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Pardo M, Spencer E, Odunayo A, Ramirez ML, Rudloff E, Shafford H, Weil A, Wolff E. 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2024; 60:131-163. [PMID: 38885492 DOI: 10.5326/jaaha-ms-7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Fluids are drugs used in veterinary patients capable of producing beneficial therapeutic or inadvertent harmful effects within the body's intravascular, interstitial, and intracellular fluid spaces. The individualized design of a fluid therapy plan requires careful patient assessment and targeted selection of proper fluid types, administration routes, and rates, along with adjustments during therapy tailored specifically as per the individual patient's fluid requirement and therapeutic response. Personalized fluid prescriptions and vigilant patient monitoring help avoid patient morbidity from body fluid deficiencies, fluid excess, and electrolyte derangements and support better patient outcomes. These guidelines provide an overview of fluid dynamics within the fluid spaces of the body, describe various types of fluids and their uses, and outline recommendations for fluid administration for resuscitation, rehydration, and maintenance purposes. The guidelines also outline approaches to fluid therapy for anesthetized patients and reiterate the recommendations of reduced fluid rates in this population of patients. Additionally, the guidelines include practical fluid therapy strategies for patients with various common disorders. The goal of these guidelines is to help veterinary professionals safely and effectively prescribe and administer fluid therapy for canine and feline patients.
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Affiliation(s)
- Mariana Pardo
- Critical Care Veterinarian Consulting, Pleasantville, New York (M.P.)
| | - Erin Spencer
- Veterinary Emergency Group, Derry, New Hampshire (E.S.)
| | | | - Mary L Ramirez
- North Dallas Veterinary Emergency and Specialty Hospital, Frisco, Texas (M.L.R.)
| | - Elke Rudloff
- Blue Pearl Pet Hospice, Milwaukee, Wisconsin (E.R.)
| | - Heidi Shafford
- Veterinary Anesthesia Specialists, Gladstone, Oregon (H.S.)
| | - Ann Weil
- Purdue University, West Lafayette, Indiana (A.W.)
| | - Ewan Wolff
- Blue Pearl NE Portland, Portland, Oregon (E.W.)
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Nóbrega JCD, Dinallo HR, Geraldes SS, Azevedo MGPD, Moraes RSD, Maia SR, Souza FFD, Melchert A, García HDM, Andreatti Filho RL, Okamoto AS, Okamoto PTCG. Symmetric dimethylarginine correlates with the urea, creatinine, potassium, and clinical scores in feline urethral obstructions. J Vet Sci 2024; 25:e27. [PMID: 38568828 PMCID: PMC10990919 DOI: 10.4142/jvs.23268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND A urethral obstruction (UO) is an emergency commonly observed in male cats, which can result in significant clinical and laboratory alterations, leading to complications and death. OBJECTIVES This study aimed to correlate symmetric dimethylarginine (SDMA) with the urea, creatinine, potassium, and bicarbonate levels in cats with UO. In addition, the correlation between clinical score and time of obstruction was evaluated. METHODS Thirty male cats were selected and allocated into a control group (CG, n = 13) and an obstruction group (OG, n = 17). The laboratory analyses were conducted before treatment (M0) and at different times after treatment (12 h [M12], 24 h [M24], and 48 h [M48]). Correlations were established between SDMA and creatinine, urea, bicarbonate, potassium, time of obstruction, and the clinical score. RESULTS A strong correlation (r > 0.6) was observed between SDMA and creatinine, urea, and potassium in the OG. Furthermore, there was substantial agreement (kappa value) between SDMA and creatinine at M24. A higher clinical score was associated with a longer time of obstruction. In the OG, at M48, the SDMA and creatinine levels were 50% and 41.2% higher, respectively. CONCLUSIONS A correlation was observed between SDMA and creatinine in obstructed cats, and significant agreement between these values was observed 24 h after the unblocking treatment. A correlation among SDMA, urea, and potassium was observed. Approximately 9% more cats continued to have elevated SDMA levels after 48 h of treatment compared to creatinine. This suggests a slightly lower sensitivity of the latter biomarker but does not exclude the possibility of congruent and normalized values after a longer evaluation period.
