Source of 0.45% NaCl?

Re: Source of 0.45% NaCl?

tess — Wed, 26 Sep 2012 10:35:30 GMT

[quote user="robloxley"]

I was taught "Hartman's unless you can think of a good reason why not".

[/quote]

Same here.

Re: Source of 0.45% NaCl?

Rob Loxley — Tue, 25 Sep 2012 22:52:57 GMT

I was taught "Hartman's unless you can think of a good reason why not".

Re colloids, the theory sounds good but the more I read it doesn't seem to be borne out in practice, but then I'd hardly claim to be an ECC guru

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 20:22:17 GMT

[quote user="David Mills"]Gosh, we do overthink this whole fluid thing don't we? [/quote]Probably - yes. But some animals do need a bit more thought than being bunged on whichever fluid is hanging around ;)

[quote user="David Mills"]It distinctly doesn't worsen anything, and we've found it normalises paramters in urethral obstruction cases more quickly and consistently than Hartmann's.[/quote]

I'm sure you're familiar with the paper looking at hartmans vs 0.9% NaCl in urethral obstructions. They both helped equally to bring down K+ but hartmans was better for the acidemia associated with the condition as it was not acidifying like NaCl. Since then I use Hartmans for this condition too.

[quote user="David Mills"]In cases of increased vascular permeavbility such as sepsis they may even worsen circulating volume by translocating to the interstitium[/quote]

Maybe... maybe not. Depends on size of colloid molecule you put in and what sizes are leaking (how big the holes are) and how much. But as a means of expanding plasma volume they are definitely better than crystalloids ml for ml. There's definitely 'camps' and I am more in the colloid camp - there is some recent info on crystalloids potentially being deletrious in large volumes (As we would use in sepsis) but that's for another forum discussion (maybe!).

[quote user="David Mills"]I've never seen any issue with the theoretical, non-clinically relevant NaCl acidifying properties[/quote]

I find it does acidify - based on blood gases- and patients feel better when they aren't being acidified or when their acid base disturbance is corrected/brought towards normal. I'd disagree with it being theoretical and non clinically relevant- though I can accept for patients that are relatively well and getting fluids say for periop use or for a short period of time/to correct mild fluid losses either fluid would be acceptable- because the body can deal with the excesses and 'keep' what it needs pretty well.

Just my 2c.

Re: Source of 0.45% NaCl?

David Mills — Tue, 25 Sep 2012 19:32:21 GMT

[quote user="Rajat"]

[quote user="Martin Atkinson"] I was about to post exactly the same. We use 0.9% saline for nearly everything, but have some 0/9% saline with 5% glucose for animals that haven't been eating well and Hartmanns for the odd acidotic case but given I don't have a means of measuring acidosis its on a wing and a prayer and based on best guess and the assumption its unlikely to do any harm.[/quote]

NaCl 0.9% is pretty acidifying and given most hypovolemic patients have some degree of metabolic acidosis due to poor perfusion and it only worsens with worsening hypovolemia (and maybe dehydration) that I think it makes more sense to do the reverse - use hartmans for everything and 0.9% Nacl for cases with marked chloride loss e.g. upper GI obstruction or addisons (or hyperkalemia). Also hartmans has some bicarb and potassium that 0.9%NaCl doesn't - though not very much. (Hey at least it wont cause potassium loss like NaCl will ! )

Best

Raj

[/quote]

Gosh, we do overthink this whole fluid thing don't we? I've never seen any issue with the theoretical, non-clinically relevant NaCl acidifying properties - it is perfectly adequate as a main fluid replacement source. It distinctly doesn't worsen anything, and we've found it normalises paramters in urethral obstruction cases more quickly and consistently than Hartmann's.

As for Hartmann's. any over-perfusion of any fluid will cause K+ loss.

We don't use colloids. It's not a cost thing, but they're use has no convincing evidence behind them in either veterinary or medical literature. In cases of increased vascular permeavbility such as sepsis they may even worsen circulating volume by translocating to the interstitium. We simply use crystalloids and, occasionally, whole blood in FBAs etc. Choice of fluids is pretty arbitrary really.

