Normal Saline Versus Ringer's Lactate for Intravenous Fluid Therapy in Children with Diabetic Ketoacidosis: A Randomized Controlled Trial.

OBJECTIVES: To compare normal saline (NS) and ringer's lactate (RL) as intravenous fluid therapy in children with diabetic ketoacidosis (DKA). METHODS: This was a triple blinded randomized controlled trial conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital in New Delhi from November 2018 to March 2020. The study compared intravenous fluid therapy with ringer's lactate and normal saline in children aged 6 mo to 18 y with DKA as defined by The International Society for Pediatric and Adolescent Diabetes (ISPAD). The primary objective was comparing the time taken to achieve resolution of acidosis (pH ≥ 7.3) in both groups. Secondary objectives included comparing the proportion of patients that develop acute kidney injury; comparing the time taken for normalization of anion gap and blood glucose; time taken to change the type of fluid; total amount of fluid and insulin administered; and total length of PICU and hospital stay. RESULTS: Fifty patients were enrolled, with 25 in each arm and all but one achieved the primary outcome. The median age of the patients was 9 (5, 12) y. The time taken for resolution of acidosis in patients treated with NS was 12 (4, 18) h and with RL was 8 (4, 10) h (p = 0.16). The NS group had a significantly higher incidence of hyperchloremia (p < 0.05) and longer PICU stay (p < 0.05). The metabolic profile and incidence of complications were comparable in both groups. CONCLUSIONS: Ringer's lactate can safely be considered for the management of pediatric DKA and may be preferred in patients that are at a risk of complications due to hyperchloremia.

Intravenous fluid therapy in hospitalized adult dengue patients without shock: Impact on subsequent severe dengue and potential adverse effects.

There is a lack of evidence on the optimal administration of intravenous (IV) fluids in hospitalized adult dengue patients without compensated and hypotensive shock. This study utilized a well-established cohort of dengue patients to compare risks of progressing to severe dengue (SD) over time for patients who were administered IV fluid versus others who were not. We included adult patients (n = 4781) who were hospitalized for dengue infection from 2005 to 2008. Cases were patients who developed SD (n = 689) and controls were patients who did not up until discharge (n = 4092). We estimated the hazard ratios (HRs) and risk of SD over time between groups administered different volumes of IV fluids versus the no IV fluid comparison group using Cox models with time-dependent covariates. The doubly-robust estimation approach was used to control for the propensity of fluid administration given clinical characteristics of patients. Subgroup analyses by age, sex, and dengue warning signs before IV fluid administration were conducted. High (>2000 mL/day) IV fluids volume was associated with a higher risk of development of SD for those who had warning signs (HR: 1.77 [1.05-2.97], p: 0.0713) and for those below 55 years old (HR: 1.53 [1.04-2.25], p: 0.0713). Low (<1000 mL/day) IV fluids volume was protective against SD for patients without warning signs (HR: 0.757 [0.578-0.990], p: 0.0883), no lethargy (HR: 0.770 [0.600-0.998], p: 0.0847), and females (HR: 0.711 [0.516-0.980], p: 0.0804). Over the course of hospitalization, there were no significant differences in IV fluid administration and SD risk in most subgroups, except in those who experienced lethargy and were administered IV fluid volume or quantity. Administering high volumes of IV fluids may be associated with an increased risk of SD during hospitalization for adult dengue patients without shock. Judicious use of IV fluids as supportive therapy is warranted.

Meta-analysis and trial sequential analysis of randomized controlled trials comparing aggressive versus non-aggressive intravenous fluid therapy in acute pancreatitis: an insight into the existence of type 2 error.

BACKGROUND AND AIM: We aimed to evaluate comparative outcomes of aggressive versus non-aggressive intravenous fluid (IVF) therapy in patients with acute pancreatitis. METHODS: A systematic search of electronic data sources and bibliographic reference lists were conducted. All randomized controlled trials (RCTs) reporting outcomes of aggressive versus non-aggressive IVF therapy in acute pancreatitis were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random-effects modeling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors. RESULTS: We included 10 RCTs reporting 993 patients with acute pancreatitis who received aggressive (n = 475) or non-aggressive (n = 518) IVF therapy. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR: 2.68, P = 0.0005) and longer length of stay (MD: 0.94, P < 0.00001) compared with the non-aggressive approach. There was no statistically significant difference in mortality (RD: 0.02, P = 0.31), SIRS (OR: 0.93, P = 0.89), respiratory failure (OR: 2.81, P = 0.07), pancreatic necrosis (OR: 1.98, P = 0.06), severe pancreatitis (OR: 1.31, P = 0.38), clinical improvement (OR: 1.12, P = 0.83) or AKI (OR: 1.06, P = 0.91) between the two groups. Sub-group analysis demonstrated higher morbidity and mortality associated with the aggressive approach in more severe disease. Trial sequential analysis detected risk of type 2 error. CONCLUSIONS: Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non-aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs.

