Reduced ability to concentrate urine, poor body condition and the content of body fats as well as vomit and diarrhea are the main reasons of dehydration in either dogs and cats with CKD. In course of dehydration, blood flow to the kidney can be reduced with increasing of renal parameters and worsening of the patient’s clinical condition . Treatment of dehydration should avoid fluid overload while correcting patient’s electrolytes imbalance. A good nutritional status is the key in these patients, as malnourished animals with low fatty content might show a relevant redistribution of fluids throughout the vascular bed.
Azotemic, dehydrated and malnourished patients should be considered really unstable, with a clinical picture that can change very quickly in association with severe complications. For these reasons, in most dehydrated patients hospitalisation is the only way to get a correct management, also in order to guarantee both clinical and laboratory monitoring which can influence the clinical outcome. Fluid administration, to be chosen based on the electrolytic and metabolic condition of patients, should be associated with therapies able to control concurrent morbidities such as vomit and diarrhea. Attention should be put to avoid patients with CKD to develop dehydration, particularly:
Domiciliary administration of fluids, subcutaneously, can be useful in patients with poor nutritional status, not eating or drinking enough. The daily amount of fluids to be administered is based on urine output, water intake and concurrent loss of fluids through vomit and/or diarrhea. Veterinarian will define type and amount of fluids to be administered, depending on electrolyte abnormalities (e.g. sodium, chloride and potassium) and acid base balance of the patient. Ringer Lactate is one of the most common used fluid; dosage and frequency of administration depend on patients’ needs and size. In any case, Veterinarians are the only ones who can decide type and rate of fluids to be administered. Owners, as well, should report any discomfort of the patient during the treatment, as well as pain at the administration site and liquid retention in the subcutaneous district.
There is evidence that a correct hydration, together with a good nutritional status, reduces the risk of death because of uremic crisis in both dogs and cats with chronic kidney disease. Fluid therapy should be instituted under veterinary control, strictly.