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 18:54:13 GMT

Best

Raj

Re: Source of 0.45% NaCl?

Martin Atkinson — Tue, 25 Sep 2012 18:43:45 GMT

[quote user="Michael Woodhouse"]We used to keep about 4 different fluids and I went to a CPD event a few years ago and the strong message was that most of them were not needed![/quote] I was about to post exactly the same. We use 0.9% saline for nearly everything, but have some 0/9% saline with 5% glucose for animals that haven't been eating well and Hartmanns for the odd acidotic case but given I don't have a means of measuring acidosis its on a wing and a prayer and based on best guess and the assumption its unlikely to do any harm.

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 18:40:06 GMT

[quote user="Michael Woodhouse"] I cannot quote papers but they had references to human patients (IIRC) given artificial colloids doing worse in trauma and sepis that adequate dosages of crystalloids alone.[/quote]

As far as I know, all the trials looking at this have found no major differences between colloids and crystalloids. there is still debate in human ECC about this as there is in veterinary ECC. Personally I prefer crystalloids for initial volume resuscitation and in sepsis/septic shock I almost always end up using colloids. I agree with you tho that vast majority of cases are ok with hartmans - if one is into fluids and trying to fine tune the therapy better then for maintenance we would use something like normosol-M and obviously with certain diseases 0.9% Nacl is useful as are lower sodium fluids to finely treat certain lyte disturbances etc. but most of the time I reach for hartmans. Tho it is isotonic it is lower sodium than average dog (144) and cats (150 upto 155 for some texts) plasma.

Re: Source of 0.45% NaCl?

Michael Woodhouse — Tue, 25 Sep 2012 18:11:28 GMT

We used to keep about 4 different fluids and I went to a CPD event a few years ago and the strong message was that most of them were not needed!

We just keep Hartman's now and use it for everything - used to also keep 0.9% saline, glucose/saline and colloid. I cannot quote papers but they had references to human patients (IIRC) given artificial colloids doing worse in trauma and sepis that adequate dosages of crystalloids alone. Can't say I have missed them.

(I do sometimes make up hypertonic saline for cows using table salt, tap water and the garden sprayer, but that is nor especially relevant here.....)

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 17:33:17 GMT

[quote user="Thomas Johnson"]I was under the impression that the glucose made it isotonic, and that the 0.18% saline was enough for maintenance, I'll have to see if I've still got Polly Taylor's notes at home and check![/quote]

I think this will be primarily free water that we are giving the animal..and would prob be ok at low rates if we need to replenish free water i.e. only free water loss leading to relative increase in sodium concentrations (or diseases where sodium retention is a problem) - but as a replacement fluid (tonicity and lytes should be equal to plasma) it isn't and as a maintenance fluid (tonicity=E CF) it still isn't IMHO - but happy to be corrected if anyone has other ideas!

Cheers

Raj

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 17:19:49 GMT

Wynne that was my understanding with 0.45% but wasn't sure if it still applied to 0.18%. Will dig around some books and report back if anything interesting crops up.

Re: Source of 0.45% NaCl?

Hannah Wynne Richards — Tue, 25 Sep 2012 16:37:26 GMT

It's isotonic as it enters the animal-but as the glucose is metabolised it rapidly becomes very hypotonic

Wynne

Re: Source of 0.45% NaCl?

Thomas Johnson — Tue, 25 Sep 2012 15:46:04 GMT

[quote user="Rajat"]

[quote user="Thomas Johnson"]What would be the advantage of 0.45% saline over 0.18% saline and 4.0% glucose (Aqupharm 18)?[/quote]

That's wayyyy too hypotonic and very low sodium levels. Not sure that glucose makes it isotonic the same way it does for 0.45% [would have to look it up], and I have never used 0.18% Na fluids. I remember being taught it was the devil's fluid (by Dez hughes, a true ECC genius - due to potential for hyponatremia and brain swelling+ death if used instead of a regular replacement/maintenance fluid at regular rates.

