Food Ani. Med- Fluids for Rumis 1

drraythe's version from 2016-04-29 15:39

Check your units. She is out to getcha with those.

Question Answer
for the testshe said there will be a parasitology question from smith reading and VPs- Smith 5th edition pgs 1503-1506 (ha.ha.ha)
Remember normals for SheepT: 102.5-103.5. P: 60-120 R: 12-72
Remember normals for goatsT: 101.5-103.5 P: 70-110 R: 15-40
remember normals for cattleT: 100.5-102.5. P: 40-80 R: 12-36
3 major things to check to see if your rumi is dehydratedeyeball sunkenness, skin tent(neck, eyelid), mucous membranes
Read over the dehydration chart, get an idea of the signs which would tell you how dehydrated they are (DONT HAVE TO MEMORIZE) OR
which is a more common tube for fluid admin- nasogastric or orogastric?orogastric more common
where are most IV caths placed in rumis?jug
(DONT HAVE THE MEMORIZE) 1 gallon is how many liters? (imperial gallon?) How many gallons is how many liters?1gallon=3.79 liters (1 imperial gallon is 4.55L) . 1 liter=0.264 gallons (0.22 imperial gallons)
DON'T PUT BICARB in what kinda fluids?ANYTHING WITH Ca++ IN IT (meaning RINGERS, lactated or not) bc it will cause the bicarb to sediment out.
which fluids have Ca++, what should you know about fluids with Ca++?Ringers and Lactated ringers-- DONT ADD BICARB it'll sediment out (flunixin will too she mentioned)
How does Lactated ringers interact with acid-base balance?you'd think with lactate it would be like adding acid, but that isn't the case. the lactate goes to the liver and acts like a buffer, so it is good to give to ACIDOTIC patients.
which fluids have K+?LRS, ringers, Plasma-Lyte 148, Normosol-R, Plasma-Lyte 56, Normosol-M
**1.3% sodium bicarb has how many mEq of Bicarb per liter??156mEq/L
what is the biggest diff between maintenance and resuscitation fluids?maintenance has way more K+ in it than resuscitation
**What can you do with resuscitation fluids that you can't with maintenance?CANT BOLUS MAINTENANCE- BECAUSE THEY HAVE HIGHER AMOUNTS OF K+ IN THEM!!!! (maintainance fluids with K are: plasma-lyte 56, normosol-M)
Base excess tells you about _________ changesMETABOLIC
what two things tell you about acid-base status?(1) Anion gap (2) Strong ion difference (she has iron but it's actually ion, ask google).
where does D-lactate come from? L-Lactate?(D for dirt--) D-Lactate comes from BACTERIA. L-lactate comes from mamalian cells
when looking at acid-base status, do it in a step-wise fashion. Explain steps(step 1:) parameters of animal (posture, behavior, palpebral reflex can tell you about base excess) (Step 2:) Blood gas (can look at pH) OR if no blood gas, get serum chem, you can work with the anion gap/strong ion difference
what causes an elevated anion gap? (NORMAL 12-16)ELEVATED= ACIDOTIC= "DUELS" which stands for Diabetic Ketoacidosis, Uremia, Ethylene glycol, Lactate, and Salicylic Acid (think cats and aspirin)
What is the anion gap? What does a high vs low anion gap tell you?It is the diff between your anions. HIGH anion gap= acidosis. LOW anion gap=alkalosis. Equation is: ([Na+]+[K+]) - ([Cl-]+[HCO3-]) (so positives minus negatives) NORMAL is 12-16
explain the strong ion difference of a solution(google says: The Strong Ion Difference (SID) is the difference between the positively- and negatively-charged strong ions in plasma) She says it is more global than Anion Gap. She noted in this section that NaCl (0.9%) solution is 154mEq/L Na and Cl. So basically the equation is [SID]=[Na+] + [K+] + [Ca2+] + [MG2+] - [CL-] - [Other Strong Anions] and 40 is the NEUTRAL VALUE. >40= alkalotic, and <40 is acidotic
Explain how lactate is processed in the liver..and what it turns to? and how this works with acid base balance?LACTATE is metabolized in the liver to BICARB (HCO3), and CO2 (which you just breathe out)
what are 3 alkalinizing agents you can use to help treat acidosis?Lactate, citrate, and bicarbonate.
what are some acidifying solutions you can give if pt is alkalotic?SALINE! Bc it has a low Strong ion difference (SID) (and rememember for SID that <40 is acidic)
whats more important than volume of fluid?RATE of fluid
Remember when you are giving Calcium IV you must...LISTEN TO HEART AS YOU DO IT
