Newer HES solutions may be administered at higher rates (2 mL/kg/hour) without impacting coagulation. ýõNís'Ž“ADIC/ç2ߕ*¼ Low PCV due to age and/or anemia due to gastrointestinal (GI) bleeding may become evident after fluid therapy. Sullivan LA, Twedt DC, Boscan PL. 0 drops every 10 seconds. Destruction of bone marrow cells results in neutropenia and, to a lesser degree, thrombocytopenia. Blood smear revealed fewer neutrophils than expected, with mild toxic change; this was grossly estimated to be a white blood cell count of 2000 to 3000 (cells/mcL) on 100× magnification. Drip rate. Prognostic value of serum acute-phase proteins in dogs with parvoviral enteritis. Maintenance fluids (dogs, 60 mL/kg/q24h; cats, 45 mL/kg/q24h 12) can be provided as part of the fluid plan when a patient is not eating or drinking, in addition to correcting dehydration and restoring perfu - sion. IV Fluids Shock. Cats: Body weight (kg) 0.75 × 80 = 24-hour fluid requirement in milliliters. Expand intravascular volume and treat shock with IV bolus of fluids; JP received a 120-mL bolus (30 mL/kg). Maintenance fluid rate is 60 ml/kg/day. Use of oseltamivir in the treatment of canine parvoviral enteritis. The hemogram and bone marrow profile of normal neonatal and weanling beagle dogs. Dogs. Translocation of intestinal bacteria, complicated by neutropenia, often leads to bacteremia, endotoxemia, and sepsis. Equine endotoxin antiserum, recombinant human granulocyte-stimulating factor, and antiviral agents (eg, oseltamivir) have not been shown to improve survival or outcome.10-12 In small studies, use of feline interferon has been weakly associated with improved survival; however, this agent is not readily available in veterinary hospitals in the U.S.13,14. Dr. Cohn is a recent past president of the American College of Veterinary Internal Medicine. Provide supplemental fluid support in animals that will be under anesthesia for longer than 30 minutes. Markovich JE, Stucker KM, Carr AH, et al. … JP’s hypoglycemia was more severe than could be attributed to age, cachexia, and decreased food intake. During the remaining period of hospitalization, and after the dehydration deficit had been replaced, fluid rate was decreased to reflect only maintenance needs and ongoing losses. The hospital is very busy and all of the fluid pumps are currently being used by other patients. , DVM, PhD, Diplomate ACVIM (Small Animal Internal Medicine), is a professor of veterinary medicine at University of Missouri in the Department of Veterinary Medicine and Surgery. A bolus of 120 mL (34 mL/kg) of warmed lactated Ringer’s solution was administered over 15 minutes, followed by 33 mL/H (10 mL/kg/H) of lactated Ringer’s solution with 5% dextrose and potassium chloride supplementation. If the vet sent you home with a catheter still in, they may have written instructions on the discharge paper how to treat and how quickly to allow the drip to run. She completed her veterinary training at Cornell University, Angell Animal Medical Center (Boston), and University of Pennsylvania. 1) Daily volume formula: (100 mL for each of the first 10 kg) + (50 mL for each kg between 11 and 20) + (20 mL for each additional kg past 20 kg) = … It is the dedication of healthcare workers that will lead us through this crisis. The dog is no longer vomiting. Calculate the rehydration fluid volume based on the percent dehydration. Therefore, supplemental oxygen was probably not necessary but could have been provided until normoxemia was confirmed. McMichael M, Dhupa N. Pediatric critical care medicine: Physiologic considerations. Kocaturk M, Martínez S, Eralp O, et al. Patients with renal or endocrine disease will likely need higher maintenance fluid rates… Although there are differences between young and adult animals, pediatric patients can still be treated aggressively and respond well to therapy. The small size of these patients should not limit our ability to appropriately treat them. In this patient, canine parvovirus infection had been diagnosed before referral. Her clinical interests are diverse, but she especially enjoys treating pets with infectious disease. Normal rectal temperature in neonates is 96°F ± 1.5°F (35.6°C ± 0.7°C) in the first week of life; then 98.6°F to 100°F (37°C to 38.2°C) in the second and third weeks of life. The dog was estimated to be 9% dehydrated. The Maintenance Fluids Calculator calculates maintenance fluid requirements by weight. 