Retrospective evaluation of and risk factor analysis for presumed fluid overload in cats with urethral obstruction: 11 cases (2002–2012)

Ostroski, Cassandra J.; Drobatz, Kenneth J.; Reineke, Erica L.

doi:10.1111/vec.12631

Cited by 24 publications

(19 citation statements)

References 22 publications

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“…2,53 Bolus IV fluid therapy has been associated with the development of pulmonary edema in a population of cats with urethral obstruction as well. 54 Although the median volume of resuscitative fluids administered in that report (18.8 [55][56][57][58][59] Additionally, the site of DBP recording varied throughout the cases in this study and is thus associated with a margin of error pertaining to different measurement sites. [59][60][61] However, DBP is generally accepted as the most reliable blood pressure technique in hypotensive cats when a rapid BP measurement is needed.…”

Section: Discussionmentioning

confidence: 99%

“…Cats are particularly prone to this potential complication of resuscitative therapy, 2,48,49 which has been attributed to their smaller blood volume per kilogram of body weight, 2,48 the inadvertent use of the canine‐derived shock fluid doses, 48 anemia of chronic disease, 2,50 occult cardiac disease, 2,51,52 and the role of the lung as the shock organ in cats 2,53 . Bolus IV fluid therapy has been associated with the development of pulmonary edema in a population of cats with urethral obstruction as well 54 . Although the median volume of resuscitative fluids administered in that report (18.8 mL/kg) was similar to the current study (20 mL/kg), only 3 cats (4%) were suffering from urethral obstruction in the current study.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012–2019)

Chalifoux

Hess

Silverstein

2021

J Vet Emergen Crit Care

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Objective: To evaluate the effectiveness of intravenous fluid resuscitation in hypotensive cats in an emergency room setting. Secondary objectives were to investigate changes in heart rate (HR) and body temperature (BT) in response to fluid resuscitation, and the association of these changes with patient survival.Design: Retrospective study.Setting: University teaching hospital. Animals: Eighty-two cats with confirmed hypotension. Interventions: None.Measurements and main results: Medical records from 2012 to 2019 were searched for cats that had documented systemic arterial hypotension (blood pressure measured using a Doppler ultrasonic flow probe [DBP] < 90 mm Hg) on presentation to the emergency room. Data collected included patient characteristics and DBP, HR, and BT before and after fluid resuscitation, type and volume of fluids administered, and outcome. The median DBP before and after resuscitative fluid therapy in all cats was 65 mm Hg (range, 20-85 mm Hg) and 80 mm Hg (range, 20-128 mm Hg), respectively (P < 0.001). However, only 30 cats (37%) were classified as responders to fluid resuscitation (DBP ≥ 90 mm Hg following bolus therapy). The mean HR and median BT before resuscitative fluid therapy was 159/min and 36.7 • C. Following fluid resuscitation, where measured, the mean HR and median BT was 154/min (P = 1.00) and 35.9 • C (P = 1.00). No significant differences in HR and BT were identified between responders and non-responders. Cats had a low survival rate of 7%. All survivors (n = 5) were initially bradycardic (HR < 160/min), compared to only 45% of non-survivors (P = 0.4). Conclusions:Bolus fluid resuscitation effectively increases blood pressure in hypotensive cats; however, it does not result in normalization of blood pressure, HR, or BT in the majority of cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012–2019)

Chalifoux

Hess

Silverstein

2021

J Vet Emergen Crit Care

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“…When difficulty or inability to aspirate the catheter was encountered, forceful flushing of the catheter with small volumes of 0.9% normal saline was first attempted. If saline flush was unsuccessful in restoring catheter flow, tissue plasminogen activator 10 (1 mg/mL) was instilled into the partially occluded catheter lumen (0.23 mL) and aspiration was reattempted after a 1-h dwell time. When required, replacement of central venous catheters was performed at least 24 h prior to the next scheduled experiment using similar technique and general anesthesia protocol.…”

