Featured veterinarian: Dr. Deborah Silverstein, emergency and critical care expert
‘Understanding how to use fluids as drugs allows us to avoid harm, and provide the most benefit for our patients’
by Mary Guiden
Dr. Deborah Silverstein, DVM, is a professor in emergency and critical care at the University of Pennsylvania School of Veterinary Medicine. Her research focuses on emergency medicine and respiratory issues, and she serves as chief of emergency and critical care at Ryan Veterinary Hospital at U Penn. Silverstein is also a diplomate of the American College of Veterinary Emergency and Critical Care.
She is the co-author of “Fluid therapy in dogs and cats,” published in February 2023 by Edra Publishing. The book offers a deep dive into one of the most necessary therapies for critically ill patients and those who are not able to maintain their own hydration or feed themselves voluntarily. In this recent interview, she discussed the role of fluid therapy in emergency medicine, who can benefit from reading the book and why this topic is critical — pun intended — in veterinary medicine. Dr. Fabio Viganò DVM, from Clinica Veterinaria San Giorgio Legnano in Italy is a co-author and editor of the book.
Q: How important is fluid therapy in emergency and critical care?
Silverstein: Fluid therapy is one of the tenets of treatment in emergency and critical care. It is a key treatment for animals that require any form of fluid support; this is a common presenting problem for animals in the emergency room. And often these animals have some degree of fluid responsive disease or diseases. In the ICU, we have animals that are battling fluid, electrolyte and even acid-based disorders that might require careful attention when choosing the best fluid therapy. For many animals, fluids are lifesaving. In the critical care unit, it often is a part of the supportive care that can help patients recover and get home sooner.
Q: What should people know about fluid therapy and its importance in veterinary medicine?
Silverstein: Fluids are sometimes taken for granted, that they’re always there, always used. One of the things this book points out is that not only is proper assessment of volume status vitally important, but the treatment of volume disorders in the body, electrolyte or acid-based imbalances and even lifesaving resuscitation treatments can be accomplished with fluid and electrolyte therapy. This topic could be simplified to a chapter in a book but one of the beauties of this small animal fluid therapy book is that it provides readers with a more detail-oriented approach to assessment, treatment and monitoring of patients that receive fluid therapy. The more that the person prescribing fluids understands about fluid therapy and how to fine tune treatment to the individual patient, hopefully the better the outcome, and the shorter the hospital stay for the animal.
Q: What interests you most about this topic?
Silverstein: I’ve always had an interest in fluid therapy since I was a student. I did my resident research project on fluid therapy in dogs and the change in blood volume and response to bolus therapy with different types of fluids (not only isotonic crystalloids), including synthetic colloids and hypertonic saline.
Most living organisms are made up of at least 60% water mixed with electrolytes and protein. It’s very tightly regulated for homeostasis within the body. Fluids play such an integral part of any treatment plan. They’re immensely beneficial when they’re used properly. Conversely, they can be severely detrimental when used improperly. Understanding how to best use fluids as drugs allows us to avoid harm and provide the most benefit for our patients.
Q: The description for the book mentions new developments in imaging. Would you please describe that development and its importance for fluid therapy?
Silverstein: We don’t typically think of imaging as part of a fluid therapy plan. Although there is an increased use of point of care ultrasound for the assessment of volume status and response to fluid therapy, the research realm has recently started to make advances in the use of microcirculatory imaging, video microscopy, to evaluate the microcirculation, and how it responds to fluid therapy. This allows us to monitor how different disease states affect the microcirculation and the resulting changes we might expect to see with fluid therapy.
Although we may not understand everything at this point and it’s not yet considered to be clinically useful — because it still does require big expensive machines, and users who have been trained how to use them and then provide the proper interpretation — the information gleaned from investigational studies can provide all of us with useful information regarding the proper use of fluids in clinical patients.
Looking at how intravenous fluid therapy can change microcirculatory perfusion, which is what we care about when we’re using fluids, it’s not just about increasing the amount of volume in the blood vessels.
It’s about getting the oxygen and nutrients to the cells of the different organisms so that they can perform normal metabolism and respiration. Fluid therapy also helps those cells release any byproducts of metabolism, such as carbon dioxide, and that is also carried away from the tissues, and excreted from the body.
The use of fluids helps us understand how they affect individual organ and cellular function and how they affect the vascular lining, the endothelium and the delicate structure we now understand to be the endothelial glycocalyx.
It's becoming more and more important to recognize that the detrimental aspects of fluids typically involve excessive administration such that we damage the vessels and the delicate endothelial lining of all the blood vessels in the body. This is an evolving area of research.
Although there has been some research thus far looking at this in veterinary medicine and even further research in human medicine, we still have a long way to go. I hope that someday it can be used clinically to evaluate patients before, during and after the administration of various fluid types.
Q: Who do you hope will read the book?
Silverstein: Fluid therapy in dogs and cats is a book that applies to anybody who works in a veterinary hospital and uses fluid therapy regularly to treat patients. It could also be a valuable resource for those that are learning about fluid therapy. This includes general practitioners to nurses, students, trainees and specialists.
Some of the early chapters in the book apply to those who want to learn more about the fundamentals of fluid therapy, how fluids are distributed in the body, and how the normal homeostatic mechanisms work to maintain the fluid balance in various compartments of the body.
For those that want to delve a little deeper into more specifics about hemorrhagic shock, or as we discussed, imaging of the microcirculation, this information is included in the later chapters of the book.
Q: What else would you like people – veterinarians and the public – to know about fluid therapy?
Silverstein: Fluids are drugs. We don’t tend to think about prescribing fluids the way we prescribe other medications. But really, they can help or hurt any patient in much the same way. It’s important to understand how to best assess volume status, prescribe certain types of fluids based on each patient’s disease process and projected fluid losses, and how to monitor for any adverse effects of fluid therapy.
This book provides valuable information to all levels of learners to help maximize the potentially immense beneficial effects of fluids in the way they practice veterinary medicine.
Read an editorial by Silverstein and colleagues in Australia and Tennessee published in October 2021 in Frontiers in Veterinary Medicine. The editorial was part of a special issue dedicated to fluid therapy.
Comments
Related Articles
Copyright © 2026 - All Rights Reserved
ISSN 2768-198X
List
Add
Please enter a comment