Basics of Equine Fluid Therapy

Question 1

How do you address hydration status

Answer 1

via the circulating fluid volume (HR, CRT, PP, Jugular filling time and amount, temperature of extremities), TBW (MM and skin tent), CLinical signs and Lab measures

Question 2

How do you calculate Fluid Requirements?

Answer 2

Need to know Fluid decificts
Maintenance needs
Abnormal fluid losses

Question 3

How do you decide type of fluids?

Answer 3

Crystalloids or collids? (how long will we need help bringing up fluids?)
What electrolytes will it need? Na/K
What is the acid base status?
Is glucose controlled? esp in foals!!

Question 4

How do you decide rate of fluids?

Answer 4

consider if we are replacing deficit, maintenance fluids, fluids with ongoing abnormal losses.

Question 5

How do you decide route of fluids?

Answer 5

Go IV if there are immediate needs, need to be precise, or greater than 5% DH (which is any time we see dehydration). Otherwise go oral when it is not needed immediately and not severe.

Question 6

Basic outline of TBW…

Answer 6

60% of BW is water, of which
20% is ECF (1/4 plasma, 3/4 ISF)
40% is ICF

Question 7

How do we replace the deficit?

Answer 7

Assess hydration status
Use clinical signs to find the deficit
Laboratory parameters

Question 8

Replacing deficits should include which rates of fluids?

Answer 8

adults - 4L per hour is the fastest. (give the amount over 2 hours if possible)
neonates - don’t handle well so .5 in first 6 hrs and the rest over 12-24 hrs.

Question 9

What is maintenance fluid rates?

Answer 9

adults - 55-65 ml/kg/day (1L/hr for 500kg)

neonates - 80-120 ml/kg/day (200 ml/50 kg)

Question 10

whats a tolerable oral rate of fluids?

Answer 10

8L q 2-4 hours. no more than 20L at once.

Question 11

What are examples of crystalloids and which is most important?

Answer 11

plasmalyte, ringers, LRS, normosol, 0.9 NaCl (saline), 5% dextrose. 
Hypertonic saline (7.2%) is the most important to know how to use

Question 12

What should we know for giving hypertonic saline

Answer 12

give at 2-4 ml/kg FAST
give with isotonic fluids later
restores volume, Bp, and CO

Question 13

Colloids include

Answer 13

plasma, whole blood, dextran, hetastarch and pentastarch (safer)

Question 14

What are the indications for plasma?

Answer 14

hypoprotein, FPT, coagpathies

Question 15

how much plasma do you give?

Answer 15

7L per 1g/dL of TP

1-2 L for FPT septic foal

Question 16

CLinical signs of plasma complications

Answer 16

tachy, tahcypnea, muscle fascic, hypotension,m collapse, urticaria, possible anaphylaxis.

Question 17

How do you give plasma?

Answer 17

slowly (50 ml/hour) and TPR every 5 minutes for 3 times.

Question 18

t1/2 of hetastarch

Answer 18

7 days.

Question 19

When will we give K electrolytes in the fluids?

Answer 19

if

Question 20

When will we give Na electrolytes in the fluids?

Answer 20

If

Question 21

How much K will change pH 0.1 units?

Answer 21

0.6 mEq/L

Question 22

What do you do if hypoglycemia?

Answer 22

bolus 5-10 g into the foal

Question 23

what is normal BG in a foal?

Answer 23

80-120 mg/dL

Question 24

What is the ECF for the bicarb calc in foals and adults?

Answer 24

30% in adults, 50% ECF in foals.

Question 25

When do you include bicarb in the fluids?

Answer 25

if BD is >10-15 mEq/L or

if venous blood is pH is

Question 26

When anion gap is down, what is the most important (and common) thing to look into and fix?

Answer 26

Lactic acidosis which is caused by decreased peripheral O2. So increase the BV and this will come back to normal.

Question 27

What is the formula for calculating bicarb deficit?

Answer 27

mMol/mEq = BWECFBD

Question 28

What are the causes of hyperkalemia and what is the best way to treat the main one?

Answer 28

Metabolic acidosis - Correct which will bring the H back out of Intracellular space and K goes in.
uroperitoneum
HYPP

Question 29

What is the formula to figure out fluids (L) needing replaced

Answer 29

% DH *BW (kg) = L deficit

Question 30

Mild moderate and severe DH are what percentages DH?

Answer 30

5, 8, and 12.

Question 31

What are causes of maintenance water losses?

Answer 31

sensible losses - Urinary and GI

insensible losses - Resp and sweating

Question 32

What are numbers associated with maintenance losses?

Answer 32

adult - 55-65 ml/kg/day

neonates - 80-120 ml/kg/day

Question 33

Causes of abnormal losses ongoing

Answer 33

high temp, fever, diarrhea, polyuria.

Question 34

Explain 5% DH in MM, CRT, Skin tent, HR

Answer 34

normal to tacky mm

Question 35

Explain 8% DH in MM, CRT, Skin tent, HR

Answer 35

tacky mm
2-3 sec CRT
3-5 s ST
>50 HR
sunken eyes, weak pulse

Question 36

Explain 12% DH in MM, CRT, Skin tent, HR

Answer 36

dry mm
>5 s CRT
>5 s ST
>60 HR
moribund, cold extremities

Question 37

What are some lab parameters that assess Hydration status?

Answer 37

PCV - increased but there is splenic contraction too
TP - increased, chronic inflammation too though
USG, Cr/BUN, lactate, CVP, BP