Section: Instrumentationmentioning

confidence: 99%

“…Extrapolation of data across species is less than ideal as there may be critical species variations in body water physiology and fluid dynamics associated with different IV solutions. Fluid therapy has the potential to result in fluid overload that increases morbidity and mortality (8,9), especially in cats (10), yet little evidence exists to support current fluid administration practices in this species (7). The landmark publication reporting increased mortality following standard fluid boluses in African children with severe infection (11) took the medical profession by surprise and subsequently raised many questions regarding our understanding of fluid pharmacokinetics (PK).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats

et al. 2020

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This prospective, randomized, blinded, interventional cross-over study investigated the distribution, elimination, plasma volume expansion, half-life, comparative potency, and ideal fluid prescription of three commonly prescribed intravenous (IV) fluids in 10 healthy conscious cats using volume kinetic analysis that is novel to veterinary medicine. Each cat received 20 mL/kg of balanced isotonic crystalloid (PLA), 3.3 mL/kg of 5% hypertonic saline (HS), and 5 mL/kg of 6% tetrastarch 130/0.4 (HES) over 15 min on separate occasions. Hemoglobin concentration, red blood cell count, hematocrit, heart rate, and blood pressure were measured at baseline, 5, 10, 15, 20, 30, 40, 50, 60, and every 15 min until 180 min. Urine output was estimated every 30 min using point-of-care bladder ultrasonography. Plasma dilution derived from serial hemoglobin concentration and red blood cell count served as input variables for group and individual fluid volume kinetic analyses using a non-linear mixed effects model. In general, the distribution of all IV fluids was rapid, while elimination was slow. The half-lives of PLA, HS, and HES were 49, 319, and 104 min, respectively. The prescribed fluid doses for PLA, HS, and HES resulted in similar peak plasma volume expansion of 27–30%. The potency of HS was 6 times higher than PLA and 1.7 times greater than HES, while HES was 3.5 times more potent than PLA. Simulation of ideal fluid prescriptions to achieve and maintain 15 or 30% plasma volume expansion revealed the importance of a substantial reduction in infusion rates following initial IV fluid bolus. In conclusion, volume kinetic analysis is a feasible research tool that can provide data on IV fluid kinetics and body water physiology in cats. The rapid distribution but slow elimination of IV fluids in healthy conscious cats is consistent with anecdotal reports of fluid overload susceptibility in cats and warrants further investigation.

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“…In hemodynamically unstable patients, IV fluids are administered to increase cardiac output (CO) and improve tissue perfusion (1). However, in humans, cats, and dogs both insufficient and excessive IV fluid administration are associated with increased morbidity and mortality (2)(3)(4)(5)(6)(7)(8). In human medicine, recommendations have historically focused on the rapid and efficient administration of fluids (referred to as "fluid loading"), however, over the past few decades mounting evidence has demonstrated the negative effects of overzealous fluid therapy ("fluid overload") (5,6,(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Volume Status and Fluid Responsiveness in Small Animals

Boysen

Gommeren

2021

Front. Vet. Sci.

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Intravenous fluids are an essential component of shock management in human and veterinary emergency and critical care to increase cardiac output and improve tissue perfusion. Unfortunately, there are very few evidence-based guidelines to help direct fluid therapy in the clinical setting. Giving insufficient fluids and/or administering fluids too slowly to hypotensive patients with hypovolemia can contribute to continued hypoperfusion and increased morbidity and mortality. Similarly, giving excessive fluids to a volume unresponsive patient can contribute to volume overload and can equally increase morbidity and mortality. Therefore, assessing a patient's volume status and fluid responsiveness, and monitoring patient's response to fluid administration is critical in maintaining the balance between meeting a patient's fluid needs vs. contributing to complications of volume overload. This article will focus on the physiology behind fluid responsiveness and the methodologies used to estimate volume status and fluid responsiveness in the clinical setting.

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Retrospective evaluation of and risk factor analysis for presumed fluid overload in cats with urethral obstruction: 11 cases (2002–2012)

Cited by 24 publications

References 22 publications

Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012–2019)

Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012–2019)

Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats

Assessment of Volume Status and Fluid Responsiveness in Small Animals

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