Striking fear into students' hearts: Unforeseen consequences of prescribing education.

PURPOSE: Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). METHODS: Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. RESULTS: There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. CONCLUSIONS: After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.

Effect of intravenous fluid therapy for acute alcohol intoxication on length of time from arrival at the emergency department until awakening: A prospective observational cohort study.

Aim: To evaluate the association of intravenous fluid (IVF) therapy on the length of time from arrival at the emergency department (ED) until awakening in cases of acute alcohol intoxication. Methods: This single-center, prospective, observational study was conducted in the ED of the Self-Defense Forces Central Hospital during October 1, 2018 to July 31, 2019. Patients with 1,000 mL bolus of lactated Ringer's solution and those without bolus were compared. The primary outcome was the length of time until awakening. Secondary outcomes were the length of stay in the ED and occurrence of conditions requiring extra care. Predictors of the occurrence of any event requiring extra care were identified. Results: We included 201 patients, of whom 109 received IVF and 92 did not. No significant difference existed in the baseline characteristics between the groups. The median length of time until awakening did not significantly differ between the groups (P = 0.77). Multivariable regression analysis adjusted by age, sex, hemoglobin, blood alcohol concentration, and initial Glasgow Coma Scale (GCS) score demonstrated that the regression coefficient of IVF for length of time until awakening was -9.55 (95% confidence interval [CI], -36.2 to 17.2). Hemoglobin (regression coefficient, 10.1; 95% CI, 0.38-19.9) and initial GCS score (regression coefficient, -7.51; 95% CI, -10.8 to -4.21) were significantly associated with length of time. Conclusion: IVF therapy was not associated with the length of time until awakening in patients with acute alcohol intoxication in the ED. Routine IVF administration was unnecessary.

Intravenous fluid therapy in accordance with kidney injury risk: when to prescribe what volume of which solution.

Acute kidney injury (AKI) is common in hospitalized patients while common risk factors for the development of AKI include postoperative settings, patients with baseline chronic kidney disease (CKD) or congestive heart failure. Intravenous (IV) fluid therapy is a crucial component of care for prevention and treatment of AKI. In this narrative review, we update the approach to IV fluid therapy in hospitalized patients including the timing of fluid prescription, and the choice of fluid type, amount and infusion rate along with the potential adverse effects of various crystalloid and colloid solutions, addressing specifically their use in patients with acute kidney disease, CKD or heart failure, and their potential impact on the risk of hospital-acquired AKI.

Intravenous fluid therapy: a multi-national, cross-sectional survey of common medical student resources.

BACKGROUND: Inappropriate prescription of intravenous fluid therapy is highly prevalent in hospitals, with up to 1 in 5 patients suffering from preventable, additional morbidity. Since trainee physicians are frequently responsible for prescribing intravenous fluids, it is possible that common medical student resources do not sufficiently cover the topic. There is a paucity of recent literature on this issue, which this study was designed to address. METHODS: Two original evaluation tools were created by the authors to evaluate reference books, official guidelines, and online reference sources commonly used by medical students in the United States of America, Australia, and the United Kingdom on their coverage of foundational and clinically relevant principles of intravenous fluid prescription. The choice of student resources was guided by a literature search and personal experience. A total of 10 resources was assessed. RESULTS: Resources were generally deficit in their coverage of basic intravenous fluid topics. The total points each topic accumulated ranged from 0.5 (5%) to 7.5 (75%), with the median score being 4.5 (45%), on a scale from 0 to 10 points. CONCLUSIONS: Popular medical student resources poorly cover intravenous fluid therapy topics. This may be contributing to inadequate fluid prescribing practices.

Drowning in antibiotics.

