Equine Med- Fluid Therapy

drraythe's version from 2016-04-29 15:08


Question Answer
what is a cause of continued electrolyte loss in horses?SWEATING!! When they sweat, the sweat out lots of water AND electrolytes. Since they lost the electrolytes, the conc of Na in the blood did not go up, so there is no stimulation for them to start drinking (so these horses are prolly candidates for fluid therapy)
what is urine SG like in neonatal foals?Foals are 75% water and adults are 60%. So, foals have a much more dilute USG (1.003-1.008) (hyposthenuric to beginning of isosthenuric))
how/when do horses drink?they are POST-PRANDIAL drinkers
what are the two main routes of admin for fluids?mainly enteral + IV
if you are gonna supplement potassium.... you know the schtickMAX 0.5mEq/kg/hr
what would you see on your PE which would indicate HYPOVOLEMIA?inc Heart rate, inc RR, dec pulse pressure, dec jugular fill, cold extremities, dec urine output (SG)
what would you see on your PE which would indicate dehydration?Tacky oral m.m. (if you put your fingers up their lips, you hands should come back all slimy. If not, theyre tacky), Skin tent, sunken eyes
where do you check your skin tent?Do ABOVE THE EYELIDS (neck isnt good bc if old, they dont have much elasticity left, and in neonates the neck is too stretchy)
what is a way to check if a neonatal foal is dehydrated? but isnt a reliable indicator in adults?(only reliable for neonate) neonates dont have as much fat behind eye so if they are dehydrated, their eyes will sink (adult have lots of fat behind their eyes so even if they are dehydrated it wont sink)
what are the 4 overlapping phases (parts of) a fluid plan?Resuscitation (<2hr), Rehydration (12-24hr), Maintenance, Ongoing losses
*Resuscitation phase is the ER phase. what is the SHOCK DOSE RATE of a horse?50-80ml/kg which is apprx 8% of their body weight (which is one blood volume). Bit this is a lot all at once and kinda clinically impractical (500kg horse= ~40L) do administration in quarter till you have the full shock dose in there, after each quarter you reassess
IF you use HYPERtonic solutions, how much do you need to replace in isotonic solutions?for ever 1L of hypertonic, need 10L isotonic
if you start to rapidly administer crystalloids, what is a good parameter to reasses them and see how they are doing?look at HR! are they still tachycardic?
you want goal directed therapy for fluids for a dehydrated/hypovolemic pt- what are some things your goals are to fix?want to fix: HR, lactate (high bc anaerobic metabolism), PCV/TP, CRT
which two electrolytes are very important for you to consider in your fluid plan?Calcium and potassium!
when do you add calcium to your fluid plan? (how much would you add?)Added to each 5L bag. 25ml 23% calcium-gluconate / liter
when do you want to supplement potassium in your fluid plan? (2)For horses with hypokalemia or on iv fluids > 24h
how much K+ do you give? (in terms of liters and in terms of the animal)10-40mEq / liter, but more importantly, ****Caution: K+ must be <0.5 mEq/kg/hour
normal adult horse urine specific gravity?(got this off the net/mercks, not her notes) 1.025–1.060
when might you not want to give enteral fluids, even though it is the cheaper (arguably easier) option?if GI is impaired, like diarrhea
If you have a horse which is dehydrated with low protein, you might consider giving...colloids
what is average gauge and location and material for IV cath?14-16G cath. (choose between inert or more reactive material of cath... teflon reactive) so have to decide which is better, and then choose jug, cephalic, or lateral thoracic
If you want to give plasma to the horse (expensive), how much (rate) would you give?20ml/kg/hr (check for adverse reactions)
If you have a 100lb mini filly with diarrhea and a estimate dehydration of 6-8%--what is the deficit? what is your maintenance rate? How might you approximate ongoing loss? How much fluid does your patient need in 24 hours to cover the deficit + maintenance + ongoing losses? Is it safe to add 40 mEq Potassium per liter fluid for this patient?Deficit... 100 lbs= 45.5kgs. about 6% dehydrated means.... 45.5 x 0.06 = 2.73= 3L dehydrated. (1kg= 1L). Maintenance is 50ml/kg/day~, so 50 x 45.5= 2,275ml/day (which is about 2L/day). then she said in this case, about 1x maintenance for diarrhea. So, you have 3L deficit+2L/day maintain+2L loss from diarrhea= about 7-8 L will be needed in 24h. Also you can add 10-40mEq / liter of potassium but cannot exceed 0.5 mEq/kg/hour