2. Electrolyte depletion was attributed to vomiting and diarrhea. iii. Dehydration or fluid loss is a frequent problem in puppies younger than six weeks. tain regular metabolism. An 18-gauge, 6-cm catheter was placed into the left jugular vein, allowing a minimal volume of blood to be obtained for analysis of packed cell volume (PCV), total solids (TS), blood urea nitrogen (BUN) (Azostix, usa.healthcare.siemens.com), blood glucose (BG), and blood smear. Clinkenbeard KD, Cowell RL, Meinkoth JH, et al. 90 ml/hr The most basic calculation to approxiamte maintenance rate fluids in a dog is: 60mL/kg/day . The physical examination findings of JP upon presentation to the referral facility are listed in Table 1. 90mL/kg IV. Leah A. Cohn, DVM, PhD, Diplomate ACVIM (Small Animal Internal Medicine), is a professor of veterinary medicine at University of Missouri in the Department of Veterinary Medicine and Surgery. After initial treatment, blood was collected in low-volume tubes for routine complete blood count (CBC) and serum biochemical profile (Table 2). Losses should be added to the maintenance fluid rate and provided over 6-12 hours. The dog weighs 80 lbs. The prognosis for canine parvovirus infection is fair to good. To achieve a 7.5% dilution, add 17 ml of the 23% hypertonic saline solution to 43 ml of the colloid solution. The hematopoietic and lymphoid systems. Justine A. Lee, DVM, Diplomate ACVECC & ABT, is the CEO and founder of VETgirl (vetgirlontherun.com), a subscription-based podcast and webinar service that offers RACE-approved veterinary continuing education. However, for a neonate (< 2 weeks of age), oxygen therapy would be recommended. You are asked to start a dog on maintenance fluids. Duffy A, Dow S, Ogilvie G. Hematologic improvement in dogs with parvovirus infection treated with recombinant canine granulocyte-colony stimulating factor. Maintenance fluids represent the amount of fluids needed to meet the metabolic requirements of a patient. The size of the catheter will be determined, placing the largest catheter possible to provide adequate rates of fluid. 2x maint. Calculators for Emergency and Anesthetic drugs, Constant Rate Infusions (CRI), IV Fluid Rates, Chocolate Toxicity, Calorie requirements for dogs and cats and Unit conversion (including Weight, Temperature, Body Surface Area, mg to ug, cc's to ounces's, cm's to inches). Copyright © 2021 Today's Veterinary Practice. Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis. Shock Fluid Therapy i. While JP was able to stand with support, he was extremely weak. Dr. Cohn is a recent past president of the American College of Veterinary Internal Medicine. Drip rate. Factors affecting the occurrence, duration of hospitalization and final outcome in canine parvovirus infection. Hypertonic saline solution is normally diluted with a colloid solution in a 60-ml syringe. Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus. Adult temperatures are reached by 7 weeks of age. However, if you keep it simple, you can develop a tailored fluid therapy plan for you patient that is much better than a blanket ‘twice maintenance’ rate. Hypoglycemia is worsened by anorexia, ongoing losses (eg, vomiting, diarrhea), dehydration, and sepsis. Due to sepsis secondary to leukopenia, antibiotic therapy was initiated (IV initially; then PO once vomiting abated). Not covered by this SOP. What is the true maintenance fluid rate? JP was dewormed with fenbendazole and discharged later that day. The primary care veterinarian performed a recheck examination 3 days later, and reported that JP was acting and eating normally at that time. What is the drug of choice for treating Tritrichomonas foetus in cats: metronidazole, sulfasalazine, Fenbendazole, Sulfadimethoxine, or Ronidazole? a) 125 mL bolus, then 29 mL/hr Marked lymphopenia and neutropenia were seen, typical of parvoviral enteritis. 1. * If result is negative but parvovirus is still suspected, perform polymerase chain reaction on feces. On day 4, JP was presented to the primary care veterinarian, who evaluated him for progressive listlessness, anorexia, continued vomiting, and bloody diarrhea. Doppler blood pressure measurement was attempted, but proved difficult due to the small size of the puppy (pediatric [6- to 8-weeks old] reference range, approximately 112 mm Hg). JP was treated with symptomatic and supportive care (see Typical Supportive Therapies for Parvoviral Enteritis), including provision of warmth and zinc oxide barrier therapy to prevent moist dermatitis. The remaining deficit was corrected over 12 H. 3.5 kg (body weight) × 0.12 (dehydration) = 420 mL fluid deficit, 420 mL (original deficit