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Affiliation(s)
- Jéssica Cavalcante da Nóbrega
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Heloíse Rangel Dinallo
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Silvano Salgueiro Geraldes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Maria Gabriela Picelli de Azevedo
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Reiner Silveira de Moraes
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Suellen Rodrigues Maia
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Fabiana Ferreira de Souza
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Alessandra Melchert
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Henry David Mogollón García
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Raphael Lúcio Andreatti Filho
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
| | - Adriano Sakai Okamoto
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, 18618-681, São Paulo, Brazil
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Sampaio KDO, da Silva-Junior VA, de Sousa-Filho RP, Aleixo GADS, Mori da Cunha MGMC, da Silva ECB. Neutering is not associated with early-onset urethral obstruction in cats. J Feline Med Surg 2022; 24:e611-e617. [PMID: 36453601 PMCID: PMC10812360 DOI: 10.1177/1098612x221128781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the correlation between clinical aspects and urethral lesions with reproductive status and age at neutering in obstructed male cats. METHODS All cats with compatible signs of urethral obstruction (UO) treated at the Veterinary Hospital of the Federal Rural University of Pernambuco from 2019 to 2021 were divided into three groups according to their reproductive status: intact; prepubertal neutered; and post-pubertal neutered. Cats with compatible signs of UO were selected for further analysis. Age, clinical signs, age at neutering and age of the first obstructive event were documented. Cats with recurrent obstructive urinary signs or urethral trauma that made catheterization impossible were referred for perineal urethrostomy. The morphology of the excised penises was assessed by histopathological analysis. RESULTS Of 84 cats with signs of UO included in this study, 28.6% were classified as intact, 28.6% as prepubertal neutered and 42.8% as post-pubertal neutered. Intact cats had a significantly earlier onset of UO compared with prepubertal and post-pubertal neutered cats, as seen by the age at obstruction (3.6 vs 5.7 and 5.5 years, respectively). Similar clinical signs and histopathological lesions were observed in all groups. The main clinical signs observed were stranguria, hematuria and pollakiuria. All cats had some degree of injury in the penile urethra. The most common lesions were hemorrhage, fibrosis and congestion. CONCLUSIONS AND RELEVANCE It appears that intact cats had an earlier onset of UO than neutered cats, regardless of age at neutering. Urethral histopathological lesions and clinical signs were similar in both groups. Pediatric neutering represents a useful tool in the control of abandoned and stray animals and the consequent dissemination of zoonoses, thus having a positive impact on public health.
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Breheny C, Blacklock KB, Gunn‐Moore D. Approach to urethral obstruction in cats. Part 1: presentation and stabilisation. IN PRACTICE 2022. [DOI: 10.1002/inpr.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ryan A, Gurney M, Steinbacher R. Suspected vagal reflex and hyperkalaemia inducing asystole in an anaesthetised horse. Equine Vet J 2021; 54:927-933. [PMID: 34738246 PMCID: PMC9543672 DOI: 10.1111/evj.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022]
Abstract
A 10‐year‐old 466 kg mustang gelding presented to an equine referral hospital for surgical repair of nasal, frontal and lacrimal bone fractures from an unknown trauma. Surgical repair was performed under general anaesthesia, including a right‐sided maxillary regional anaesthetic block with mepivacaine hydrochloride. Progressive hyperkalaemia was documented perianaesthetically (T‐3 mins; 134 mins after induction; potassium 6.4 mmol/L (ref 3.5‐5.1 mmol/L). Perianaesthetic bradycardia was attributed to alpha −2 agonist infusion administration, and other characteristic ECG changes (flattened P waves, narrow T waves of increased amplitude, prolonged QRS complex) were not documented. Asystole occurred 137 min after induction of anaesthesia; however, a review of the available literature suggests the degree of hyperkalaemia documented was unlikely to be the primary cause of asystole but may have been a contributing factor. It is hypothesised that a trigeminocardiac reflex was the primary contributory factor to asystole in the described case, and may represent a maxillomandibulocardiac reflex that has not been previously described in the horse.
