# Clin Med - Ruminant FT

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drraythe's
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2016-01-29 00:55

## Fluid therapy in Ruminants

Question | Answer |
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****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) Homemade 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 w/ Ca++ in them? (Why do we care?) | The RINGERS solutions!! (Lactated ringers solution, ringers solution). We care bc if we ad certain medications, like Flunixin Meglumine, the Ca++ will precipitate |

Which 2 commercial crystalloid fluids CONTAIN POTASSIUM? Why do we care that they contain potassium? | Plasma-Lyte 56 & Normosol-M. CANT BOLUS THIS bc you'll kill them from too much K+ |

How much sodium & potassium are in Plasma-Lyte 56? Normosol? | Na+= 40mEq/L, K+= 13mEq/L. ....THE SAME FOR NORMOSOL |

How much sodium & potassium are in 0.45% Na+ 2.55 dextrose? | Na+=77mEq/L, K+= 0 |

How much sodium & potassium are in 5% dextrose? | None of either! |

What are the pros & cons of enteral fluids that are homemade? | PRO: fast, cheap. CON: If diarrhea or probs w/ GI, slower than IV |

What are the pros & cons of IV fluids which are homemade? | 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 something to consider. |

**** SLIDE 13 → dont need to memorize any of the numbers | Maybe just glance at it |

What should you know about volumes & stuff when making homemade fluids? | IMPERIAL & AMERICAN GALLONS ARE DIFFERENT |

Homemade 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) |

Homemade fluids → IV → how would you make an isotonic bicarbonate solution? | 1L distilled water, 13g NaHCO3 (Baking soda) (Supplies 156 mEq/L bicarb) |

Homemade 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 |

Homemade fluids → IV → how would you make a Isotonic Dextrose (5%) fluid? | 200g Dextrose to 4L distilled water |

Homemade fluids → IV → how would you make an 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 3 main dz processes which are associated w/ fluid or electrolyte loss? | GI Renal Hemorrhage |

What are the Dz processes associated w/ inadequate perfusion, w/o 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 & PE signs associated w/ % dehydrated for neonates... take a look at this | Dont have to memorize too in depth I think |

What percent dehydration is incompatible w/ 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 (<8days old), your fluid should contain AT LEAST how much of ____ or ____? | AT LEAST 60mmol/L of acetate OR bicarbonate |

Tell me the apprxn base deficit of a calf <8days old which is.... (1) Standing w/ a strong suck reflex (2) Standing, weak suck reflex (3) Sternal recumbency (4) Lateral recumbency | (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 maintenance 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? (W/ base deficit) | Bicarbonate (mmol) = Body weight (Kg) x Base deficit (mmol/L) x (0.5) ← THIS LAST NUMBER IS A FACTOR & 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 & 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 (4) Teenagers: 0.5 |

What are the characteristics of an 8% dehydrated ruminant? | Depression Mild to moderate ↓ in skin turgor (skin tent duration 2 – 4 seconds) Obvious enophthalmos Slight tachycardia (heart rate >90 beats/ minute) ↑ capillary refill time (3 – 4 seconds) |

How does a mmol & a mEq of bicarb relate? | They are the same thing! 1mmol= 1mEq |

How do you calculate the bicarb deficiency? (w/ 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 w/ half the amount in 30min & 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 w/ 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 3 contraindications for giving electrolytes? | (1) Chronicity (2) Heart & muscle (3) Acid-base balance |

4 contraindications against fluid volume? | (1) Vasculitis (2) Lungs (3) Kidneys (4) Neonates & ALPACAS |

A rule of thumb fluid plan in a ruminant consists of what 3 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 1st 2 hours & the 2nd 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? | (BW x 80ml/24hrs for a neonate) (BW 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 1st hour of your fluid plan is...? | ¼ deficit + maintenance/hr + on going losses/hr |

The volume of fluid you should be giving in the 2nd hour of your fluid plan is...? 3rd hour? | The 2nd hour is the same as in the 1st hour (¼ deficit + maintenance/hr + on going losses/hr) but the volume in the 3rd hour is different bc the remainder of the deficit is divided over ~ 12-24 hours. |

