Clin Med - Ruminant FT

drraythe's version from 2016-01-29 00:55

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) 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 numbersMaybe 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 are 3 main dz processes which are associated w/ fluid or electrolyte loss?GI
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
MM moisture
Capillary refill time
Position of globe in socket
Skin turgor (skin tenting)
Extremity temp
Pulse quality
Jugular fill time
Urine output
Slide 23 → % dehydration & PE signs associated w/ % dehydrated for neonates... take a look at thisDont 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 THEMUseful 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.