Fluid therapy
The aim of fluid therapy should be to restore the circulation and to improve tissue and organ perfusion. Fluids should be administered as quickly as possible by the placement of two wide bore intravenous catheters into the cephalic or jugular veins. The saphenous veins should not be used for intravenous fluids as they will be ineffective at restoring circulating volume due to the reduced venous return caused by the gastric compression of the vena cava.
The choice of fluids is primarily crystalloids in combination with a colloid. This is the fluid combination of choice as colloids have the advantage of prolonged effect within the circulation and they also increase oncotic pressure, this has the effect of enhancing the effect of the crytalloids. Another readily available and cheap fluid which has been used successfully in the treatment of GDV patients is Hypertonic (7.2%) saline. Hypertonic saline should be given as a one off bolus at a rate of 5-10ml/kg over 15 minutes followed by crystalloids, e.g. Hartmann’s solution at 20ml/kg/hour.
Haemoglobin based oxygen carriers (HBOC) e.g. Oxyglobin® or synthetic blood substitutes may be useful as an initial resuscitation fluid as it has the ability to help maintain intravascular colloid oncotic pressure and perfuse tissues which whole blood cannot due to its small cell size, i.e. ischaemic areas.
Colloids are not currently recommended for critical patients unless there has been acute haemorrhage. However if the patient has a low PCV or haemoglobin level, then oxyglobin could be considered to improve oxygen carrying ability and to provide some oncotic support.
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