What are the primary uses of Hetastarch. How does Hetastarch work in the body. What are the most common side effects of Hetastarch. Who should avoid using Hetastarch. How is Hetastarch administered and dosed. What precautions should be taken when using Hetastarch. How does Hetastarch interact with other medications.

Understanding Hetastarch: A Vital Plasma Volume Expander

Hetastarch, also known by its brand name Hespan, is a crucial medication used in medical emergencies and surgical settings. This synthetic colloid solution is derived from natural starch sources and plays a pivotal role in maintaining blood volume in critical situations. How does Hetastarch work in the body? It functions as a plasma volume expander, effectively increasing the amount of fluid in the bloodstream. This action is essential for circulating oxygen-carrying red blood cells throughout the body, particularly in cases of severe blood loss or shock.

The Science Behind Hetastarch

Hetastarch’s effectiveness lies in its molecular structure. The large molecules of hydroxyethyl starch remain in the bloodstream longer than other fluids, helping to maintain blood pressure and organ perfusion. This property makes it particularly valuable in emergency situations where rapid volume expansion is necessary.

Primary Uses and Applications of Hetastarch

Hetastarch is primarily used to treat or prevent hypovolemia, a condition characterized by decreased blood plasma volume. What specific medical conditions benefit from Hetastarch treatment?

• Shock resulting from severe injury or trauma
• Significant blood loss during surgery
• Burn injuries causing fluid depletion
• Other traumatic conditions leading to plasma volume loss

In these scenarios, Hetastarch helps to quickly restore blood volume, ensuring adequate circulation and preventing organ damage due to insufficient blood flow.

Critical Side Effects and Safety Concerns

While Hetastarch can be life-saving, it’s crucial to be aware of potential side effects. What are the most serious adverse reactions associated with Hetastarch use?

• Allergic reactions: Symptoms may include hives, difficulty breathing, and facial swelling
• Kidney damage: Manifesting as swelling, rapid weight gain, or changes in urination
• Bleeding disorders: Increased risk of bruising or uncontrolled bleeding
• Severe skin reactions: Rare but potentially serious, including fever and blistering rashes

Healthcare providers must carefully monitor patients receiving Hetastarch for these and other potential complications. Prompt recognition and management of side effects are crucial for patient safety.

Monitoring Kidney Function

Of particular concern is the potential for Hetastarch to harm kidney function. Patients should be closely monitored for signs of kidney damage, including changes in urine output, swelling, and unexplained fatigue. Early detection of kidney issues is essential for preventing long-term complications.

Contraindications and Precautions

Who should avoid using Hetastarch? The medication is contraindicated in several conditions:

• Individuals with bleeding or blood clotting disorders
• Patients with pre-existing kidney disease
• Those diagnosed with congestive heart failure
• People with urination problems not related to hypovolemia
• Individuals with known allergies to corn or hetastarch

Additionally, caution is advised for patients with liver disease or a history of heart problems. Healthcare providers must carefully evaluate a patient’s medical history before administering Hetastarch.

Hetastarch in Pregnancy and Breastfeeding

The use of Hetastarch during pregnancy and breastfeeding requires careful consideration. How is Hetastarch classified for use in pregnancy? The FDA categorizes it as Pregnancy Category C, indicating that potential risks to the fetus cannot be ruled out. Pregnant women should only receive Hetastarch if the potential benefits clearly outweigh the risks.

For breastfeeding mothers, the safety of Hetastarch is not well-established. It’s unknown whether the medication passes into breast milk or could affect a nursing infant. Healthcare providers should be informed of pregnancy or breastfeeding status before administering Hetastarch.

Administration and Dosage Guidelines

How is Hetastarch administered and dosed? Hetastarch is typically given intravenously in a controlled medical setting. The dosage is carefully calculated based on the patient’s condition, body weight, and specific medical needs. It’s crucial that Hetastarch is administered only by qualified healthcare professionals who can monitor the patient’s response and adjust the treatment as necessary.