[/quote]

I was under the impression that the glucose made it isotonic, and that the 0.18% saline was enough for maintenance, I'll have to see if I've still got Polly Taylor's notes at home and check!

Re: Source of 0.45% NaCl?

Rajat — Tue, 25 Sep 2012 15:17:28 GMT

[quote user="Thomas Johnson"]What would be the advantage of 0.45% saline over 0.18% saline and 4.0% glucose (Aqupharm 18)?[/quote]

Re: Source of 0.45% NaCl?

Hannah Wynne Richards — Tue, 25 Sep 2012 14:43:41 GMT

I'm obviously not the only one who gets decimal points mixed up

Wynne

Re: Source of 0.45% NaCl?

Thomas Johnson — Tue, 25 Sep 2012 14:21:25 GMT

[quote user="Rajat"]

Hi Martin

I thought you'd never ask ;)

Low sodium fluids are often helpful for patients who handle sodium poorly such as those in CRF CHF where plasma expansion is less desirable but one wants to replenish the interstitial space- obviously hypotonic fluids need to be used cautiously - but select cases do benefit from them - additionally any case with a sodium disturbance may benefit from it to help bring the sodium down - albeit slowly!

[/quote]

What would be the advantage of 0.45% saline over 0.18% saline and 4.0% glucose (Aqupharm 18)?

Re: Source of 0.45% NaCl?

Martin Atkinson — Tue, 25 Sep 2012 11:56:23 GMT

[quote user="Hannah Wynne Richards"]

Totally ignore what I wrote above I thought you meant HYPERtonic saline

Wynne

[/quote] yet someone still gave you 5 stars for your first post

Re: Source of 0.45% NaCl?

Hannah Wynne Richards — Tue, 25 Sep 2012 10:26:35 GMT

Totally ignore what I wrote above I thought you meant HYPERtonic saline

Wynne

Re: Source of 0.45% NaCl?

Rajat — Mon, 24 Sep 2012 18:35:49 GMT

Hi Martin

I thought you'd never ask ;)

I have previously made them up with putting sterile water into a bag of NaCl 0.9% having removed half its volume first- but TBH its a pain - and if I can source the 0.45% that'd be ideal - and seems NVS may magically have them again! Yay!

Thanks for your help folks

Re: Source of 0.45% NaCl?

Rajat — Mon, 24 Sep 2012 18:29:38 GMT

Thanks Luke I will check them out

Re: Source of 0.45% NaCl?

Martin Atkinson — Mon, 24 Sep 2012 10:53:06 GMT

I'm interested to know why you would need it Rajat.

Re: Source of 0.45% NaCl?

Luke Edwards — Fri, 21 Sep 2012 20:58:31 GMT

Rajat,

If you are still struggling, might be worth directly contacting the company "Fresenius -Kabi". they seem to make all manner of infusions.

Luke

Re: Source of 0.45% NaCl?

Tim Cheyne — Fri, 21 Sep 2012 20:12:33 GMT

Is it not possible to dilute 'normal' (0.9%) saline with sterile 'pyrogen-free water for injection', or am I missing something?

Tim.

Re: Source of 0.45% NaCl?

Michael Woodhouse — Fri, 21 Sep 2012 19:22:49 GMT

SOD.CHL 0.45%+GLUCOSE 5% 500ML listed on Dunlops

Re: Source of 0.45% NaCl?

Rajat — Fri, 21 Sep 2012 18:42:53 GMT

Thanks Wynne, will wait and see if any of the SA vets here are using it or else will try an equine vet.. I hardly use it, but now have a kitty who could do with it and can't seem to source it from anywhere!

Re: Source of 0.45% NaCl?

Hannah Wynne Richards — Fri, 21 Sep 2012 15:55:10 GMT

Mainly used in equine work so maybe what they mean is they can't get small bags-or maybe temporary supply prob

Wynne