before fluid bolus) – 120-mL bolus fluid volume = 300 mL, Provide for estimated ongoing loss: JP had frequent diarrhea and vomiting, with an estimated loss of 75 mL Q 24 H; therefore, 75 mL/24 H =, Provide maintenance fluids; fluid requirements for puppies vary with age (, 3.5 kg (body weight) × 80 mL Q 24 H = 280 mL Q 24 H, VetStarch (abbottanimalhealth.com): 2 mL/kg/H. Poor husbandry (eg, lack of vaccination, lack of parasite prevention) often worsens clinical disease. (30cc x kg) + 70cc IV x 2. Cholesterol is often lower in puppies than adult dogs. Insensible loses can increase fluid amounts by 15-20 mL/kg/day. Loss of both intestinal epithelial villous and crypt cells leads to malabsorption and increased intestinal permeability, accompanied by vomiting, diarrhea, and GI bleeding. They also confirmed the puppies had not received any vaccinations. He had been acquired from a flea market and seemed healthy but thin. ii. Woldford ST, Schroer RA, Gohs FX, et al. Neonatal and pediatric care of the puppy and kitten. The total 24-hour fluid requirement for the dehydrated animal is the sum of maintenance volume and volume required to … In the past, fresh or fresh frozen plasma from recovered dogs had been suggested to provide antiparvoviral antibodies. JP’s vital parameters improved markedly over the first few hours of therapy. However, clinicians must be aware of their normal physiologic and hemodynamic measures. Hospitalization with intensive therapy was initially indicated for JP due to his severe hypoglycemia, dehydration, and shock, but a modified outpatient protocol (SC fluids, antiemetics, antibiotics) may be a good alternative for less severely affected patients or clients with financial limitations. • Maintenance fluid rate for an adult dog or cat is estimated as 2mL/kg/hr OR 50mL/kg/24 hours • e.g. Please calculate the total fluids required for Annie for that day. The total 24-hour fluid requirement for the dehydrated animal is the sum of maintenance volume and volume required to … Taking insensible fluid loss into consideration, the 24-hour maintenance volume for a dog or cat whose urine output is normal is approximately 50 to 60 ml/kg (25 to 30 ml/lb) per day. Taking insensible fluid loss into consideration, the 24-hour maintenance volume for a dog or cat whose urine output is normal is approximately 50 to 60 ml/kg (25 to 30 ml/lb) per day. In critically ill neonate and pediatric patients, goals of treatment should be prioritized by the four H’s: Canine parvovirus (CPV) is a common and severe pathogen that affects young dogs that are unvaccinated, under-vaccinated, or immunosuppressed. Fluid requirements for neonates and pediatric patients are much higher than those for adults. These are the two methods for calculating pediatric maintenance fluid rates, applied in the case of a child weighing 26 kg. Basic principles for selection of fluid administration volume and rate in veterinary medicineBy: Duncan C. Ferguson, VMD, PhD, DACVIM, DACVCP While JP was tachypneic—likely secondary to hypovolemia—he was not dyspneic and his lung sounds were clear. Maintenance fluids contain significantly less sodium (such as half-strength saline or 5% dextrose in water) and are intended for animals that have free water loss or require prolonged fluid administration. Over a 20-minute period, dogs should receive 4 to 7 ml/kg of the colloid solution and cats should receive 2 to 4 ml/kg. Multiple units of the maintenance dose (rates 2× or more above the maintenance rate) Shock. Treatment of canine parvoviral enteritis with interferon omega in a placebo-controlled field trial. Relative hemoconcentration was likely due to severe dehydration. 35kg dog: Maintenance = 35kg x 2 = 70mL/hour or 50mL x 35kg = 1750mL/24 hours • Maintenance fluid rate for puppy or kitten may be estimated as 3-4mL/kg/hr • More detailed guidelines are available in the ‘2013 AAHA/AAFP Fluid Therapy They also confirmed the puppies had not received any vaccinations. Maintenance fluid therapy for dogs is 132 x body weight (kg) per 24 hours. Careful warming should be initiated to prevent overheating. Make sure the fluid is clear and the expiration date hasn’t passed already. “A rate of 100-180 ml/kg/day is often used for young animals. McClure V, van Schoor M, Thompson PN, et al. She completed her veterinary training at Cornell University, Angell Animal Medical Center (Boston), and University of Pennsylvania. The day after the owners acquired JP, the puppy began vomiting and, the following day, he had diarrhea. Dehydration can be mild