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02/05/2016

FLUID THERAPY IN THE RENAL PATIENT




Because of their reduced ability to concentrate urine, dogs and cats with chronic kidney disease are at risk dehydration. While in the early stages of chronic kidney disease the increased intake of drinking water (compensatory polydipsia) allows the maintenance of a correct hydration, as the disease worsens  and / or in the presence of vomiting and diarrhea, the amount of water taken by mouth can not be enough to replace lost fluids and the patient may become dehydrated.

In dogs and cats, dehydration is associated with weakness, lethargy, decreased physical activity and decreased appetite.

If the dog or cat are severely dehydrated, the kidneys can also be suffering from the loss of fluid in the organism; a lesser amount of blood will get the kidney, which will further reduce its filtering capacity, causing an additional accumulation of uremic toxins and an increase in blood creatinine and BUN values.

For the reasons described above, dehydration should never be underestimated and, if diagnosed, must be resolved urgently.

When a patient is dehydrated, the correction of dehydration and the restoration of a good state of hydration are based on the administration of fluids (on the balance between fluid intake and body fluids lost / deleted).

The easiest way to replace fluids lost or deleted is by mouth, through drinking water and liquids contained in foods; the replacement through food and drinking water (which intake can also be encouraged by the owner) can take place if the dog or cat is fed adequately and are clinically stable.

In severe cases, when the patient is not stable, because of severe dehydration, treatment should be immediate and chosen fluids will be administered by your veterinarian intravenously.

In the presence of a stable patient, but that tends to dehydrate chronically, the liquid may be replaced by mouth, through the use of rehydration solutions, or subcutaneously. Subcutaneous fluid therapy is the most common solution, especially for cats with chronic kidney disease at an advanced stage.

The choice of the fluid to be administered is always up to your veterinarian, and depends on many factors including body electrolytes (such as sodium, chloride, potassium) of which the patient needs and the route of administration selected (the main ones are intravenous, subcutaneous and oral).

A balanced electrolyte solution such as Ringer's Lactate is the one most commonly used and the dosage and the interval of administration of the fluid depend on the needs and the patient's size.

In any case, your veterinarian will define the type of fluid to be administered, its amount and how often to give it to your cat or dog.

It’s important to underline that, as well as any grades of dehydration require prevention and proper treatment, so the continuous administration of fluids should be carefully monitored. Dogs and cats with chronic kidney disease may in fact be at risk of fluid retention and in some cases may have as many serious complications if administered fluid is not appropriate or is administered to an incorrect dosage.

WHY? Fluid therapy is useful to correct patient’s dehydration or electrolyte abnormalities (eg sodium, potassium, chloride). Patient's fluid balance to be replaced.

CAN IT BE DANGEROUS? A fluid therapy set incorrectly can cause fluid and electrolyte overload, or may fail to correct the problems initially evaluated. The veterinarian will define what kind and what quantity of fluids to administer.

WHAT ARE THE ROUTES OF ADMINISTRATION OF FLUIDS? The first route to consider is always the oral one. In some cases, the veterinarian may recommend the administration of subcutaneous fluids. The intravenous route is usually preferred in the case of severe dehydration.

TIPS If the patient undergoes the therapy at home(for example, for subcutaneous administration of fluids).

- Bring fluids to body temperature to avoid discomfort during their administration.

- Do not give fluids too quickly.

- Use a new needle every time you administer fluids.

- Do not give fluids if you even suspect that may have been contaminated.



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