Clin Med- Equine Fluid Therapy 2 + Fluid Therapy in Ruminants 1

mepihuja's version from 2016-05-02 07:28

Equine Fluid Therapy Continued...

Question Answer
what kinda bore do you want on your catheter if you're using it in a horse?a LARGE bore (bore= hole in needle)
what are the three types of catheters she mentioned? Explain when they'd be used(1) Over the needle (good for short term use) (2) Over the wire (good for long term use, it is very supple and non-thrombogenic) (3) through the needle (for peel-off systems)
chart on slide 16- she said we shouldn't freak out about it too much, but still look over ittypes of catheters and their pros and cons
what are the two major complications of IV fluid therapy in horses?thrombophlebitis and overhydration in neonates/foals
is a hypertonic saline solution (HSS) a crystalloid or colloid?crystalloid
Isotonic = ____ solutionpolyionic solution
how do you calculate how much fluid a dehydrated patient needs?Liters of water ‘lost’ = B.W. in kg x estimated % of dehydration
what are the 4 overlapping phases of a fluid therapy plan? (if time relevant, give the time)(1) Resuscitation (<2hrs) <-- emergency! (2) Rehydration (12-24 hours) (3) maintenance (4) Ongoing losses
**what is the rate for resuscitation that she said we should keep in our heads?50ml per kg per day
What is the shock dose of fluids for a horse? How does this relate to body weight/blood volume? What is something to keep in mind about this, clinically? 50-80ml/kg. This is about ~8% of body weight, aka about 1 blood volume. (that means for a 500 kg horse, it would be about 40L! So this isn't always clinically practical) (so start by giving 1/4 of dose as bolus, reeval, etc)
Hypertonic Saline Solution (HSS)--> how much of the solution is sodium chloride? how many osmols per liter does it provide?7% Sodium Chloride, 1200mEq Na + 1200mEq Cl = 2400Osmol/L
Hypertonic Saline Solution (HSS)--> What is the amount of bolus you'd want to give for HSS? What is the effect on the blood volume/ body?2-4 ml/kg bolus (1-2L per 500kg). This causes an Immediate vascular expansion at about 2-3xs the amount infused. It alters the ECF and leads to a shift in the ICF
***If you are giving HSS (hypertonic saline solution) what else MUST YOU DO? (include #s)Every 1L HSS needs replacement with 10L isotonic fluid!!!!!!
what is the natural colloid for horses? what are the two synthetic colloids?Equine plasma is the natural colloid. Hetastarch and Pentastarch are the two synthetic colloids.
What are some benefits to using colloid fluids? When is it especially useful?Contain large molecules that remain in the vascular space, Plug capillary endothelium, Improve plasma oncotic pressure, Useful in cases with hypoproteinemia
When is Rehydration the first step? Why must you still do rehydration after Resuscitation?Rehydration is the first step in mild cases of fluid deficits. The reason that we must perform rehydration after Resuscitation is because Resuscitation may not correct whole deficit, and rehydration accounts for Loss of vascular volume AND total body water
How much is the minimum amount of dehydration required for clinical signs to appear?5%
Equation to determine how many L have been lost/ are needed?Amount (L) = % dehydration X body weight (kg)
how fast must administration take place in resuscitation? rehydration?resuscitation must happen in <2hours, Rehydration can occur over 12-24 hours
which routes of admin can be used in resuscitation? rehydration?resuscitation must be IV. rehydration can be IV OR enteral (if GI tract is healthy)
what type of fluids would you want to use in rehydration? Why?Isotonic crystalloids, because they replace fluids and Correct electrolyte imbalance
***WHAT IS MAINTENANCE RATE???50 ml / kg / day ---> So, 1 liter/hr maintenance (500kg horse)
maintenance--> When would you want to supplement electrolytes?If there is an existing deficit / or if on fluids > 24 hours
maintenance--> What kind of fluids should you use--> what would you base this decision off of? What if you didn't have these tools?Base decision on actual measurement of electrolytes and blood gases...if no lab, choose balanced polyionic
what are the two important electrolytes she mentioned?Ca and K
Calcium--> how much is usually in fluids? per L?Ca is usually added in 5L bags, 25ml 23% calcium-gluconate / liter
Potassium--> When would you want to give K to a horse? How much would you give per L? Cautions?You would give K to horses with hypokalemia or on iv fluids > 24h, and you'd add 10-40mEq / liter. CAUTION!!: K+ must be <0.5 mEq/kg/hour
what are some factors which the rate of fluid administration is dependent on?Patient (adult horse or foal), Severity of underlying deficit, Ongoing losses, Type of fluid administered (Crystalloid / Plasma / Blood products), Route of administration (enteral vs IV)
Ongoing losses--> these are usually difficult to estimate. What must you do to try to figure these out? How would you administer for ongoing losses, in general? How would you monitor? You will have to try to compare the "ins and outs" of the horse (drinking, peeing, etc). You typically replace by higher maint. requirements. Lastly, you can monitor response to therapy by looking at clinical signs, and laboratory parameters

