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Basic Fluid Therapy in Horses

Basic Fluid Therapy in Horses. Jill McClure, DVM, MS Diplomate ACVIM, ABVP. Educational Objectives. To recognize clinical dehydration To know acceptable routes of fluid administration To select acceptable rates of administration To select appropriate fluids

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Basic Fluid Therapy in Horses

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  1. Basic Fluid Therapy in Horses Jill McClure, DVM, MS Diplomate ACVIM, ABVP

  2. Educational Objectives • To recognize clinical dehydration • To know acceptable routes of fluid administration • To select acceptable rates of administration • To select appropriate fluids • To recite ‘expected’ abnormalities for common diseases

  3. Fluid therapy considerations • volume (water) • tonicity (osmolality) • pH (hydrogen ion concentration) • ion concentration (Na, Cl, K, Ca)

  4. Where is the water? • if 500 kg body weight • 60% is water • ICF is 40% of b.w. • ECF is 20% of b.w. • interstitial ~ 75 l • plasma ~ 25 l

  5. Recognition of dehydration • dry mucous membranes • sunken eyes • loss of skin turgor • mild 4-6 % 2-3 seconds • moderate 7-10% 4-8 seconds • severe 11-12% >8 seconds • % of body weight

  6. liters of water ‘lost’ = body weight in kg x est. % dehydrated(500 kg x 6% = 30 liters)

  7. Laboratory Evaluation of Dehydration • Packed cell volume (PCV) • Hemoglobin • Total plasma protein • BUN

  8. PCV and TPP • useful to monitor progress • pre-existing anemia may mask actual increase in PCV due to dehydration • loss of protein may not reflect water loss

  9. How much fluid to give???500 kg horse @ 8% dehydrated has a 40 liter deficit40 liters of fluids are administeredupon re-exam, the horse is still 8% dehydratedHow can this be??

  10. “Snapshot” of hydration status • existing deficits • maintenance needs • continuing losses

  11. How can this be? • Patient is anorexic and not taking in water • Patient has continuing losses (e.g. diarrhea, profuse sweating)

  12. What routes should I use? • IV • Subcutaneous • PO • IP

  13. How fast should I give fluids? • 3-12 ml/lb/hr • (6-25 ml/kg/hr) • 3-12 liters/hr in adults • 1 liter/hr maintenance

  14. What kind of fluids to use? • base on actual measurement of electrolytes and blood gases • make an “educated guess”

  15. What choices of fluids? • balanced polyionic • isotonic water • alkalinizing • acidifying

  16. Which fluid should I choose? • If no laboratory, chose balanced polyionic

  17. “New” Acid-Base • Respiratory • pCO2 • Non-respiratory • water • strong ions • measured (Na,Cl) • unmeasured • protein

  18. Acid-Base Regulation

  19. Using the ‘new’ acid-base • Free water 0.3([Na]-140) = ________ • Chloride 102-([Cl]x 140/[Na] = ________ • Protein 3(6.5-[Prot]) = ________ • Unidentified anions = • ______________ • Total observed Base Excess = ________

  20. Using the ‘new’ acid-base • Free water 0.3([Na]-140) = ________ • normal [Na] - no effect • dilution (low [Na]) results in acidosis • concentration (high [Na]) results in alkalosis

  21. Using the ‘new’ acid-base • Chloride abnormalities 102 - [Cl-]corr = ____________ • normal [Cl] - no effect • loss of Cl - alkalinizing effect • increased hyperchloremia - acidifiying

  22. Using the ‘new’ acid-base • Protein 3(6.5-[Prot] = __________ • normal [Prot] - no effect • loss of protein (loss of acid) - alkalinizing • increased protein - acidifiying

  23. Using the ‘new’ acid-base • Unidentified anions = __________ • Calculated from measured values • Equivalent to anion gap when protein is within normal range

  24. Using the ‘new’ acid-base • Free water 0.3([Na]-140) = ________ • Chloride 102-([Cl]x 140/[Na] = ________ • Protein 3(6.5-[Prot]) = ________ • Unidentified anions = • ______________ • Total observed Base Excess = ________

  25. ‘Thumb Rules’ • ‘educated guesses’ for common conditions

  26. Severe Diarrhea • dehydration • metabolic acidosis • hyponatremia • hypokalemia

  27. Intestinal obstructions/displacements • similar to diarrhea because sequestered fluid equivalent to loss by diarrhea • ‘high’ obstructions similar to vomiting with loss of acid

  28. Exhaustion • Loss of chloride in sweat • alkalosis • hypochloremia • hypokalemia • hypocalcemia

  29. Exertional Rhabdomyolysis • Hypochloremia • Metabolic alkalosis • Pigmenturia • Azotemia

  30. Ruptured Urinary Bladder • Hyponatemia • Hypochloremia • Hyperkalemia

  31. Summary • How much? (dehydration) • What route? • How fast? • What kind? • Best guess

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