INTRODUCTION: The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid prescription is commonly delegated to junior doctors despite being a notoriously challenging topic. When antibiotics are given as an infusion they are diluted in 100ml of fluid, which is often unaccounted for when thinking about a patient's fluid requirements. This closed-loop audit aimed to assess first, intravenous (IV) fluid therapy and second, electrolyte prescribing compliance with National Institute for Health and Care Excellence (NICE) guidelines, with and without the additional fluid given with antibiotic administration. METHODS: Two retrospective audits were performed. Total fluid and electrolyte volume received with and without antibiotic fluids was correlated with recommendations in the NICE guidelines. Between cycles 1 and 2, potassium chloride with sodium chloride and glucose (PSG) was introduced as an alternative to IV maintenance fluid, and bolusing of antibiotics was mandatory. RESULTS: When analysing total fluid volume input per day, 10.4% and 7.45% of patients met their fluid requirement accurately in the first and second cycles, respectively. Within cycle 1, the mean total additional fluid that was given over 3 days with antibiotics was 1,572.73ml. In cycle 2, this decreased to 469.44ml when antibiotics were given as a bolus. CONCLUSIONS: In this closed-loop audit we noted that patients receiving IV fluids and IV antibiotics received too much additional fluid when the antibiotic dilution fluid was taken into account. Additional fluid was reduced alongside the proportion of electrolyte complications when bolusing of antibiotics was introduced. We recommend that that all nurses are trained to give antibiotics as a bolus because it can help to reduce fluid-related complications.

Gelatin and the risk of acute kidney injury after cardiac surgery.

BACKGROUND: Gelatin has been used as a plasma volume expander because of its ability to preserve intravascular volume more effectively than crystalloids. However, gelatin may have detrimental effects on kidney function and increase the risk of acute kidney injury (AKI). METHOD: We investigated by retrospective analysis of prospectively collected data whether the administration of 4% succinyl gelatin is associated with an increased risk of AKI after cardiac surgery. We compared two propensity score-matched groups of 1,187 patients (crystalloid group and gelatin group). RESULTS: The incidence of AKI was similar in both groups (gelatin 21% and crystalloid 20%) (p = 0.414). The incidence of moderate AKI (8% vs. 6%) was higher in the gelatin group, but there was no difference in mild or severe AKI. Postoperative serum creatine on the first (70 vs. 70 µmol L-1 , p = 0.689) or fourth (71 vs. 70, p = 0.313) postoperative day was similar between groups and there was no difference in the need for new renal replacement therapy (p = 0.999). Patients in the gelatin group received less crystalloids (2080 ml vs. 4130 ml, p = 0.001) and total fluids (3760 ml vs. 4180 ml, p = 0.001), their fluid balance was less positive (p = 0.001) and they required less vasoactive and inotropic medication (p = 0.001). Gelatin was not associated with increased mortality compared to the crystalloid group. CONCLUSION: Gelatin was not associated with AKI after cardiac surgery.

Comparative Trial of Continuous Flow Enteral and Intravenous Fluid Therapy in Horses.

Continuous flow enteral fluid therapy with isotonic and hypotonic enteral electrolyte solutions are as safe and effective as intravenous fluid therapy. The aim of this study was to carry out a comparative assessment between continuous flow enteral and intravenous (IV) fluid therapy in adult experimentally dehydrated horses. Six experimentally dehydrated adult mares were used in a study carried out in a 6 × 3 crossover design, which each animal received three different treatments (isotonic enteral fluid therapy-EsISO, hypotonic enteral fluid therapy-EsHYPO and intravenous fluid therapy with Lactate Ringer Solution-LR IV, all in continuous flow). Solutions were administered at a rate of 15 mL-1.kg-1.h-1 for 8 h, after 36 h of water and food deprivation. Serum and urinary biochemical assessment; urinary volume, pH and specific gravity; and blood gas analysis were measured at -36, 0, 2, 4, 6, and 8 h. The dehydration period (DP) caused discrete hydroelectrolytic and acid base imbalances. The EsISO, EsHYPO and LR IV increased blood volume. Enteral solutions restored the imbalances yielded by the DP and all treatments increased urine volume. Also, the EsHYPO and LR IV showed no effects in acid base balance, while EsISO showed slightly acidifying effect. The present study certifies the efficacy and safety of isotonic and hypotonic continuous flow enteral fluid therapy in comparison to IV fluid therapy in dehydrated horses.

0.9% Sodium chloride solution versus Plasma-Lyte 148 versus compound sodium lacTate solution in children admitted to PICU-a randomized controlled trial (SPLYT-P): study protocol for an intravenous fluid therapy trial.

