Fluid therapy, and electrolyte and acid–base abnormalities

image of Fluid therapy, and electrolyte and acid–base abnormalities
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Abnormalities in electrolytes and in fluid and acid–base balance are commonly seen in surgical patients. Abnormalities may be due to the primary surgical disease process, concurrent illness or surgical intervention. This chapter focuses on identification of fluid, electrolyte and acid–base disturbances, their pathophysiology and treatment. The following topics are considered: Fluid therapy; Fluid therapy options; Electrolyte abnormalities; and Acid-base abnormalities.

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10.1 Contributions of different body fluid compartments and dry matter to total body weight. Note that approximately 60% of the mass of a healthy adult dog or cat is fluid; approximately 65% of that fluid is within the cells and 35% is extracellular. The extracellular fluid is mostly (75%) interstitial (fluid which surrounds the cells), with 25% being within the vessels.
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10.2 Physical examination findings such as loss of skin turgor, sunken eyes and dry mucous membranes are often cited as identifying features of dehydration, but they are subjective and often inaccurate.
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10.5 Pulse profiles from direct arterial pressure measurements.
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10.8 Hypoproteinaemic animals may become oedematous. Administering colloid instead of crystalloid fluids in these patients is useful to increase the colloid osmotic pressure, thereby retaining water within the intravascular space and reducing interstitial fluid overload.
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10.11 Dog with large burn wounds covering the forelimbs, hindlimbs, chest and pectoral region. A jugular catheter was placed to administer intravenous crystalloid and colloid fluids to treat the dog for the large volumes of fluid and protein being lost through the burn wounds. (Courtesy of V Lipscomb)
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10.14 ECG trace from a hyperkalaemic cat. Note the large T waves (red arrows) and wide QRS complexes (blue arrows). ECG from the same cat after calcium gluconate therapy. T waves are now smaller and QRS complexes narrower.
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10.18 Cat with hypocalcaemia receiving a calcium gluconate infusion 3 days after bilateral thyroidectomy. The cat had become depressed and displayed twitching and facial rubbing clinical signs.
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10.22 Changes in bicarbonate, base excess and carbon dioxide seen with simple acid–base disorders. Primary changes are demonstrated by the red arrows, with compensatory responses demonstrated by the blue arrows. Note that reference values provided are for venous blood ( ).
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