In the Literature
Pfaff A, Butty EM, Rozanski EA, deLaforcade AM, Hicks JN, Berlin N. Retrospective evaluation of risk factors and outcome in dogs with and without fluid overload during hospitalization. J Vet Intern Med. 2025;39(4):e70132. doi:10.1111/jvim.70132
The Research …
Fluid overload (FO) has been associated with increased hospitalization time and costs and morbidity in critically ill humans.1-4
This study evaluated risk factors, hospitalization time, and outcomes in dogs receiving IV fluids that did and did not develop clinical FO. Included dogs were hospitalized for at least 3 days; daily weight measurements and blood test results were recorded at admission and at least once during hospitalization. Dogs were categorized into disease groups based on recorded clinical diagnosis. Daily fluid volume administered, total fluid volume administered during hospitalization, hospitalization cost and duration, and outcomes were tracked. FO was identified based on clinician assessment of peripheral edema, respiratory signs, pulmonary edema, and/or body cavity effusion. Baseline nondehydrated body weights were calculated to investigate the incidence of FO in patients that gained body weight >10% above their calculated nondehydrated baselines (ie, the definition of FO in human medicine).5-7
Results showed that dogs with FO were significantly more likely to be in the intensive care unit and have certain underlying conditions (eg, cardiovascular disease, chronic kidney disease, acute kidney injury, protein-losing nephropathy, GI disease, metabolic disease, respiratory disease). Patients with FO were also more likely to require longer hospitalization and have higher treatment costs and lower survival rates compared with dogs in the control group. Despite similar total fluid volumes between patients with and without FO, median percent body weight increased daily in dogs in the FO group but remained stable or decreased in dogs in the control group. A similar percentage of patients in both groups gained >10% of their baseline body weight, suggesting weight gain alone may not be the only determinant of FO.
… The Takeaways
Key pearls to put into practice:
Patients with certain underlying conditions (eg, cardiovascular disease, chronic kidney disease, acute kidney injury, protein-losing nephropathy, GI disease, metabolic disease, respiratory disease) may be at higher risk for developing FO due to impaired fluid regulation. Close monitoring of daily weight and signs of fluid intolerance is essential.
Precise titration of fluids is important, and fluid responsiveness should be assessed during hospitalization. Administration of miniature IV boluses (3-5 mL/kg isotonic fluids over 5 minutes) and serial evaluation of point-of-care ultrasound images (eg, caudal vena cava collapsibility index, left atrium:aorta ratio) may be necessary.8,9 In addition, de-escalation of fluid therapy rates after fluid resuscitation may be crucial for preventing FO.9
Relying solely on total fluid volume administered or daily body weight changes may cause early signs of FO to be overlooked. Assessment should also include monitoring for early subclinical signs (eg, nasal discharge, chemosis) and, if possible, measurement of total fluids in versus out (by tracking total IV fluids, nutrition, and water intake against a combined estimate of urine production and drainage, GI, and insensible losses).10
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