Basics of Equine Fluid Therapy Flashcards
How do you address hydration status
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
How do you calculate Fluid Requirements?
Need to know Fluid decificts
Maintenance needs
Abnormal fluid losses
How do you decide type of fluids?
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!!
How do you decide rate of fluids?
consider if we are replacing deficit, maintenance fluids, fluids with ongoing abnormal losses.
How do you decide route of fluids?
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.
Basic outline of TBW…
60% of BW is water, of which
20% is ECF (1/4 plasma, 3/4 ISF)
40% is ICF
How do we replace the deficit?
Assess hydration status
Use clinical signs to find the deficit
Laboratory parameters
Replacing deficits should include which rates of fluids?
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.
What is maintenance fluid rates?
adults - 55-65 ml/kg/day (1L/hr for 500kg)
neonates - 80-120 ml/kg/day (200 ml/50 kg)
whats a tolerable oral rate of fluids?
8L q 2-4 hours. no more than 20L at once.
What are examples of crystalloids and which is most important?
plasmalyte, ringers, LRS, normosol, 0.9 NaCl (saline), 5% dextrose. Hypertonic saline (7.2%) is the most important to know how to use
What should we know for giving hypertonic saline
give at 2-4 ml/kg FAST
give with isotonic fluids later
restores volume, Bp, and CO
Colloids include
plasma, whole blood, dextran, hetastarch and pentastarch (safer)
What are the indications for plasma?
hypoprotein, FPT, coagpathies
how much plasma do you give?
7L per 1g/dL of TP
1-2 L for FPT septic foal
CLinical signs of plasma complications
tachy, tahcypnea, muscle fascic, hypotension,m collapse, urticaria, possible anaphylaxis.
How do you give plasma?
slowly (50 ml/hour) and TPR every 5 minutes for 3 times.
t1/2 of hetastarch
7 days.
When will we give K electrolytes in the fluids?
if
When will we give Na electrolytes in the fluids?
If
How much K will change pH 0.1 units?
0.6 mEq/L
What do you do if hypoglycemia?
bolus 5-10 g into the foal
what is normal BG in a foal?
80-120 mg/dL
What is the ECF for the bicarb calc in foals and adults?
30% in adults, 50% ECF in foals.
When do you include bicarb in the fluids?
if BD is >10-15 mEq/L or
if venous blood is pH is
When anion gap is down, what is the most important (and common) thing to look into and fix?
Lactic acidosis which is caused by decreased peripheral O2. So increase the BV and this will come back to normal.
What is the formula for calculating bicarb deficit?
mMol/mEq = BWECFBD
What are the causes of hyperkalemia and what is the best way to treat the main one?
Metabolic acidosis - Correct which will bring the H back out of Intracellular space and K goes in.
uroperitoneum
HYPP
What is the formula to figure out fluids (L) needing replaced
% DH *BW (kg) = L deficit
Mild moderate and severe DH are what percentages DH?
5, 8, and 12.
What are causes of maintenance water losses?
sensible losses - Urinary and GI
insensible losses - Resp and sweating
What are numbers associated with maintenance losses?
adult - 55-65 ml/kg/day
neonates - 80-120 ml/kg/day
Causes of abnormal losses ongoing
high temp, fever, diarrhea, polyuria.
Explain 5% DH in MM, CRT, Skin tent, HR
normal to tacky mm
Explain 8% DH in MM, CRT, Skin tent, HR
tacky mm 2-3 sec CRT 3-5 s ST >50 HR sunken eyes, weak pulse
Explain 12% DH in MM, CRT, Skin tent, HR
dry mm >5 s CRT >5 s ST >60 HR moribund, cold extremities
What are some lab parameters that assess Hydration status?
PCV - increased but there is splenic contraction too
TP - increased, chronic inflammation too though
USG, Cr/BUN, lactate, CVP, BP