BACKGROUND: Intravenous fluid therapy represents the most common intervention critically ill patients are exposed to. Hyperchloremia and metabolic acidosis associated with 0.9% sodium chloride have been observed to lead to worse outcomes, including mortality. Balanced solutions, such as Plasma-Lyte 148 and Compound Sodium Lactate, represent potential alternatives but the evidence on optimal fluid choices in critically ill children remains scarce. This study aims to demonstrate whether balanced solutions, when used as intravenous fluid therapy, are able to reduce the incidence of a rise in serum chloride level compared to 0.9% sodium chloride in critically ill children. METHODS: This is a single-centre, open-label randomized controlled trial with parallel 1:1:1 assignment into three groups: 0.9% sodium chloride, Plasma-Lyte 148, and Compound Sodium Lactate solutions for intravenous fluid therapy. The intervention includes both maintenance and bolus fluid therapy. Children aged < 16 years admitted to intensive care and receiving intravenous fluid therapy during the first 4 h of admission are eligible. The primary outcome measure is a ≥ 5mmol/L increase in serum chloride level within 48 h post-randomization. The enrolment target is 480 patients. The main analyses will be intention-to-treat. DISCUSSION: This study tests three types of intravenous fluid therapy in order to compare the risk of hyperchloremia associated with normal saline versus balanced solutions. This pragmatic study is thereby assessing the most common intervention in paediatric critical care. This is a single-centre open-label study with no blinding at the level of delivery of the intervention. Certain paediatric intensive care unit (PICU) patient groups such as those admitted with a cardiac condition or following a traumatic brain injury are excluded from this study. TRIAL REGISTRATION: The study has received ethical approval (HREC/19/QCHQ/53177: 06/06/2019). It is registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12619001244190 ) from 9th September 2019. Recruitment commenced on 12th November 2019. The primary results manuscript will be published in a peer-reviewed journal.

Gelatin and the risk of bleeding after cardiac surgery.

BACKGROUND: Gelatins has been used in cardiac surgery because of their ability to preserve intravascular volume better than crystalloids. Unfortunately, gelatin has been associated with impaired coagulation and hemostasis, that may cause increased bleeding. We investigated whether the administration of gelatin increases postoperative bleeding after cardiac surgery. METHODS: Retrospective, observational single-center cohort study in the intensive care unit of a tertiary teaching hospital. Postoperative bleeding, chest tube drainage volume and consumption of blood products were compared between groups. RESULTS: Cohort included 3067 consecutive patients who underwent cardiac surgery. First 1698 patients received gelatin (gelatin group), and 1369 patients did not (crystalloid group). The characteristics of the patients in the gelatin and crystalloid groups were comparable. Postoperative chest tube drainage was 18% (95% CI 11%-20%) greater during the first 12 hours (P < .001) and 15% (95% CI 7%-17%) greater during the first 24 hours (P < .001) in the gelatin group compared to the crystalloid group. Severe and massive postoperative bleeding was more common in the gelatin group compared to the crystalloid group (21% vs 16%, P < .001). Patients in the gelatin group received red blood cells (40% vs 20%, P < .001) and platelets (12% vs 8%, P < .001) more frequently than patients in the crystalloid group. However, the number of administered fresh-frozen plasma transfusions did not differ between the groups. CONCLUSION: Gelatin may increase postoperative bleeding and the need for blood product transfusions after cardiac surgery.

Intravenous fluids for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization.

Introduction: Contrast-induced nephropathy is a known complication that can occur after intravascular administration of iodinated contrast medium. Its consequences can range from a mild worsening of the renal function to renal failure requiring renal replacement therapy. There is no known effective treatment for contrast-induced nephropathy, and thus, efforts have focused on its prevention. Many approaches have been studied, but the most common strategy in use at the present time is prophylactic intravenous isotonic saline.Areas covered: This article reviews the data supporting the current practice of prophylactic periprocedural intravenous isotonic saline for lowering the incidence of contrast-induced nephropathy. We reviewed PubMed to search primarily for the latest clinical trials and meta-analyses pertaining to contrast-induced nephropathy and the use of prophylactic measures, specifically intravenous infusion of isotonic saline.Expert commentary: Currently, there are no universally accepted methods for the prevention of contrast-induced nephropathy. The best evidence for contrast-induced nephropathy prophylaxis is the administration of intravenous isotonic saline. Our review article provides an overview of the current knowledge, latest research, and current practice on contrast-induced nephropathy prophylaxis using intravenous isotonic saline administration.