with no clinical signs, or it can be life-threatening, causing shock, circulatory shutdown, and death. The presence of hypovolemic shock and sepsis—caused by dehydration, leukopenia, and intestinal bacterial translocation—is the most life-threatening condition present in JP. What fluid rate do you start on this dog: 150 ml/hr, 90 ml/hr, 45 ml/hr, or 25 ml/hr? Double check it is the correct fluid to be administered. By the following day, he subjectively looked less nauseated and had less abdominal pain. Infusion Rate Calculator 1. Dr. Cohn earned her DVM from University of Tennessee, and completed her residency and PhD at North Carolina State University. Calculation of Maintenance Fluid Requirements* Dogs: Body weight (kg) 0.75 × 132 = 24-hour fluid requirement in milliliters. In critically ill pediatric patients, fluid therapy for shock must initially be given by IV or intraosseous routes. What fluid rate do you start on this dog? Ronidazole. Get the latest peer-reviewed clinical resources delivered to your inbox. “When calculating a fluid rate, the dehydration maintenance rate and ongoing losses are the first considerations,” Butler says. Approximately 10 platelets per high power field were seen on 1000×; this was estimated to be a platelet count of 100,000 to 150,000 (cells/mcL). JP was discharged on day 4, and the owner was taught how to administer medications and encourage JP to eat. Rule of thumb: 2–3 mL/kg/hr. 3. Standard mammalian monitoring techniques apply to dogs. Formula: 80 x body weight (kg) 0.75. The #1 Veterinary Drug Calculator website and the #1 Veterinary Drug Calculator App! JP also had bloody diarrhea staining his ventral abdomen and hindlimbs. In neonate and pediatric patients, the immune system is not fully mature until 3 to 6 months. Colloid volume was subtracted (39.8 mL/H – 7 mL/H), which equaled a crystalloid fluid rate of 33 mL/H. Dimmitt R. Clinical experience with cross-protective anti-endotoxin antiserum in dogs with parvovivral enteritis. Canine parvoviral enteritis. Crystalloid fluid rate for the first 12 hours—after the initial fluid bolus—was calculated by considering: Replacement (25 mL/H) + ongoing losses (3.1 mL/H) + maintenance (11.7 mL/H) = 39.8 mL/H. Appropriate fluid rates range from 5-10 mls/kg/hour, and may vary based on the anesthetic combination. Ishiwata K, Minagawa T, Kajimoto T. Clinical effects of the recombinant feline interferon-omega on experimental parvovirus infection in beagle dogs. A colloid was administered in addition to the crystalloid. (We know there is variability depending on formula you use, so choose the closest answer!) You are asked to start fluids at 180 mL/hr for Charley after giving her a 400 mL bolus. The owners stated that JP had 2 littermates at the flea market that were not as playful as JP. Justine A. Lee, DVM, Diplomate ACVECC & ABT BG was measured every 6 H, with glucose supplementation adjusted as necessary to maintain normoglycemia. 0 drops every 10 seconds. The virus initially replicates in oropharyngeal lymphoid tissues, leading to viremia; rapidly dividing cells of the GI tract, thymus, lymph nodes, and bone marrow are most affected. Effect of age on serum chemistry profile, electrophoresis and thyroid hormones in beagle dogs two weeks to one year of age. IV fluids Maintenance rates are typically calculated using the following formulae: ml/day = 80 × bodyweight (kg)0.75 (cats) ml/day = 132 × bodyweight (kg)0.75 (dogs) Fluid support. Fluid therapy is beset by many misconceptions, so I talked to Dr. Sean Smarick, a board-certified criticalist at AVETS in Monroeville, Pa., to clarify them. Colloids can be used in pediatric patients; however, keep in mind that puppies have a lower colloid osmotic pressure than adult dogs. Cats. The supportive medications and nutrition JP received are outlined in Table 4; daily in-hospital monitoring for parvovirus patients is described in Table 5. Dr. Lee recently received the 2015 NAVC Speaker of the Year Award, and is the author and editor of several veterinary textbooks, book chapters, and scientific publications. Increased alkaline phosphatase, bilirubin, and phosphorus were most likely related to a combination of age and illness. BG = blood glucose; BUN = blood urea nitrogen; CBC = complete blood count; GI = gastrointestinal; PCV = packed cell volume; TS = total solids. How much will you administer? Hi Jacustomer-yplqn0zy~ IV fluids are generally provided in a slow drip while the dog is still vomiting or having diarrhea. Calculate the drip rate for this patient after her bolus