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Affiliation(s)
- Aoife Ryan
- University of Veterinary Medicine, Vienna, Austria.,Anderson Moores Veterinary Specialists, Winchester, UK
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Heitland A, Klein-Richers U, Hartmann K, Dörfelt R. Influence of acetate containing fluid versus lactate containing fluid on acid-base status, electrolyte level, and blood lactate level in dehydrated dogs. Vet World 2021; 14:2714-2718. [PMID: 34903930 PMCID: PMC8654756 DOI: 10.14202/vetworld.2021.2714-2718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Acetate or lactate buffered, balanced isotonic rehydration fluids are commonly used for fluid therapy in dogs and may influence acid-base and electrolyte status. This study aimed to assess acid-base status, electrolyte levels, and lactate levels in dehydrated dogs after receiving acetate or lactate-containing intravenous rehydration fluids. MATERIALS AND METHODS In this prospective, randomized study, 90 dehydrated dogs were included and randomized to receive acetate [Sterofundin® ISO B. Braun Vet Care (STERO), Germany) or lactate (Ringer-Lactat-Lösung nach Hartmann B. Braun Vet Care (RL), Germany] containing intravenous fluids for rehydration. The exclusion criteria were as follows: Age <6 months, liver failure, congestive heart failure, and extreme electrolyte deviation. Physical examination, venous blood gas, and lactate levels were analyzed before and after rehydration. The two groups were compared using t-test and Chi-square test. The significance level was set at p≤0.05. RESULTS Post-rehydration heart rate decreased in the STERO group (p<0.001) but not in the RL group (p=0.090). Lactate levels decreased in both groups STERO (p<0.001) and in group RL (p=0.014). Sodium and chloride levels increased during rehydration in group STERO (p<0.001; p<0.001) and group RL (p=0.002; p<0.001). There was a larger decrease in lactate levels in group STERO compared to group RL (p=0.047). CONCLUSION Both solutions led to a mild increase in sodium and chloride levels and decreased lactate levels. The acetate-containing solution had an inferior effect on the decrease in lactate level.
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Affiliation(s)
| | - Ute Klein-Richers
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katrin Hartmann
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Dörfelt
- Centre of Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Rudloff E, Hopper K. Crystalloid and Colloid Compositions and Their Impact. Front Vet Sci 2021; 8:639848. [PMID: 33869319 PMCID: PMC8044465 DOI: 10.3389/fvets.2021.639848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/01/2021] [Indexed: 12/18/2022] Open
Abstract
This manuscript will review crystalloid (hypo-, iso-, and hyper-tonic) and colloid (synthetic and natural) fluids that are available for intravenous administration with a focus on their electrolyte, acid-base, colligative, and rheological effects as they relate to each solution's efficacy and safety. The goal is for the reader to better understand the differences between each fluid and the influence on plasma composition, key organ systems, and their implications when used therapeutically in animals with critical illness.
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Affiliation(s)
- Elke Rudloff
- BluePearl Specialty + Pet Emergency, Glendale, WI, United States
| | - Kate Hopper
- Department of Veterinary Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Jones SJ, Mama KR, Brock NK, Couto CG. Hyperkalemia during general anesthesia in two Greyhounds. J Am Vet Med Assoc 2020; 254:1329-1334. [PMID: 31067178 DOI: 10.2460/javma.254.11.1329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 36-kg (79-lb) castrated male Greyhound (dog 1) and a 25-kg (55 lb) spayed female Greyhound (dog 2) underwent general anesthesia for dental care with similar perianesthetic protocols on multiple occasions from 2013 to 2016. Both dogs had periodontal disease but were otherwise deemed healthy. Both dogs developed clinically relevant hyperkalemia, with signs including loss of P waves on ECG tracings, during multiple anesthetic events. CLINICAL FINDINGS Dog 1 developed hyperkalemia during 2 of 2 anesthetic events, with ECG changes noted during the first event. Dog 2 developed hyperkalemia during 3 of 4 anesthetic events, with ECG changes identified during the second and third events. Serum potassium concentration for both dogs was within the reference range prior to and between anesthetic events. No underlying etiopathogenesis for hyperkalemia was identified for either dog. TREATMENT AND OUTCOME In each hyperkalemic event, the clinician stopped the dental procedure and continued to provide supportive care and monitoring while the dog recovered from anesthesia. The ECG changes resolved, and serum potassium concentration returned to the reference range rapidly after inhalant anesthetic administration was discontinued. The dogs were discharged from the hospital without further complications. CLINICAL RELEVANCE Hyperkalemia in anesthetized Greyhounds resulted in serious cardiac conduction abnormalities, which could be potentially fatal if not recognized and promptly treated. Further investigation into the etiopathogenesis, prevention and treatment strategies, and genetic or familial components of this condition is indicated.