Perioperative fluid therapy and intraoperative blood loss in children.

Fluid and blood administration are required during surgery in children. The type, amount and tonicity of the intravenous fluids is an important aspect to be considered during anaesthesia management. The physiological differences between adults and children regarding the body water and blood volume needs to be understood. We performed a PUBMED search for English language articles using keywords including 'children', 'intravenous fluid therapy', 'crystalloids', 'colloids', 'fluid homeostasis', 'Starling equation', 'Donnan effect', 'blood loss', 'estimation of blood loss', 'blood management program'. This review discusses the physiological basis, historical background, risk of hyponatraemia, need of glucose in the intravenous fluids as well as the recent concepts in blood transfusion as related to children.

A quantitative approach to intravenous fluid therapy in the syndrome of inappropriate antidiuretic hormone secretion.

BACKGROUND: A wide range of interesting mathematical models has been derived to predict the effect of intravenous fluid therapy on the serum sodium concentration (most notably the Adrogué-Madias equation), but unfortunately, these models cannot be applied to patients with disorders characterized by aberrant antidiuretic hormone (ADH) release, such as the syndrome of inappropriate ADH secretion (SIADH). The use of intravenous fluids in these patients should prompt caution, as the inability of the kidneys to properly dilute the urine can easily result in deterioration of hyponatremia. METHODS: In this report, a transparent and clinically applicable equation is derived that can be used to calculate the estimated effect of different types and volumes of crystalloid infusate on the serum sodium concentration in SIADH patients. As a "proof of concept", we discuss five SIADH patient cases from our clinic. Alternatively, our mathematical model can be used to determine the infusate volume that is required to produce a certain desired change in the serum sodium concentration in SIADH patients. CONCLUSION: The presented model facilitates rational intravenous fluid therapy in SIADH patients, and provides a valuable addition to existing prediction models.

Avaliação comparativa entre diferentes modalidades de reposição hidroeletrolítica em equinos desidratados experimentalmente pela utilização de parâmetros do exame físico e marcadores hematológicos / Comparative evaluation between different kinds of hydroeletrolitic reposition in horses experimentally dehydrated by the use of physical examination parameters and hematological markers

O objetivo do presente estudo foi realizar a comparação entre três modalidades de terapias hidroeletrolíticas, sendo uma hipotônica (SeHIPO) e outra isotônica (SeISO), ambas por via enteral em fluxo contínuo (HETfc), com a solução de ringer lactato por via intravenosa (RL IV), na taxa de infusão de 15 ml/kg/h, administradas simultaneamente em tempo real por 8 horas num delineamento crossover6X3 em equinos desidratados experimentalmente pela utilização de parâmetros clínicos do exame físico e de alguns exames laboratoriais. Para tanto foram utilizadas 6 éguas adultas da raça Brasileiro de Hipismo submetidas a um protocolo experimental de indução de desidratação (PD) e posteriormente tratadas de acordo com o delineamento experimental. Os resultados obtidos demonstraram que ambos os tratamentos HETfc demonstraram eficácia equivalente ao RL IV na reversão dos efeitos determinados pelo PD, ainda que para os marcadores da volemia, tais como o Volume Globular (VG), Proteínas Plasmáticas Totais (PPT) e porcentagem de Volume Plasmático (%VP) tenham sido relativamente mais lentos. Porém, para os demais marcadores clínicos a eficácia entre as três terapias estudadas foi equivalente. Esses resultados comprovam a ação das terapias HETfc ao serem comparadas ao tratamento RL IV, pela utilização dos marcadores clínicos e laboratoriais utilizados, e justificam a indicação e utilização dessas modalidades terapêuticas em equinos.

The objective of the present study was to compare three modalities of hydroelectrolytic therapies, one hypotonic (SeHIPO) and another isotonic (SeISO), both by continuous enteral flow (HETfc), with intravenous lactated ringer solution ( RL IV), at the infusion rate of 15 ml / kg / h, administered simultaneously in real time for 8 hours in a 6X3 crossover design in horses experimentally dehydrated by the use of clinical parameters of the physical examination and some laboratory tests. Six adult mares of the Brazilian Equestrian race were submitted to an experimental protocol for induction of dehydration (PD) and later treated according to the experimental design. The results showed that both HETfc treatments demonstrated an efficacy equivalent to RL IV in the reversal of the effects determined by PD, although for volume markers such as Globular Volume (VG), Total Plasma Proteins (PPT) and Percentage of Plasmatic Volume (% VP) were relatively slower. However, for the other clinical markers the efficacy among the three therapies studied was equivalent. These results confirm the action of HETfc therapies when compared to RL IV treatment, by the clinical and laboratorial markes used, and justify the indication and use of these therapeutic modalities in horses.