Typical Dosing Protocol

While specific dosages may vary, a general guideline for Hetastarch administration is as follows:

1. Initial dose: Usually 500 to 1000 mL for adults
2. Maximum daily dose: Generally not exceeding 1500 mL per day
3. Infusion rate: Typically adjusted based on the patient’s hemodynamic response

Healthcare providers must carefully balance the benefits of volume expansion against the risks of fluid overload and other potential complications.

Interactions and Precautions

What precautions should be taken when using Hetastarch? Patients and healthcare providers should be aware of potential drug interactions and take necessary precautions:

• Avoid concurrent use with medications that increase bleeding risk
• Monitor carefully when used with drugs that affect kidney function
• Be cautious with simultaneous administration of other volume expanders

How does Hetastarch interact with other medications? While specific drug interactions are not well-documented, the potential for additive effects on blood coagulation and renal function should be considered. Patients should inform their healthcare providers of all medications, including over-the-counter drugs and supplements, to minimize the risk of adverse interactions.

Long-term Considerations and Follow-up Care

After receiving Hetastarch, patients require careful monitoring and follow-up care. What should patients expect in terms of long-term effects and monitoring? Healthcare providers typically focus on:

• Assessing kidney function through regular blood and urine tests
• Monitoring for signs of fluid overload or electrolyte imbalances
• Evaluating coagulation parameters to ensure normal blood clotting
• Watching for delayed allergic reactions or other adverse effects

Patients should be educated about potential delayed side effects and instructed to report any unusual symptoms promptly. Long-term follow-up may be necessary, especially for patients who received multiple or high doses of Hetastarch.

Recovery and Rehabilitation

For patients who received Hetastarch following traumatic injuries or major surgeries, the recovery process may involve:

1. Gradual resumption of normal activities under medical guidance
2. Nutritional support to replenish lost nutrients and aid in healing
3. Physical therapy to address any weaknesses or mobility issues
4. Psychological support, particularly for those who experienced traumatic events

A comprehensive recovery plan should be tailored to each patient’s specific needs and medical history.

Alternatives to Hetastarch: Exploring Other Volume Expanders

While Hetastarch is an effective plasma volume expander, healthcare providers may consider alternative treatments in certain situations. What other options are available for managing hypovolemia? Some alternatives include:

• Crystalloid solutions: Such as normal saline or Ringer’s lactate
• Other colloid solutions: Including albumin or dextran
• Blood products: In cases of severe blood loss

The choice of volume expander depends on various factors, including the patient’s specific condition, the cause of hypovolemia, and potential contraindications. Each alternative has its own set of benefits and risks, which must be carefully weighed by the healthcare team.

Comparing Efficacy and Safety Profiles

How do these alternatives compare to Hetastarch in terms of efficacy and safety? While crystalloid solutions are often considered first-line treatments due to their lower cost and fewer side effects, they may be less effective in maintaining intravascular volume over time. Albumin, while effective, can be expensive and carries its own set of potential complications. Blood products are reserved for specific situations due to the risks associated with transfusions.

Healthcare providers must consider the unique advantages and disadvantages of each option when selecting the most appropriate treatment for their patients.

Future Developments and Research in Plasma Volume Expansion

The field of plasma volume expansion continues to evolve, with ongoing research aimed at improving efficacy and reducing side effects. What potential advancements are on the horizon for managing hypovolemia?

• Development of novel synthetic colloids with improved safety profiles
• Exploration of targeted therapies to address specific causes of volume depletion
• Investigation of biomarkers to guide more precise fluid management
• Research into the long-term outcomes of different volume expansion strategies

These areas of research hold promise for enhancing the treatment of hypovolemia and related conditions, potentially leading to better patient outcomes and reduced complications.

