number 18 fluids

Re: number 18 fluids

ruths — Wed, 18 Mar 2015 07:12:48 GMT

Cats that have licked salty snow -)) Oh and I saw a puppy who was recovering from a head injury and he stopped drinking- SIADH (sudden inappropriate adh release or something). He had very low sodium due to his adh release. So he stopped drinking due to relative low blood osmolarity. Number 18 would have killed him!

Re: number 18 fluids

ruths — Wed, 18 Mar 2015 07:08:11 GMT

I have used it on a number of occasions for congenitally adypsic dogs. I've seen 4 of them! All staffies. They just don't drink and usually get enough fluid from food. If they get hot or go off their food for some reason, then they become dehydrated and have a very high sodium. Then they become neurological. I can't remember exactly what the mix was- but I mixed it with hartmanns and trickled it in! I had one of these animals on daily gruel at home and doing well but something happened and it became severely hypernatraemic again. It went to see another vet and we talked about what they needed to do over the phone. I saw the dog about 5 hrs later in bloody agony - head pressing and screaming. Mannitol sorted it but I don't think I've ever seen such a sore dog. Anyway- I don't think you need to keep a stack of it- but I agree that it's good for hypernatraemic animals- I've also seen cars who have licked salty snow and locked in shed cats as well as the congenital adypsics

Re: number 18 fluids

Hannah Wynne Richards — Tue, 17 Mar 2015 17:12:58 GMT

I suppose it's worth keeping a bag or two for the cat who's been locked in the neighbour's garden shed for a weekend, but it certainly hasn't much routine use.

Wynne

Re: number 18 fluids

David Mills — Tue, 17 Mar 2015 10:55:08 GMT

No18 has its potential uses in animals that deal with salt poorly - mainly cardiac disease, but also renal. It essentially replaces or maintains free water - which, technically, is what is missing in dehydrated animals (i.e. they lose minimal electrolytes compared to the water loss). However, these patients are also most sensitive to fluid overload and secondary problems, being on semwhat of a blood volume/pressure knife edge, and so monitoring has to be close. I believe they are used in people more as a subsitute for drinking water - which a lot of hospitalised patients don't or can't do - and due to humans dealing with intravenous salt more poorly than animals. To call it the 'devils fluid' is a little tabloid for my tastes,

The Hartmanns vs NaCl debate acidosis debate rages still, even in human medicine. No convincing survival benefits of one or the other over each other exist.

Re: number 18 fluids

Martin Atkinson — Tue, 17 Mar 2015 10:43:28 GMT

I have No1 saline, No11 Hartmanns and No3 5% Glucose with 0.9% NaCl. From CPD I've been to, if I had to make the choice of keeping only one fluid it would be No11. It can do no harm in normal animals but as a lot of our sick patients may be slightly acidotic may be of value. The No3 is use for maintenance in patients that are anorexic to give them some nutrition. I understand that hypertonic NaCl may be of value in shock patients to restore circulating volume ASAP but we don't keep it as there is a risk of problems if patients are inadvertently over-infused.

I wouldn't have any problems giving glucose S/C but as we tend to use part used bags for S/C therapy I don't store those with glucose in case of risk of a nice culture growing in them.

Re: number 18 fluids

Gareth C. — Mon, 16 Mar 2015 18:36:45 GMT

Every cpd I have been on says don't use it. It's a human thing I think. Basically it's water the glucose just stops rbc getting lysed at entry point

Re: number 18 fluids

Clive Ansell — Mon, 16 Mar 2015 11:47:05 GMT

There is some good online CPD on fluid therapy on Dechra's website. 6 hours small animal and 6 hours equine if I remember correctly.

I've also used glucose containing fluids given s/c. and have never had any problems or seen any skin sloughs.

Re: number 18 fluids

Hannah Wynne Richards — Mon, 16 Mar 2015 09:15:16 GMT

On 1 CPD course I went on, the speaker (I think Amanda Boag) described No 18 as "the devil's fluid".

Maybe human kidneys are les able to cope with sodium overload.

Wynne

(I ncidentally, I'm succumbing to initial disease, the lecture was on small animal fluid therapy, not sheepdisease!"

Re: number 18 fluids

Thomas Johnson — Mon, 16 Mar 2015 08:39:37 GMT

[quote user="Michael Woodhouse"]

It is used extensively for maintenance in people - they get really excited about sodium overloading.

[/quote]

This was my understanding as well, for a 40kg dog on maintenance fluids you are giving 2 litres of fluids a day, Hartmann's is 0.6% NaCl w/v, so that is 12g of salt a day, and if you're using 0.9% saline that's 18g of salt a day. I suspect as we rarely have animals on fluids for extended periods it's not a problem, but in people on fluids for longer periods of time it's a real concern.

Re: number 18 fluids

Gillian Mostyn — Sun, 15 Mar 2015 20:18:09 GMT

[quote user="Robin Grimmer"] Also fluids containing glucose should never be given sub cut as this can cause a slough. [/quote]

Really? Didn't know that. We use it extensively, often S/C, in various exotics and haven't seen any sloughs. Do you know where the evidence for this came from?

Re: number 18 fluids

Michael Woodhouse — Sun, 15 Mar 2015 19:46:57 GMT

It is used extensively for maintenance in people - they get really excited about sodium overloading. I wouldn't be too worried by 5% glucose sub cut.

We used to keep 5 different fluids in stock. We looked at the evidence and we keep Hartmanns (number 11) and hypertonic (number 20). That is all. Haven't missed the others. Could live without the number 20, but has uses in cows mainly (and for nebulisation). Not missed a colloid. Have the equipment to collect blood and I guess we may do an extra transplant or two where we might have managed with artificial colloid.

Re: number 18 fluids

Robin Grimmer — Sun, 15 Mar 2015 19:36:13 GMT

Yes I don't think this really has any clinical use nowadays. Also fluids containing glucose should never be given sub cut as this can cause a slough. Stick to no 1 or 11.