is given. Formula: 132 x body weight (kg) 0.75. Hydroxyethyl starch solutions can be administered as a constant-rate infusion at 0.5–1 mL/kg/hour in dogs, or 0.25–1 mL/kg/hour in cats. Recent studies, however, have demonstrated no beneficial effect of this method and shown that even recently recovered animals have minimal anti-canine parvovirus antibody concentrations.8,9 Moreover, such treatment may prime the dog for future transfusion reactions later in life. Koenig A. Colloid osmotic pressure in healthy puppies. All 3 forms of CPV are environmentally stable, nonenveloped viruses transmitted via the fecal–oral route. Due to the life-threatening hypoglycemia, JP received an initial IV bolus of 0.5 g/kg dextrose (3 mL of 50% dextrose diluted in 7 mL of 0.9% saline over 1 minute). Dr. Lee recently received the 2015 NAVC Speaker of the Year Award, and is the author and editor of several veterinary textbooks, book chapters, and scientific publications. Immature skin and kidneys, and high metabolic rate result in increased water loss. For the 40-kg dog: 60 mL X 40 kg = 2400 /24 hours = 100 mL/hr While there are variations in fluid rate calculations, the fluid rate should always be determined based on the hydration Cornell Veterinarians and Physicians Partner for Rare Canine Open-Heart Surgery, Veterinarians Donate Life-Support Ventilators in Coronavirus Response, Minnesota Urolith Center Analyzes 1.5 Millionth Stone and Marks 40 Years of Service, Veterinary Cannabis Society Aims to Empower Through Education, Complete blood count, with smear evaluation, Venous blood gas (eg, acid–base, electrolytes), Serum biochemical profile or venous blood gas (eg, acid–base, electrolytes), along with blood glucose and blood urea nitrogen, BG concentration of 36 mg/dL (pediatric [6- to 8-weeks old] reference interval, 134–272 mg/dL), PCV of 40% (pediatric [6- to 8-weeks old] reference interval, 27%–36%), TS of 4.8 g/dL (pediatric [6- to 8-weeks old] reference interval, 3.9–4.2 g/dL). Neonates:' ' '60]180'ml/kg/day' ' Should Oxygen Be Given During Initial Resuscitation? Effects of canine parvovirus strain variations on diagnostic test results and clinical management of enteritis in dogs. The dosage is adjusted to maintain an adequate mean arterial pressure and CVP. Savigny MR, Macintire DK. Kalli I, Leontides LS, Mylonakis ME, et al. Neonates and pediatric patients are prone to hypoglycemia due to decreased glycogen stores, inefficient hepatic gluconeogenesis, and an immature glucose feedback mechanism. Fluid rate (ml/hr) Drops/ml of giving set. Her clinical interests are diverse, but she especially enjoys treating pets with infectious disease. In Bonagura JD, Twedt DC (eds): Bragg RF, Duffy AL, Dececco FA, et al. Recommended maintenance fluid rates (mL/kg/hr)49. Perhaps surprisingly, severity of neutropenia is not a negative prognostic factor; rather, severity of dehydration and lymphopenia may be instead.15 Recently, several studies have evaluated other measures that may affect prognosis.16-18, A study from Colorado State University compared standard in-hospital treatment versus a modified outpatient treatment (using volume resuscitation followed by SC fluid therapy and supportive care), with recent survival rates of 80% to 90% reported with treatment.19 Both protocols can be successful, with a slightly lower survival rate in outpatients.19. A potent antiemetic was initiated to treat nausea and minimize risk for aspiration pneumonia. Veir JK. Monitoring. This is an unprecedented time. Web Design by PHOS Creative, https://todaysveterinarypractice.com/table-of-contents-may-june-2021/. Clinical evaluation of a single dose of immune plasma for treatment of canine parvovirus infection. VETgirl (vetgirlontherun.com), Leah A. Cohn, DVM, PhD, Diplomate ACVIM (Small Animal Internal Medicine) Without treatment, CPV can be life threatening due to sepsis, severe fluid losses and electrolyte derangements secondary to anorexia, vomiting, and diarrhea. University of Missouri. Fluid rate (ml/hr) Drops/ml of giving set. SNAP Parvo Test (idexx.com) results were positive, and JP was referred to another facility that had an isolation unit and provided 24-hour care. Prior to opening the protective outer bag, check for leaks and damage. Traditional shock doses cited are 90 mL/kg for dogs and 60 mL/kg for cats, though these numbers represent the total estimated blood volume of a patient and can lead to volume overload, especially if the patient has reasons to be less tolerant of fluid administration (heart disease, for example).