Personalized Approaches to Volume Expansion

The future of plasma volume expansion may lie in more personalized approaches. How might individualized treatments improve patient care? Researchers are exploring:

1. Genetic factors that influence response to volume expanders
2. Advanced monitoring techniques to guide real-time fluid management
3. Combination therapies tailored to specific patient characteristics
4. AI-assisted decision support systems for optimizing fluid resuscitation

These advancements could lead to more precise and effective treatments, minimizing risks and improving outcomes for patients requiring volume expansion therapy.

Education and Training for Healthcare Providers

Proper use of Hetastarch and other volume expanders requires specialized knowledge and skills. How can healthcare providers stay up-to-date on best practices in fluid management? Continuing education is crucial and may include:

• Regular training sessions on fluid resuscitation techniques
• Workshops focusing on recognizing and managing complications
• Simulation exercises to practice emergency scenarios
• Interdisciplinary conferences to share knowledge across specialties

Healthcare institutions should prioritize ongoing education to ensure that all providers involved in administering volume expanders are well-informed about current guidelines and emerging research.

Implementing Evidence-Based Protocols

Standardized protocols based on the latest evidence can help improve patient safety and outcomes. What elements should be included in comprehensive fluid management protocols?

1. Clear indications and contraindications for Hetastarch use
2. Detailed dosing guidelines based on patient characteristics
3. Monitoring requirements during and after administration
4. Strategies for preventing and managing potential complications
5. Criteria for transitioning to alternative treatments if needed

By implementing and regularly updating these protocols, healthcare institutions can ensure consistent, high-quality care for patients requiring volume expansion therapy.

Patient Education and Informed Consent

Ensuring patients and their families understand the risks and benefits of Hetastarch treatment is crucial for informed decision-making. How can healthcare providers effectively communicate this information? Key strategies include:

• Using clear, non-technical language to explain the treatment
• Providing written materials outlining potential side effects and precautions
• Encouraging questions and addressing concerns openly
• Discussing alternative treatment options when appropriate

Informed consent should be obtained whenever possible, even in emergency situations where time is limited. This process helps build trust and ensures that patients are active participants in their care.

Long-Term Follow-Up and Support

For patients who have received Hetastarch, ongoing support and education are important. What should be included in long-term follow-up care?

1. Regular check-ups to monitor for delayed side effects
2. Education on signs and symptoms that should prompt medical attention
3. Psychological support for patients who experienced traumatic events
4. Guidance on lifestyle modifications to support overall health and recovery

By providing comprehensive follow-up care, healthcare providers can help ensure the best possible outcomes for patients who have undergone Hetastarch treatment.

Hetastarch (Hespan) – Side Effects, Interactions, Uses, Dosage, Warnings

Reviewed: June 23, 2020

Hetastarch (hydroxyethyl starch) is made from natural sources of starch. Hetastarch increases the volume of blood plasma that can be lost from bleeding or severe injury. Plasma is needed to circulate red blood cells that deliver oxygen throughout the body.

Hetastarch is used to treat or prevent hypovolemia (decreased blood plasma volume, also called “shock”) that may occur as a result of serious injury, surgery, severe blood loss, burns, or other trauma.

Hetastarch may also be used for purposes not listed in this medication guide.

uses

What is Hetastarch (Hespan) used for?

• Hypovolemia

warnings

What is the most important information I should know about Hetastarch (Hespan)?

You should not receive this medication if you are allergic to hetastarch, or if you have:

• a bleeding or blood clotting disorder;
• kidney disease;
• congestive heart failure; or
• urination problems not caused by hypovolemia (decreased blood plasma volume).

If possible before you receive hetastarch, tell your doctor if you have:

• liver disease;
• a history of heart disease; or
• if you are allergic to corn.

FDA pregnancy category C. It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation it may not be possible to tell your caregivers about your health conditions, or if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

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Side Effects

What are the side effects of Hetastarch (Hespan)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

• wheezing or gasping for breath, rapid breathing, sweating, and anxiety;
• a light-headed feeling, like you might pass out;
• weak pulse, slow breathing;
• chest pain, fever, chills, cough; or
• easy bruising, unusual bleeding, or any bleeding that will not stop.