Fluid therapy in Ruminants

Question Answer
****how much of body weight is contributed to blood volume??8%!
what's a route of fluid administration which is particularly helpful in pigs?per rectum
what are the 4 types of fluids you can use in ruminants?(1) sterile fluids (2) non sterile fluids (3) commercial preparations (4) home made preparations
**If you have a fluid which has Calcium in it, what must you be very careful about?NEVER ADD flunixin meglumine TO THESE SOLUTIONS! The Ca++ will precipitate out (baddd news)
**what are the solutions with Ca++ in them? (why do we care?)The RINGERS solutions!! (lactated ringers solution, ringers solution). We care because if we ad certain medications, like flunixin meglumine, the Ca++ will precipitate
which two commercial crystalloid fluids CONTAIN POTASSIUM? why do we care that they contain potassium?Plasma-Lyte 56 and Normosol-M. CANT BOLUS THIS because you'll kill them from too much K+
how much sodium and potassium are in Plasma-Lyte 56? Normosol?Na+= 40mEq/L, K+= 13mEq/L. ....THE SAME FOR NORMOSOL
how much sodium and potassium are in 0.45% Na+ 2.55 dextrose?Na+=77mEq/L, K+= 0
how much sodium and potassium are in 5% dextrose?none of either!
what are the pros and cons of enteral fluids that are home made?PRO: fast, cheap. CON: If diarrhea or probs with GI, slower than IV
what are the pros and cons of IV fluids which are home made?PROS- everyone can do it, easy to get electrolytes, can calc exactly what you want for that animal. CONS- not that much cheaper in food animals. not that many reports of homemade IV fluids not being sterile enough, but sthing to consider.
**** SLIDE 13--> dont need to memorize any of the numbersMaybe just glance at it
what should you know about volumes and stuff when making homemade fluids?IMPERIAL AND AMERICAN GALLONS ARE DIFFERENT
Home made fluids--> IV--> how would you make a fluid to treat ACIDOSIS?Use a 5:4:1 formula! This is 1L distilled water, 5g NaCl, 4g NaHCO3, 1g KCl (Supplies 48mEq/L HCO3)
Home made fluids--> IV--> how would you make a isotonic bicarbonate solution?1L distilled water, 13g NaHCO3 (Baking soda) (Supplies 156 mEq/L bicarb)
home made fluids--> IV--> how would you make a fluid to treat ALKALOSIS? ( 2 types- saline or ringers. explain both)(1) Saline (0.9%): I gallon of distilled water, 36g NaCl (Supplies 154mEq/L) (2) Ringers solution: 5 gal distilled water, 170g NaCl, 6g KCl, 6.5g CaCl2
home made fluids--> IV--> how would you make a Isotonic Dextrose (5%) fluid?200g Dextrose to 4L distilled water
home made fluids--> IV--> how would you make a Isotonic Potassium Chloride Solution?40g KCl added to 1gallon distilled water... (Supplies 556 mEq K+ /gallon)
WHAT IS THE RATE LIMIT FOR GIVING POTASSIUM?should not exceed <0.5mEq/kg/hr
what are three main dz processes which are associated with fluid or elecrolyte loss?GI, Renal, Hemorrhage
what are the Disease processes associated with inadequate perfusion, without loss of fluid to the outside world?Vascular compromise, Cardiac compromise, “Shock” (Endotoxemia / Cytokine storm)
Physical examination parameters affected by fluid volume loss? (long list, read over. Understand that out in the field sometimes the PE is all you have to go off of)weight loss, attitude, MM moisture, capillary refill time, position of globe in socket, skin turgor (skin tenting), HR, extremity temp, pulse quality, jugular fill time, urine output, RR
Slide 23--> % dehydration and PE signs associated with % dehydrated for neonates... take a look at thisdont have to memorize too in depth i think
what percent dehydration is incompatable with life?>15%
Physical examination parameters affected by electrolyte loss or imbalance (acid-base changes) (list, understand why)Attitude, In neonates the willingness to nurse may be affected, ambulatory or recumbent, HR/rhythm, pulse quality, Muscle status (tremors, paralysis, paresis, etc.), RR/pattern
if you have a diarrheic calves (less than 8days old), your fluid should contain AT LEAST how much of ____ or ____?AT LEAST 60mmol/L of acetate OR bicarbonate
Tell me the apprx base deficit of a calf <8days old which is..... (1) standing with a strong suck reflex (2) standing, weak suck reflex (3) sternal recumbency (4) lateral recumbancy(1) 0 (2) 5 (3) 10 (4) 10