Avaliação comparativa entre diferentes modalidades de reposição hidroeletrolítica em equinos desidratados experimentalmente pela utilização de parâmetros do exame físico e marcadores hematológicos / Comparative evaluation between different kinds of hydroeletrolitic reposition in horses experimentally dehydrated by the use of physical examination parameters and hematological markers

O objetivo do presente estudo foi realizar a comparação entre três modalidades de terapias hidroeletrolíticas, sendo umahipotônica (SeHIPO) e outra isotônica (SeISO), ambas por via enteral em fluxo contínuo (HETfc), com a solução de ringer lactatopor via intravenosa (RL IV), na taxa de infusão de 15 ml/kg/h, administradas simultaneamente em tempo real por 8 horas numdelineamento crossover 6X3 em equinos desidratados experimentalmente pela utilização de parâmetros clínicos do exame físicoe de alguns exames laboratoriais. Para tanto foram utilizadas 6 éguas adultas da raça Brasileiro de Hipismo submetidas a umprotocolo experimental de indução de desidratação (PD) e posteriormente tratadas de acordo com o delineamento experimental.Os resultados obtidos demonstraram que ambos os tratamentos HETfc demonstraram eficácia equivalente ao RL IV na reversãodos efeitos determinados pelo PD, ainda que para os marcadores da volemia, tais como o Volume Globular (VG), ProteínasPlasmáticas Totais (PPT) e porcentagem de Volume Plasmático (%VP) tenham sido relativamente mais lentos. Porém, para osdemais marcadores clínicos a eficácia entre as três terapias estudadas foi equivalente. Esses resultados comprovam a ação dasterapias HETfc ao serem comparadas ao tratamento RL IV, pela utilização dos marcadores clínicos e laboratoriais utilizados, ejustificam a indicação e utilização dessas modalidades terapêuticas em equinos.

The objective of the present study was to compare three modalities of hydroelectrolytic therapies, one hypotonic (SeHIPO) andanother isotonic (SeISO), both by continuous enteral flow (HETfc), with intravenous lactated ringer solution ( RL IV), at the infusionrate of 15 ml / kg / h, administered simultaneously in real time for 8 hours in a 6X3 crossover design in horses experimentallydehydrated by the use of clinical parameters of the physical examination and some laboratory tests. Six adult mares of the BrazilianEquestrian race were submitted to an experimental protocol for induction of dehydration (PD) and later treated according to theexperimental design. The results showed that both HETfc treatments demonstrated an efficacy equivalent to RL IV in the reversalof the effects determined by PD, although for volume markers such as Globular Volume (VG), Total Plasma Proteins (PPT) andPercentage of Plasmatic Volume (% VP) were relatively slower. However, for the other clinical markers the efficacy among thethree therapies studied was equivalent. These results confirm the action of HETfc therapies when compared to RL IV treatment,by the clinical and laboratorial markes used, and justify the indication and use of these therapeutic modalities in horses.

Endothelial glycocalyx: Role in body fluid homeostasis and fluid management.

Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions.

Diagnosis and Treatment of Undifferentiated and Infectious Acute Diarrhea in the Adult Horse.

Acute, infectious, diarrhea in adult horses is a major cause of morbidity and is associated with numerous complications. Common causes include salmonellosis, clostridiosis, Coronavirus, and infection with Neorickettsia risticii (Potomac horse fever). Treatment is empirical and supportive until results of specific diagnostic tests are available. Supportive care is aimed at restoring hydration, correcting electrolyte imbalances, and limiting the systemic inflammatory response. The mainstays of therapy are intravenous fluid therapy, electrolyte supplementation where necessary, nonsteroidal anti-inflammatory agents, and nutritional support. Specific therapies include colloid oncotic support, antibiotics, hyperimmune plasma, polymyxin B, pentoxifylline, probiotics, binding agents, gastroprotectants, laminitis prevention, and coagulation prophylaxis.