Rare but serious side effects may include:

• severe headache, vision or speech problems, mental changes;
• drooping eyelids, loss of feeling in your face, tremors, trouble swallowing; or
• severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.

Common side effects may include:

• mild itching or skin rash;
• mild headache;
• muscle pain; or
• swollen glands, mild flu symptoms.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Pregnancy & Breastfeeding

Can I take Hetastarch (Hespan) if I’m pregnant or breastfeeding?

FDA pregnancy category C. It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Interactions

What drugs and food should I avoid while taking Hetastarch (Hespan)?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Dosage Guidelines & Tips

How to take Hetastarch (Hespan)?

Use Hetastarch (Hespan) exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

What should I do if I missed a dose of Hetastarch (Hespan)?

Because you will receive hetastarch in a clinical setting, you are not likely to miss a dose.

Overdose Signs

What happens if I overdose on Hetastarch (Hespan)?

Since hetastarch is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

If you think you or someone else may have overdosed on: Hetastarch (Hespan),  call your doctor or the Poison Control center

(800) 222-1222

If someone collapses or isn’t breathing after taking Hetastarch (Hespan), call 911

911

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Medical Disclaimer

Drugs A-Z provides drug information from Everyday Health and our partners, as well as ratings from our members, all in one place. Cerner Multum™ provides the data within some of the Overview, Uses, Warnings, Side Effects, Pregnancy, Interactions, Dosage, Overdose, and Images sections. The information within all other sections is proprietary to Everyday Health. 

Hetastarch Uses, Side Effects & Warnings

Generic name: hetastarch [ HET-a-starch ]
Brand names: Hespan, Hextend
Dosage form: intravenous solution (60 mg/mL-LR; 60 mg/mL-NaCl 0.9%)
Drug class: Plasma expanders

Medically reviewed by Drugs.com on Jul 19, 2022. Written by Cerner Multum.

What is hetastarch?

Hetastarch (hydroxyethyl starch) is made from natural sources of starch. Hetastarch increases the volume of blood plasma that can be lost from bleeding or severe injury. Plasma is needed to circulate red blood cells that deliver oxygen throughout the body.

Hetastarch is used to treat or prevent hypovolemia (decreased blood plasma volume, also called “shock”) that may occur as a result of serious injury, surgery, severe blood loss, burns, or other trauma.

Hetastarch may also be used for purposes not listed in this medication guide.

Warnings

You should not receive this medication if you have a bleeding or blood clotting disorder, congestive heart failure, kidney disease, or urination problems not caused by hypovolemia (decreased blood plasma volume).

Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.

Before taking this medicine

You should not receive this medication if you are allergic to hetastarch, or if you have:

• a bleeding or blood clotting disorder;

• kidney disease;

• congestive heart failure; or

• urination problems not caused by hypovolemia (decreased blood plasma volume).

If possible before you receive hetastarch, tell your doctor if you have:

FDA pregnancy category C. It is not known whether hetastarch will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether hetastarch passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation it may not be possible to tell your caregivers about your health conditions, or if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received hetastarch.

How is hetastarch given?

Hetastarch is injected into a vein through an IV. A healthcare provider will give you this injection.

Your breathing, blood pressure, oxygen levels, kidney function, and other vital signs will be watched closely while you are receiving hetastarch. Your blood will also need to be tested daily during treatment.

What happens if I miss a dose?

Because you will receive hetastarch in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since hetastarch is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving hetastarch?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Hetastarch side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

• wheezing or gasping for breath, rapid breathing, sweating, and anxiety;

• a light-headed feeling, like you might pass out;

• weak pulse, slow breathing;

• chest pain, fever, chills, cough; or

• easy bruising, unusual bleeding, or any bleeding that will not stop.

