June 2017
Internal Medicine
Peer Reviewed | Web-Exclusive

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Patient weight gain and excellent hydration should, in theory, be good goals in the ICU.
Unfortunately, recent research has shown that positive water balance and weight gain are actually negative prognostic indicators.1-3 This research has forced practitioners to rethink the approach to fluid therapy for critical patients. This quiz uses a case-based approach to test your knowledge of current thought on fluid strategies for the most critical patients.
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Quiz: Contemporary Fluid Strategies in the ICU

Quiz: Contemporary Fluid Strategies in the ICU

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Quiz: Contemporary Fluid Strategies in the ICU
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References and author information Show
  1. Malbrain ML, Marik PE, Witter I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361-380.
  2. Zhang L, Chen Z, Diao Y, et al. Associations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis. J Crit Care. 2015;30(4):860.e7-13
  3. Barmparas G, Liou D, Lee D, et al. Impact of positive fluid balance on critically ill surgical patients: a prospective observational study. J Crit Care. 2014;29(6):936-941.
  4. Haskins S, Pascoe PJ, Ilkiw JE, Fudge J, Hopper K, Aldrich J. Reference cardiopulmonary values in normal dogs. Comp Med. 2005;55(2):156-161. 
  5. Aiello SE, Moses MA, eds. The Merck Veterinary Manual. 11th ed. Hoboken, NJ: Wiley; 2016.
  6. Day TK. Shock syndromes in veterinary medicine. In: DiBartola SP (ed). Fluid Therapy in Small Animal Practice. 2nd ed. Philadelphia, PA: Saunders; 2000:429-439. 
  7. Shires GT, Coln D, Carrico J, Lightfoot S. Fluid therapy in hemorrhagic shock. Arch Surg. 1964;88:688-693.
  8. Dillon J, Lynch JL, Myers R, et al. The treatment of hemorrhagic shock. Arch Surg Gynecol Obstet. 1966;11:967-977.
  9. Driessen B, Brainard B. Fluid therapy for the traumatized patient. J Vet Emerg Crit Care. 2006;16(4):276-299.
  10. Silverstein DC, Kleiner J, Drobatz KJ. Effectiveness of intravenous fluid resuscitation in the emergency room for treatment of hypotension in dogs: 35 cases (2000-2010). J Vet Emerg Crit Care (San Antonio). 2012;22(6):666-673.
  11. Hammond TM, Holm JL. Limited fluid volume resuscitation. Compend Contin Educ Vet. 2009;31(7):309-320.
  12. Cooper ES, Bateman SW, Muir WW. Evaluation of hyperviscous fluid resuscitation in a canine model of hemorrhagic shock: a randomized, controlled study. J Trauma. 2009;66(5):1365-1373.
  13. Palmer L, Martin L. Traumatic coagulopathy—part 1: pathophysiology and diagnosis. J Vet Emerg Crit Care. 2014;24(1):63-74.
  14. Palmer L, Martin L. Traumatic coagulopathy—part 2: resuscitative strategies. J Vet Emerg Crit Care. 2014;24(1) 75-92.
  15. Gelman S. Venous function and central venous pressure: a physiologic story.  Anesthesiology. 2008;108(4):735-748.
  16. Strunden MS, Heckel K, Butcher HR, Moyer CA. Perioperative fluid and volume management: physiological basis, tools and strategies. Ann Intensive Care. 2001;1(2):3-8.
  17. Chatrah V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol. 2015;31(3):308-316.
  18. Besen B, Gobatto A, Melro L, Maciel A, Park M. Fluid and electrolyte overload in critically ill patients: an overview. World J Crit Care Med. 2015;4(2):116-129. 
  19. Otto CM. Sepsis in veterinary patients: what do we know and where can we go? J Vet Emerg Crit Care. 2007;17(4):329-332.
  20. Butler AL, Campbell VL, Wagner AE, Sedacca CD, Hackett TB. Lithium dilution cardiac output and oxygen delivery in conscious dogs with the systemic inflammatory response syndrome. J Vet Emerg Crit Care. 2008;18(3):246-257.
  21. Hamlin RL. Heart rate of the cat. J Am Anim Hosp Assoc. 1989;25(3):284–286.
  22. Veterinary Medical Center; Hospital for Companion Animals; Clinical Pathology Laboratories. Columbus, OH: The Ohio State University; 2017. 
  23. Drobatz KJ, Cole SG. The influence of crystalloid type on acid–base and electrolyte status of cats with urethral obstruction. J Vet Emerg Crit Care. 2008;18(4):355-361.
  24. Brown S, Aikens C. Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med. 2007;21(3):542-558.
  25. Francis BJ, Wells RJ, Rao S, Hackett TB. Retrospective study to characterize post-obstructive diuresis in cats with urethral obstruction. J Feline Med Surg. 2010;12(8):606-608.
  26. Cooper ES. Controversies in the management of feline urethral obstruction. J Vet Emerg Crit Care (San Antonio). 2015;25(1):130-137.

Amy Butler

DVM, MS, DACVECC Critical Consults, Clarks Summit, Pennsylvania

Amy Butler, DVM, MS, DACVECC, is chief executive officer (CEO) of Critical Consults, Clarks Summit, Pennsylvania, a telemedicine firm that specializes in consultations involving emergency and critical care cases. Dr. Butler received her veterinary degree from Michigan State University, followed by completion of a rotating internship at University of Minnesota, then a concurrent residency in small animal emergency and critical care and Master’s program at Colorado State University. She served on the faculty of The Ohio State University for 4 years prior to becoming CEO of Critical Consults.

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