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Nye AK, Luther JK. Feline Perineal Urethrostomy: A Review of Past and Present Literature. Top Companion Anim Med 2018; 33:77-82. [DOI: 10.1053/j.tcam.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/11/2022]
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Fröhlich L, Hartmann K, Sautter-Louis C, Dorsch R. Postobstructive diuresis in cats with naturally occurring lower urinary tract obstruction: incidence, severity and association with laboratory parameters on admission. J Feline Med Surg 2016; 18:809-17. [PMID: 26179575 PMCID: PMC11112202 DOI: 10.1177/1098612x15594842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this retrospective study were to investigate the actual incidence of postobstructive diuresis after relief of urethral obstruction in cats, as well as to identify changes in blood and urine parameters that might be associated with postobstructive diuresis (POD), and to assess the impact of fluid therapy. METHODS The medical records of 57 male cats with urethral obstruction that were treated with an indwelling urinary catheter were retrospectively analysed. Absolute urine output in ml/kg/h every 4 h and the incidence of cats with polyuria (urine volume >2 ml/kg/h) at any time point over a 48 h period after the re-establishment of urine flow were investigated. In addition, postobstructive diuresis in relation to fluid therapy (PODFR) was defined as urine output greater than the administered amount of intravenous fluids on at least two subsequent time points. Polyuria and PODFR were investigated for their association with blood and urine laboratory parameters. RESULTS After 4 h, 74.1% (40/54) of the cats had polyuria, with a urine output of >2 ml/kg/h. Metabolic acidosis was present in 46.2% of the cats. Venous blood pH and bicarbonate were inversely correlated with urine output in ml/kg/h after 4 h. The overall incidence of POD within 48 h of catheterisation was 87.7%. There was a significant correlation between intravenous fluid rate at time point x and urine output at time point x + 1 at all the time points except for the fluid rate at time point 0 and the urine output after 4 h. PODFR was seen in 21/57 cats (36.8%). CONCLUSIONS AND RELEVANCE POD is a frequent finding in cats treated for urethral obstruction, and can be very pronounced. Further studies are required to determine whether or not a change in venous blood pH actually interferes with renal concentrating ability. The discrepancy between the frequency of cats with polyuria and PODFR (87.7% vs 36.8%) in the present study indicates that administered intravenous fluid therapy might be the driving force for the high incidence of polyuria in some cats with naturally occurring obstructive feline lower urinary tract disease.
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Affiliation(s)
- Laura Fröhlich
- Clinic of Small Animal Medicine, LMU Munich, Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, LMU Munich, Munich, Germany
| | - Carola Sautter-Louis
- Clinic for Ruminants with Ambulatory and Herd Health Services, LMU Munich, Munich, Germany
| | - Roswitha Dorsch
- Clinic of Small Animal Medicine, LMU Munich, Munich, Germany
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Cooper ES. Controversies in the management of feline urethral obstruction. J Vet Emerg Crit Care (San Antonio) 2015; 25:130-7. [PMID: 25590677 DOI: 10.1111/vec.12278] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To discuss areas of differing opinion in the management of feline urethral obstruction and present current evidence to either support or refute common practices. ETIOLOGY Urethral obstruction may occur as a result from a functional obstruction (idiopathic obstruction) or a physical obstruction, such as mucous plugs or calculi within the urethra. Potential risk factors for obstruction in cats include predominantly indoor status, decreased water intake, and increased body weight. DIAGNOSIS The diagnosis is most commonly made based on history and initial physical exam-straining to urinate, vocalizing, signs of systemic illness, moderate to large firm bladder on abdominal palpation. THERAPY Treatment is based on available evidence. The type of IV isotonic crystalloid used does not seem to matter and rate should be determined by need for fluid resuscitation, and replacement of deficit and ongoing losses. Though controversial, cystocentesis appears to be safe and may offer some benefits in initial management. There is evidence to suggest a smaller urethral catheter (3.5 Fr) may be associated with decreased risk of reobstruction. Routine use of antimicrobial agents in hospital is not recommended; they should be dispensed based on culture performed at the time of catheter removal. Though commonly used, evidence in support of antispasmodics is limited and further prospective investigation is needed. PROGNOSIS Feline urethral obstruction is associated with 90-95% survival, with reported recurrence rates of 15-40%. Potential factors affecting recurrence include size or duration of indwelling urinary catheter, use of antispasmodic agents, patient age, and indoor-outdoor lifestyle; however, different studies offer conflicting results. Increased water intake and environmental modification do seem to decrease risk of recurrence.
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Affiliation(s)
- Edward S Cooper
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
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Holt D, Agnello K. Peritoneum. FELINE SOFT TISSUE AND GENERAL SURGERY 2014. [PMCID: PMC7149698 DOI: 10.1016/b978-0-7020-4336-9.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R, Shafford H. 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats*. J Am Anim Hosp Assoc 2013; 49:149-59. [DOI: 10.5326/jaaha-ms-5868] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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