Rare but serious side effects may include:

• severe headache, vision or speech problems, mental changes;

• drooping eyelids, loss of feeling in your face, tremors, trouble swallowing; or

• severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Hetastarch can harm your kidneys. Call your doctor at once if you have any of these symptoms of kidney damage: swelling, rapid weight gain, unusual tiredness, nausea, vomiting, feeling short of breath, red or pink urine, painful or difficult urination, or little or no urinating.

Common side effects of hetastarch may include:

• mild itching or skin rash;

• mild headache;

• muscle pain; or

• swollen glands, mild flu symptoms.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Hetastarch dosing information

Usual Adult Dose for Hypovolemia:

Dosage for Acute Use in Plasma Volume Expansion: 500 to 1000 mL IV
Maintenance dose: Total dosage and rate of infusion depends on the amount of blood or plasma lost and the resultant hemoconcentration.
Maximum dose: Doses more than 1500 mL per day (approximately 20 mL per kg of body weight) are usually not required although higher doses have been used in postoperative and trauma patients with severe blood loss.

Dosage in Leukapheresis: 250 to 700 mL to which citrate anticoagulant has been added and administered to the input line of the centrifugation apparatus at a ratio of 1:8 to 1:13 to venous whole blood.

Comments:
-Hetastarch and citrate should be thoroughly mixed to assure effective anticoagulation.
-Hetastarch admixtures of 500 to 560 mL with citrate concentrations up to 2.5% are compatible for 24 hours at room temperature.

Uses:
-For treatment of hypovolemia when plasma volume expansion is desired
-This drug in leukapheresis improves the harvesting and increasing the yield of granulocytes by centrifugal means

What other drugs will affect hetastarch?

Other drugs may interact with hetastarch, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

More about hetastarch

• Compare alternatives
• Pricing & coupons
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• Dosage information
• During pregnancy
• Drug class: plasma expanders
• En español

Patient resources

• Advanced Reading
• Hetastarch/sodium chloride (Advanced Reading)

Other brands

Hextend, Hespan

Professional resources

• Prescribing Information

Related treatment guides

• Blood Disorders
• Hypovolemia

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Copyright 1996-2023 Cerner Multum, Inc. Version: 2.02.

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Infusion therapy of dogs and cats in diseases of the gastrointestinal tract

Fluid Therapy in Cats and Dogs is used to treat shock, dehydration, and correct electrolyte and acid-base balance. It is impossible to accurately predict changes in electrolyte balance, so electrolytes must be measured. Vomiting of stomach contents often results in hypokalemia, hypochloremia, and metabolic alkalosis. Loss of intestinal contents classically leads to hypokalemia with or without acidosis, but hypokalemic metabolic alkalosis can occur. Vomiting in an animal leads to hypokalemia; however, animals with hyperadrenocorticism or anuria in renal failure may have hyperkalemia. If it is not possible to immediately measure electrolytes, it is necessary to infuse with saline, plus 20 mEq of potassium chloride per liter, with the condition that the liquid will be injected 1 or 2 times, depending on the condition. To rule out severe hyperkalemia, it is advisable to take an ECG.

The introduction of bicarbonates is rarely required, because vasodilatation, improved perfusion of the periphery facilitates the course of lactic acidosis. Bicarbonate is primarily given to patients with severe acidosis (eg, pH

Types of Fluid Therapy in Cats and Dogs

Parenteral fluid is required if the animal is severely hypovolemic or fluid absorption from the GI tract is questionable (eg, severe bowel disease, obstruction, vomiting, or ileus). Subcutaneous fluid administration is acceptable as long as the animal is not in shock, absorbs the fluid, and tolerates subcutaneous administration well. Subcutaneous depots have a capacity of 10 to 50 ml, depending on the size of the animal. Before re-introducing one depot, you need to make sure that there is no residual fluid. Severely dehydrated animals do not absorb fluid from the subcutaneous space as quickly as required, so it is desirable to administer fluid intravenously first. IV fluids are required in severely dehydrated or shocked animals, even if this requires venesection. Fluid may be given intramedullary if intravenous infusion is needed and a catheter cannot be placed. For this, large diameter hypodermic needles or bone marrow aspiration needles (preferably) are used. They can be inserted into the thigh (trochanteric fossa), tibia, iliac ala, or humerus. Fluids can be administered intramedullary at a maintenance infusion rate or faster.

