A, B and C.
After the patient has been rehydrated and seems to be improving, the fluid plan is readjusted and only maintenance fluids may be given. Eventually all fluid administration will be stopped, but abruptly stopping fluid may lead to the redevelopment of dehydration due to the increased urine production still being performed by the kid
การแปล กรุณารอสักครู่..