what does hypercalcemia do to your heart?Drops it (Ca is like K in that regard)
why dont you want to give a severely anemic pt fluids?youre diluting out RBCs even more
why do heavily parasitized animals get edema?loss of protein. (dec BV oncotic pressure)
****What is the ADULT maintenance rate of fluids?Adults: 50ml/Kg/day (UNIT IS DAYS, GDI)
*****what is the NEONATE maintenance rate of fluids?Neonate: 80ml/kg/day.(UNIT IS DAYS, GDI) (neonate is mo old and less, but if its super small and scraggily she might use this)
Rule of thumb maintenance rate? (not testing this one but useful)2ml/kg/hour (THIS IS IN HOURS.)
***how do you calculate deficit of fluid?%dehydration times body weight in Kgs= Volume missing in LITERS (1Kg=1L)
***what is the SHOCK RATE?80ml/kg/hour (HAVE I MENTIONED THE UNITS ENOUGH)-- and you give this in 4 rounds of 20ml boluses (reassess between boluses!)
to calc the amount of fluid the animal needs you need to account for what things? DEFICIT + MAINTENANCE + ONGOING LOSSES. dont forget to add all 3.
****HOW DO YOU CALC BICARB DEFICIT?Bicarbonate (mmol)= Body weight(Kg) x Base deficit (mmol/L) x 0.7 (<--this last number is a factor, its 0.7 for neonates and 0.3 for adults...she will give the factor to us she said) (in real life, factor has to do with Vd...bigger Vd, bigger number. So emaciated big cow= 0.3. If you have newborn with some edema or its a fat patient, number will be bigger= 0.7)
***how do you calculate base deficit?Base deficit is the difference between the PATIENTS bicarbonate and what the bicarbonate SHOULD be.
*****what is the normal amount of bicarb in a patient?25mEq/L.
DO NOT CONFUSE BICARB DEFICIT AND BASE DEFICITyou use base deficit to calc the bicarb deficit. So first get the BASE deficit (normal (25mEq/L) minus patients value of bicarb= the difference between the two) and then you take that base deficit to calculate the bicarb deficit: bodyweight(kgs) x base deficit(difference we got) x factor (adult 0.3 and neonate 0.7)= mmol of bicarb you need to give. (*****ALSO REMEMBER THAT IN 1.3% NaHCO3 fluid solution there is 156mEq/L of bicarb)
how do mmols and mEqs of bicarb relate?1mEq=1mmol (so when you calc bicarb deficit, you get how many mmol of bicarb you need, and then you can figure out how much fluids you need based on the mEq of bicarb in it)
what will the pH be that will tell you it's time to correct for metabolic acidosis?pH <7.2
Explain why if they are having trouble breathing, bicarb might cause problemsRemember that if you give an acidotic patient bicarb, the bicarb joins with the H+ (acid) and it makes H2O and then CO2, and they breathe off the Co2....oops, unless they can't breathe. (get more acidotic)
******uhh what is the rate i'm supposed to give K+ again?NOT GREATER THAN 0.5mEq/kg/hr
2 most important objectives of giving fluids?(1) perfusion of organs (2) metabolic requirements
*on average how big is an adult cow?about 500kg...but remember that this can vary (tiny little cow, huge bull)
*about how much blood does an adult cow have?if 500kg animal....its about 8% of the bwt, so about 40L (remember 1kg=1L)
*average volume of water an adult cow consumes per day?2ml/kg/hr (basically maintenance, but if lactating or sthing will need more-- 1L of milk requires 3L of water)
*how big should your IV caths be for an adult cow?typically 14g cath.
*what vol of fluid can you get through your 14g cath?max out around 25L/hour. the gauge of the cath and the lines and the ports and all that also slow fluid down-- so really, you can calc all you want, but there are physical limits
*how big is a rumen?couldn't hear answer but she said she'd stop around 25L for enteral fluids into the rumen (but some ppl will give 50-60L)
**RULE OF THUMB FOR FLUID PLAN?for the DEFICIT, give a quarter in the first hour, a quarter in the second hour, then the last half is given over the next 12 hrs. ((cant resuscitate them super fast (an only get 25L in at a time with a cath), and thats fine as long as they aren't crashing and burning. On the slide it also said: Should you choose to give a shock dose, the shock dose comes out of the deficit volume.