Intraperitoneal fluid administration is also possible, but replenishment of the vascular bed is slower than intravenous or intramedullary.

Dogs in shock (with tachycardia, poor peripheral perfusion, cold extremities, prolonged EOC, weak femoral pulse, and/or tachypnea) may require intravenous isotonic crystalloids 88 ml/kg or more during the first hour. The “maximum” level may be exceeded if required to restore adequate peripheral perfusion; The patient must be under constant supervision. It is important to remember that dogs with systemic inflammatory response syndrome (SIRS) initially have brick red mucosa, warm extremities, and a strong femoral artery pulse before the onset of classic signs of shock. Large dogs in severe shock, eg with gastric volvulus, may require 2x 16- and 18-gauge catheters and infusion bags must be pressurized to achieve an adequate infusion rate. Cats are easy to “drip”, so cats need to be monitored more closely when rapidly injecting fluids. In general, for cats in shock, the volume should not exceed 55 ml/kg during the first hour.

Ringer lactate or saline is used to treat shock. However, one must be sure that fluids used to treat shock do not contain a lot of potassium, due to its potential cardiotoxic effect.

Hypertonic saline (7%) may be used to treat severe hypovolemic or endotoxic shock. Relatively small volumes (ie 4-5 ml in 10 minutes) are about as effective as large volumes of isotonic crystalloid solutions. Hypertonic solutions remove fluid from the intracellular and interstitial space into the vascular bed and stimulate the vascular reflex. Hypertonic solutions should generally not be administered to animals with hypernatremia and dehydration, in cardiogenic shock, or with renal insufficiency. Uncontrolled bleeding may also be a contraindication to their use. The clinician may administer hypertonic saline in 2 ml/kg increments until a total of 10 ml/kg is administered, or until the serum sodium concentration is 160 mg/eq/l or more. After administration of hypertonic saline, the clinician may continue to administer other solutions, but at a lower volume (eg, 10-20 ml/kg/h) until shock is controlled. A mixture of 7% saline plus dextran 70 has a longer duration of action than hypertonic saline alone.

This mixture can be administered in a volume of 3-5 ml/kg over 5 minutes. Dextran rarely causes allergic reactions or renal failure, but should be used with caution and is contraindicated in animals with coagulopathy.

Colloids are also useful in the treatment of shock. Like hypertonic saline, colloids draw water from the interstitial space into the vascular bed; however, their effect lasts longer and does not increase the amount of sodium. Relatively small volumes can be administered rapidly (i.e., 5 to 10 ml/kg, no more than 20 ml/kg per day) and subsequent fluid volumes need to be reduced to prevent hypertension. Colloids should be used with caution in animals with a bleeding tendency.

If it is difficult to maintain a maximum blood pressure above 80-90 mmHg, vasopressors may be needed. Vasopressin IPS was more effective for this purpose than dopamine or dobutamine administration.

Infusion therapy for cats and dogs. Approximately 44 to 66 ml of fluid per kilogram of body weight is required daily to maintain dogs weighing 10 to 50 kg, larger dogs require smaller volumes. Dogs weighing less than 5 kg may require an infusion of 80 ml/kg per day. It is important to choose the right solution to prevent electrolyte imbalances, especially hypokalemia. In general, potassium should be added to animals with anorexia, vomiting, diarrhea, or long-term fluid therapy. The possible development of iatrogenic hyperkalemia should be monitored (eg, ECG or determination of plasma potassium, and no more than 0.5 mEq/kg/h should be administered. Oral potassium is often more effective than parenteral, but only if the animal does not vomit Cats receiving IV infusion initially show a decrease in potassium levels, even if it is found in solution at a concentration of 40 mEq/L or more.0006

Dehydrated animals that are not in shock are treated with fluid replacement. To do this, first of all, you need to assess the degree of dehydration. Prolonged straightening of the skin fold is noted in animals with 5-6% dehydration. However, in any weight loss cat or dog, the skin fold may take longer to retract, while in obese animals it may retract regardless of the severity of dehydration. Dry, sticky oral mucosa usually indicates 6-7% dehydration.

