4.4.1. Signs of dehydration

• Mental depression
• Skin fold elasticity
• Filling time of basilic vein > 1 sec
• Ocular hydration
• Pale, tacky mm
• Cool temperature of extremities
• Increased heart rate
• Decreased blood pressure

4.4.2. Types of fluids

Isotonic crystalloids distribute to all body fluid compartments

• LRS (volume replacement)
• Normosol®
• 0.9% saline (head trauma)

Nonisotonic crystalloids

• 5% Dextrose in water
• Hypertonic saline

Colloids cannot pass through capillary membranes

• IV volume expanders
• Plasma, whole blood
• Dextrans
• Hetastarch®
  • Expands to 1.4 x infused volume
  • 10-15 ml/kg bolus up to QID
• Always give with isotonic crystalloids (40-60% volume)

4.4.3. Fluid administration

• Routes of administration: oral, subcutaneous, intravenous, intraosseous
• Fluid volumes: Daily maintenance plus deficits and ongoing losses
• Rates of administration:
  • Up to 60 ml/kg IV bolus or IV, IO drip
  • Replace half of total fluid deficit in first 12 - 24 hr
  • Replace the remaining half over the following 48 hours

4.5.1. Indications

• PCV < 10-15%
• Rapidly dropping PCV

4.5.2. Blood donor choices

Closely matched or identical species blood donors are preferable, however, studies have shown that the source of the donor blood may safely come from a different species than the recipient. The use of pigeon, chicken, or raptor blood has proven to be quite safe, and often lifesaving in psittacines as a one time emergency procedure. Interspecies transfusions will not last as long as intraspecies transfusions. Administration of blood is no more difficult than administration of intravenous fluids. A life saving transfusion should be carried out even when crossmatching is not readily available.

4.5.3. Procedure

Suggested set-up

• Healthy donor bird
• Isoflurane anesthesia (mask)
• ACD or CPDA solution
• 22 ga. butterfly catheter (collection)
• 24 ga. indwelling catheter (administration)
• Blood component infusion set
• Warm lactated ringers solution
• B-Complex
• Iron dextran

Blood Donor - Blood may be collected from the donor bird from either the jugular or brachial veins. Isoflurane anesthesia of the donor may make the procedure easier to perform, although it is not always required. Ten ml of blood per kilogram of body weight may safely be taken without harm to a healthy donor bird. Blood should be collected in some form of anticoagulant. A syringe coated with heparin, EDTA, or containing a citrate solution (9 parts blood to 1 part ACD solution) will suffice. Heparin anticoagulant is preferred over EDTA for smaller recipients in order to avoid adverse effects (hypocalcemia) in the recipient. Following blood collection, the donor bird should receive an equivalent 10 ml/kg intravenous fluid replacement, as well as intramuscular administration of B vitamins and iron dextran. This supportive therapy is especially important if the donor is used repeatedly. Donated blood is best if used within hours after collection. Storage of avian blood results in an increasing potassium concentration that will become dangerous to the recipient over time (days).

Recipient - The recipient may be given blood through any available vein (cutaneous ulnar, jugular, or tibiotarsal vein). The use of an indwelling catheter or a butterfly catheter is prudent. A small blood administration set which includes an in-line filter is commercially available (Blood component infusion set, 4C2223, Fenwal Laboratories, Deerfield, IL). Care must be taken to minimize stress in the severely anemic patient. Pre-oxygenation and/or oxygen administration during the procedure may be required. Anesthesia of the recipient is usually not necessary, and may be risky. The recipient should also receive intramuscular iron dextran and B vitamins as supportive therapy.

4.5.4. Repeat transfusions

Studies have shown an increased mortality associated with repeated transfusions given to a patient from the same donor within 10 days of the first transfusion. Reasons for this observation are not understood. It is recommended that repeated transfusions should not be given to a patient from the same donor within 10 days and preferably 3 weeks of the first transfusion without crossmatching. If this is unavoidable, the recipient should be given dexamethasone sodium phosphate before repeating the transfusion. Crossmatching with unwashed red cells is apparently not valid . Crossmatching with washed and incubated red cells may be valid, showing either hemolysis or agglutination reactions.

4.5.5. Use of Oxyglobin

There are very good anecdotal reports on the use of oxyglobin in birds. No scientific papers or official recommendations for its use in birds are currently available. Since it has become available in 60 ml containers, it is now more practical to use.

• Studies in chickens and some psittacine species have used 15 ml/kg slow IV or IO route.
• Used in hemorrhagic shock, hemodilution, chronic anemia to increase oxygen to tissues
• No cross matching required
• No observable side effects seen
• Increased PCV for short periods of time only (~ 3 days)

4.6.1. Refeeding syndrome

• Always rehydrate animal first
• Give B vitamins
• Give oral electrolytes first
• Tubefeed formula low in carbohydrates, high in fat with adequate protein
• If the patient is digesting the formula, move gradually on to easily digestible solid food

6.1.1. Texts and Articles

Altman, Robert B., et al. Avian Medicine and Surgery. Philadelphia. W.B. Saunders Co., 1997. Chapter 48

Altman, RB. Heterologous blood transfusion in avian species. Proceedings of the Annual Meeting of the Association of Avian Veterinarians, San Diego, CA, 1983: 28-32.

Critical care. Agnes E. Rupley, ed. The Veterinary Clinics of North America, Exotic Animal Practice. W.B. Saunders Co., 1998.

Degernes, Laurel A., et al. A preliminary report on intraosseous total parenteral nutrition in birds. Proceedings of the Annual Conference of the Association of Avian Veterinarians, 1995., pp.25-26.

Degernes, Laurel A., ed al. Autologous, homologous, and heterologous red blood cell transfusions in cockatiels (Nymphicus hollandicus). Journal of Avian Medicine and Surgery, v.13 (1) : 2-9, 1999.

Jenkins, Jeffrey. Critical care. Seminars in Avian and Exotic Pet Medicine, Vol. 3 (4), October 1994.

Morrisey, James K., et al. Comparison of three media for the storage of avian whole blood. Proceedings of the Association of Avian Veteirnarians, 1997: pp.279-280.

Quesenberry, KE, and Hillyer, E. Hospital management of the critical avian patient. Proceedings of the AAV Basic Avian Medicine Symposium, Seattle, WA, 1989: 365-369.

Ritchie, Branson W., et al. Avian Medicine: Principles and Application. Lake Worth, Fla., c1994: Chapter 15.

Stone, E.G. and P.T. Redig. Preliminary evaluation of hetastarch for the management of hypoproteinemia and hypovolemia. Proceedings of the Annual Conference of the Association for Avian Veterinarians, 1994.