You assess the PTx for a TOTAL FLUID DEFICIT bc... | Dehydration & hypovolemia can occur TOGETHER! so assess for total fluid deficit & 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 THEM | Useful to look at |

Asiatic Formula → how many g of K+ per gallon? | 3g KCl |

## Ruminant Fluid therapy: cases

Question | Answer |
---|---|

How would you solve this?: You have a 50Kg calf that you decide is not dehydrated/ hypovolemic but has now stopped nursing. He is also loosing ~ 500ml of diarrhea & on average 100ml of urine per hour. What is his hourly fluid requirements? | THIS IS ONGOING LOSS + MAINTAINANCE RATE (no deficit/shock amount bc not dehydrated or hypovolemic) So, 600ml lost in an hour. THEN, for a neonate, the rate for maintenance is 80ml/kg/DAY. So 80mlx50kg= 4000ml (this is for a DAY tho) so divide by 24hrs= 167, then 167+600 is what you give in an hour (767ml/ hour) |

How would you solve this?: You run a blood gas analysis on a dehydrated 45Kg calf. The HCO3 – is 12mEq/L. What is the calf’s bicarb deficit? (Assume normal bicarb is 25mEq/L) | WEIGHT x DEFICIT x FACTOR (babies is 0.6) so... 45 x 13 x 0.6= 351mEq/L (the 13 is from 25-12) |

How would you solve this?: A 4kg goat kid presents to you in hypovolemic shock. You wish to give it a standard shock rate fluid bolus in the 1st hour of its arrival, how much fluid would you use? | Weight x shock rate (90ml/Kg/hour), so 4Kg x 90mL= 360mL |

As the PTx arrives you decide that it is 8% dehydrated. While your team is giving the shock rate bolus you calculate the fluid deficit & maintenance fluid rate. Does the fact that the PTx has had a shock rate bolus of fluids change your calculations? | Subtract shock fluids that you administered from calculated total fluid deficit & maintenance requirements-Give resultant volume over 24 hours |

If you have a 40kg calf, what would her HOURLY maintenance rate be? | 2 ways to solve: (1) 40kg x 80ml/24hrs = 133ml (2) 40ml x 2ml/hr = 80ml/hr |

How would you solve this?: an 8% dehydrated calf which weighs 40kg is losing 200ml/hr of diarrhea. You want to replace half her fluid deficit in the 1st 2 hours what fluid rate would you set for the 1st hour of therapy? | 1st, 8% dehydrated= .08x40kg= 3.2L deficit. This is the total deficit. You want to give HALF over 2 HOURS. So 3.2/2= 1.6L (this is half) & for 1 hour would be half of that 1.6/2= 0.8L. THEN you need to consider ongoing loss & MAINTAINANCE. So for the 1st hour, 0.8L/hr+200ml/hr+133ml/hr= 1133ml/hr ((the 200 is the ongoing loss of diarrhea & you also need to add the maintenance rate per hour which is (40kg x 80ml/24hrs = 133ml) |

If you need to give a calf 175mmol of bicarb & you have a 1.3% NaHCO3-solution, how many mLs of the solution will you need to give? | 175mmol/ 156mmol= 1100mL (the 156 comes from memorization-remember that in a 1.3% solution of NaHCO3 supplies 156mmol/L. I know I want to think of it as mult to get the answer for this prob, but it's divide-think about cross mult & divide to get the unknown # which is how much fluid I'll need) |

You want to give a little calf who needs bicarb & fluids the fluids w/ bicarb added to it. Which is best? (LRS, saline, plasmalyte, D5W) | LRS contains Ca-CANT ADD BICARB TO Ca → precipitation might happen. SALINE 0.9%-this is ACIDIFYING & the calf is already acidotic PLASMALYTE-this is the correct answer. D5W (this means 5% dextrose in water)-has no electrolytes & your PTx is losing electrolytes in the diarrhea |

*What is about the capacity of a rumen for fluid therapy? What’s Tyner’s preference? | An adult cow’s rumen volume capacity is roughly 125L; consequently they can be given large volumes of fluid at a time. Personally I do not like to give more than 30L at a time. |