However, animals that are dehydrated but nauseated may have moist mucous membranes, and animals that are short of breath or tachypneic (not dehydrated) may have dry mucous membranes. Multiplying the weight of the animal by the percentage of dehydration, the amount of fluid to replenish the deficiency is obtained. This volume is administered in 2-8 hours, depending on the condition of the animal. The infusion rate should generally not exceed 88 ml/kg/h. In general, it is better to slightly overestimate rather than underestimate fluid deficiency unless the animal has congestive heart failure, anuric or oliguric renal failure, severe hypoproteinemia, severe anemia, or pulmonary edema.

It is usually easier to injure a cat with excess liquid than a dog. Current fluid loss is assessed based on the presence of vomiting, diarrhea, urination; however, losses are usually underestimated.

Animal weighing is one way to assess the effectiveness of infusion therapy. Progressive weight loss suggests inadequate fluid therapy. For consistent evaluation of results, the same rating scale must be used. A change of 1 pound (0.45 kg) is about 500 ml of water.

The occurrence of wheezing in the lower lungs, a galloping rhythm, or pulmonary edema indicates that the animal appears to be overhydrated. The appearance of a heart murmur is not a sign of overhydration; in dogs with severe dehydration and valvular insufficiency, the murmur may not be detectable and becomes audible when the blood volume is replenished. Central venous pressure measurement is excellent for detecting fluid overdose; however, this is rarely required, except in animals with severe cardiac or renal insufficiency receiving aggressive fluid therapy. The CVP is usually less than 4 cm H2O and should not exceed 10–12 cm H2O, even during aggressive fluid therapy.

Oral rehydration is used to facilitate sodium absorption.

Supplementation with a monosaccharide (eg dextrose) accelerates the absorption of sodium and subsequent water intake. This approach works if the animal is able to consume fluids (i.e., no vomiting) and the intestinal mucosa is functional (i.e., there are sufficient villi). Absorption occurs predominantly in mature epithelial cells at the tips of the villi. On sale there are similar products for people, as well as recipes for the preparation of such solutions. Failure to adequately assess the condition of the animal can lead to severe hypernatremia. Some dogs and cats with non-parvovirus enteritis may receive oral fluids.

The type of fluid therapy for animals with hyperproteinemia depends on the degree of hypoalbuminemia. Excess fluid infusion can dilute the serum albumin concentration and cause ascites, edema, reduced peripheral perfusion, or a combination of these factors. Therefore, a careful calculation of fluid requirements and ongoing losses is necessary. For animals with severe hypoalbuminemia (eg, serum albumin 1.5 g/dl or less), plasma transfusion (6 to 10 ml/kg) should be considered first to increase oncotic pressure. A common mistake is not enough plasma. Therefore, the concentration of albumin in the blood should be measured every 8-12 hours to ensure that a sufficient volume has been injected.

Moreover, animals with severe protein-losing enteropathy or nephropathy rapidly lose the administered protein, making repeated transfusions necessary to maintain plasma albumin concentrations.

Albumin replacement can be very expensive for large dogs . Human albumin is used instead of canine plasma and is quite effective, although side effects have been reported. Hetastarch (5 to 20 ml/kg/day) and dextran 70 may be used instead of plasma and albumin. Hetastarch (provided as a 6% solution) is larger than albumin and therefore may remain in the vasculature longer than albumin, thereby helping to maintain plasma oncotic pressure in animals with protein-losing enteropathy.