The 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats are here!

There’s no denying the benefits of fluid therapy for many veterinary patients, but the importance of designing an individualized fluid therapy plan historically has been less obvious.

But that’s about to change, thanks to the new 2024 AAHA Fluid Therapy Guidelines for Dogs and Cats, which provides a detailed refresher on the basic principles of fluid therapy while also guiding veterinary professionals through common fluid therapy scenarios.

“I am particularly excited about the emphasis on individualized fluid therapy plans,” said Mariana Angelica Pardo, DVM, DACVECC, board-certified veterinary emergency and critical care specialist and guidelines task force cochair.

“The guidelines move away from the traditional ‘one-size-fits-all’ approach and focus on tailoring fluid therapy to the specific needs of each patient based on their clinical status and underlying conditions,” she said. She especially likes the algorithms that she and the other task force members created, which facilitate putting the guidelines into practice.

Pardo isn’t the only one on the task force who feels this way; Ewan D.S. Wolff, PhD, DVM, DACVIM (SAIM), Past ACVIM Foundation, Advanced Clinical Training Fellow (Nephrology/Urology), offered a similar sentiment.

“It is easy to calculate a rate and flip a fluid on switch and walk away, but the reality is that patients come in different shapes, sizes, and metabolic requirements,” they said. “We knew this before, but I think a refresher on where we are now and what makes sense for dosing is truly essential.”

A step toward avoiding significant complications

The fact is, if a practice doesn’t approach fluids as a drug prescription that necessitates accurate prescribing, ongoing monitoring, and adjustments as needed, it’s all too easy for things to go wrong.

“Even with the best intentions and high clinical skills, it is possible to cause significant fluid overload,” Wolff said. And, of course, once a patient is fluid overloaded, it can take days to weeks for them to improve—if they ever do. “If we can fix one thing with our fluid practice globally, I would hope that it would be to catch fluid overload before it begins in earnest,” they added. “We can save so many patients if we know when to intervene.”

Because of her extensive experience in emergency and critical care settings, Pardo felt a strong call to be involved in the creation of the new fluid therapy guidelines. “Throughout my career, I’ve encountered numerous situations where having a standardized, evidence-based approach to fluid therapy would have significantly improved patient outcomes. I have also received countless questions from colleagues seeking clarity on fluid therapy protocols, highlighting a clear need for comprehensive guidelines.”

And that standardized approach is just what Pardo and the rest of the task force created.

“These new guidelines emphasize the concept that fluids should be prescribed with the same precision and care as any other medication,” she said. “They provide clear, evidence-based recommendations for accurate fluid prescribing, ongoing monitoring, and necessary adjustments based on patient response.” This ensures that each patient is given the exact volume and type of fluid their specific condition requires, which minimizes the risk of adverse effects—and improves overall outcomes.

A much-needed update

AAHA’s previous fluid therapy guidelines were published over a decade ago, and task force member Libby Ramirez, DVM, DABVP (Canine/Feline), Founding Fellow Emergency Practice, said, “The revised guidelines offer a comprehensive improvement over the earlier guidelines by addressing specific clinical contexts where a uniform treatment approach, such as ‘twice maintenance,’ proves inadequate.”

Ramirez, who was driven to participate in the guidelines task force by her commitment to represent the veterinary practitioner amidst a panel of specialists, knows firsthand what it’s like to be in the trenches.

“Effective fluid prescription hinges on meticulous initial assessment, judicious bolus administration, and frequent patient reassessment,” she said. “Throughout the guidelines, there is a consistent emphasis on the precision required in fluid therapy dosing and ongoing patient evaluation. Various fluid types, including crystalloids, colloids, albumin, and other transfusion products are also addressed.”

The revised guidelines not only address this need for accuracy, but also allow for ease of implementation in busy hospital environments. Ramirez believes that small animal practitioners will find that balance of precision and accessibility invaluable.

The right team to guide your team

Providing the ongoing monitoring necessary to avoid complications requires a team approach, and these guidelines address how the whole veterinary team can work together to ensure desired therapeutic outcomes—including proper utilization of skilled veterinary technicians.

However, getting that information out to the teams who need it first required a team approach by the task force.

“I would like to highlight the collaborative effort that went into developing these guidelines,” said Pardo. “Experts from various fields of veterinary medicine contributed their knowledge and experience, resulting in a comprehensive, multidisciplinary approach to fluid therapy.”

Ramirez agreed. “Participating in this panel was a rewarding experience,” she said, “and I am proud of our collaborative effort to consolidate current best practices in fluid therapy into a practical and actionable clinical guideline.” As a veterinarian who frequently handles referral cases, she regularly encounters instances of both under- and over-administered fluid therapy—and the resultant clinical complications. “Implementing optimal fluid therapy remains a complex challenge in clinical practice. I trust that the revised guidelines will give practitioners additional recommendations to navigate the intricacies of this part of patient care effectively.”

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Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.