how do you calculate a fluid deficit?%dehydration x body weight in Kg = volume (L)
what is the rate for MAINTENANCE per day in adults? neonates?(1) adults: 50ml/kg/day (2) neonates: 80ml/kg/day
what is the RULE OF THUMB of maintainance rate per hour?2ml/kg/hr
what is the SHOCK rate for fluids?90ml/Kg/hour (ten more than the DAILY rate of neonates, in an hour. interesting)
how do you calculate the bicarb deficiency? (with base deficit)Bicarbonate (mmol) = Body weight (Kg) x Base deficit (mmol/L) x (0.5)<---THIS LAST NUMBER IS A FACTOR, AND VARIES BASED ON CERTAIN THINGS. see other care for more
what is normal bicarbonate levels?The Normal Bicarbonate is 25mEq
calculating a bicarb deficiency--> in the equation there is a factor you must multiply the BW and base deficit by. This varies...what is it in the generic formula? What is it for.... NEONATES? ADULTS? "TEENAGERS" ?(1) generic formula: 0.5 (2) neonates: 0.6 (3) adults: 0.3 (5) teenagers: 0.5
what are the charateristics of a 8% dehydrated ruminant?Depression, mild to moderate decrease in skin turgor (skin tent duration 2 – 4 seconds), obvious enophthalmos, slight tachycardia (heart rate >90 beats/ minute), increased capillary refill time (3 – 4 seconds)
how does a mmol and a mEq of bicarb relate?they are the same thing! 1mmol= 1mEq
how do you calculate the bicarb deficiency? (with CO2 levels)Bicarbonate (mmol) = Body weight (Kg) x (30 – TCO2) x (0.6) <--this factor again- depends on animal (see other card)
If you are giving bicarb IV, how would you administer the amount needed?Can start with half the amount in 30min and rest over 12 hours if bicarb is to be given IV
you'd want to give bicarb to correct a metabolic acidosis, what pH would this action be appropriate at? what else must you consider?Correct metabolic acidosis if pH <7.2..also consider WHY there is an acidosis, prior to giving bicarbonate
if you are replacing sodium in an animal, what must you know??DON'T GIVE TOO FAST!!! esp if chronic change in Na--> need to give very slowly then
If you are bolusing Ca++, what must you know/do?a bolus of Ca++ will SLOW HEART RATE! Bolus with stethoscope LISTENING TO HEART AT SAME TIME
which is more important for fluids: the choice to give fluids, or the rate?The choice to give fluids is often more vital than the specific rate of administration
which is often more vital when giving fluids--> the volume or a composition?The volume given is often more vital than the composition chosen
what are three contraindications for giving electrolytes?(1) chronicity (2) heart and muscle (3) acid-base balance
4 contraindications against fluid volume?(1) vasculitis (2) lungs (3) kidneys (4) neonates and ALPACAS
a rule of thumb fluid plan in a ruminant consists of what three steps?(1) treat for deficit (2) maintenance (3) ongoing losses
rule of thumb for rumis--> Deficit: how do you administer the fluid which you calculated to treat a deficit? (what about shock dose?)half of which is given in the first two hours and the second half is given over 12 to 24 hours. (should you choose to give a shock dose, the shock dose comes out of the deficit volume)
rule of thumb for rumis--> maintenance: what are the equations to figure out the amount/rate you should give to-- A neonate? An adult?(bwt x 80ml/24hrs for a neonate) (bwt x 50ml/24hours for adult)
rule of thumb for rumis--> ongoing losses: how much should you administer for ongoing losses?what is estimated to be lost / hour
**The volume of fluid you should be giving in the FIRST hour of your fluid plan is...?¼ deficit + maintenance/hr + on going losses/hr
The volume of fluid you should be giving in the SECOND hour of your fluid plan is...? THIRD hour?the second hour is the same as in the first hour (¼ deficit + maintenance/hr + on going losses/hr) but the volume in the third hour is different because the remainder of the deficit is divided over ~ 12 -24 hours.
you assess the patient for a TOTAL FLUID DEFICIT because...dehydration and hypovolemia can occur TOGETHER! so assess for total fluid deficit and THEN decide what to do
***a 1.3% NaHCO3- solution has how many mmol/L in it?Supplies 156 mEq/L(or mmol/L)
*****There are a bunch of cases at the end of this powerpoint!! GO OVER THEMuseful to look at
Asiatic Formula--> how many g of K+ per gallon? 3g KCl