Fluid therapy 2 Flashcards by Corinne Perra

Anorexia in a horse typically leads to what electrolyte abnormality?

K and Ca

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What are causes of a hypokalemia in a horse?

Associated with alkalosis, decreased intake (total body K+), sequestration loss (sweating, diarrhea), and elevated plasma insulin

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What are common causes of hyperkalemia in the horse?

Lab error : RBC rupture in sample

Disease: HYPP(hyperkalemic periodic paralysis), acidosis (total body K+ is normal or depleted)

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What re the clinical effects of hypokalemia???

Arrhythmias
Myocardial dysfunction
Weakness
Decreased intestinal motility (ileus)

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What is the clinical effect of hyperkalemia??

Cardiac arrhythmia, standstill

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What is the max rate of admin for IV K+?

0.5mEq/kg/hr

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The general guideline for potassium in maintenance is ???

10-20 mEq/L

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What can cause a false hypocalcemia??

Decrease in albumin and proteins

—> ionized Ca most accurately reflects Ca status

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What electrolyte is the major contributor to synchronous diaphragmatic flutter (SDF)??

Calcium

Also can be associated with
Hypokalemia and metabolic alkalosis

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What is synchronous diaphragmatic flutter??

Appears as hiccups and jerky thoracic moments

RR=HR

Hyperresponsiveness to the phrenic nerve as it courses over the aorta to diaphragm

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What are causes of hypercalcemia in the horse?

Renal failure

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What are the effects of hypercalcemia ?

Toxic to cells -> CNS, kidney, and GIT

Cardiac arrhythmia
Seizure
Twitching most important acutely

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What can you use to supplement Ca in the horse ?

Ca gluconate or borogluonate WO bicarb

Animals have much storage of Ca, do not always need to supplement in animals

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What is the consequence of too rapid administration of Ca?

Bradycardia

Sudden elevation of ST segment/shortening of QT interval

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T/F: hypomagnesemia often associated to conditions leading to hyperK+ and hyperCa+

False

Hypomagnesemia often associated to conditions leading to HYPO-K+ and HYPO-Ca+

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When is IV mg sulfate contraindicated?

Hypotensive condition —> has vasodilator properties

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What clinical signs do you see with sodium abnormalities??

Neurological
—> Depression, headpressing, seizure, semi-coma, coma and death

(Seen with both hyper- or hypo- natremia)

T/F: during exercise, fluid losses are typically isotonic

True

However when horses loose volume the sweat then becomes hypertonic

How do the brain cells compensate for changes in Na concentration and the associated fluid fluxes?

Neuronal cells produced “idiogenic osmoles” that increase tonicity within the cells (within limits) —> overtime can correct changes, mechanism not effective in managing acute changes in Na

In reduced [Na+], neuronal cells destroy osmoles

How should an acute change in Na status be treated?

Rapid restoration of Na status is recommended using fluids and tonicity that will result in rapid change of serum/plasma tonicity

How do you treat an animal with chronic Na disturbances, but has clinical signs??

Rapidly correct to recommended value (the limit of compensation )

Then correct slower over days to normal value

What is the adverse effect of rapidly correcting a chronic hypernatermia??

Can increase CNS volume significantly —> brain edema and herniation, permanent neurological deficits and lysis of myelin

What is the cellular outcome of an acute hyperNa?

Cell shrinkage

What is the cellular outcome of an acute hypoNa?

Cell swelling

What is the cellular outcome of a chronic (compensated) hyperNa that is treated rapidly??

Cell swelling —> compensated mechanism has increased the osmoles in the cells.. by acutely treating with hypotonic solution, the ECF is less concentrated.. fluid moves into the cells where there is increased osmoles

What is the cellular outcome of a chronic (compensate) hypoNa, that is acutely treated?

Cell shrinkage —> compensated mechanism has decreased the osmoles in the cells.. by acutely treating with hypertonic solution, the ECF is more concentrated.. fluid moves out of the cells where there is increased Na

``` PCV= 62 (30-45) TP= 5.6 (5.9) Na+ = 129 (134-154) K+= 3.2 (2.6-4.9) Cl- = 110 (100-115) ``` This horse is obviously dehydrated (see PCV). How would you correct this??

This horse will need substantial fluid therapy to correct the fluid deficit (reflected by the PCV) but the TP in this horse is low.. If you administer high amounts of fluid to this horse you will further decrease protein and fluid will not stay in the vasculature In this case give fluids to lower the PCV, but not the whole deficit amount... just enough to correct some dehydration but not drop TP too low

``` PCV= 62 (30-45) TP= 5.6 (5.9) Na+ = 129 (134-154) K+= 3.2 (2.6-4.9) Cl- = 110 (100-115) ``` Check out the Na and Cl levels in the horse. What does this tell you about the acid/base status of the horse??

Likely in a metabolic acidosis (hyperchloremic) Sodium and chloride usually move together. In this case, sodium in decreased but chloride is within normal range. In the presence of metabolic acidosis, there is loss of bicarb, in an attempt to maintain electroneutrality, Cl- is reabsorbed in the kidneys.

What is the most common acid/base disturbance in equines?

Metabolic acidosis

What is the most common acid/base disturbance in ruminants?

Metabolic alkalosis

What are possible causes of metabolic acidosis??

Loss of bicarb (leads to hyperchloremic met acidosis) eg. Intestinal loss Gain of acid (lactic acid, toxins, renal failure) eg. Endotoxemia/poor tissue perfusion

How do you treat a metabolic acidosis in the horse?

Use of alkalinizing solution (LRS or Normosol) —> usually improvement in tissue perfusion will help correct A/B imbalances OR ``` Bicarb administration (only if HCO3 <17-18) —> deficit x distribution x bwt in kg = ____mEq ```

What are the factors used for bicarb distribution in equine??

Conservative 0.3 Adult typical 0.4 Foal 0.5

What is the method of administration of bicarb in cases of metabolic acidosis??

Administer 1/2 of calculated deficit within a hour as an isotonic solution Then reevaluate to assess need for the rest of the amount —> cannot always factor in all facets associated with imbalance (eg if tissue perfusion reduces the met acidosis, then giving full amount of bicarb may produce a alkalosis rather than normalizing A/B status)

When is bicarb contraindicated??

Respiratory compromise (hypoventilation) —> will result in worsening academia through development of resp acidosis

Under what conditions do you see a metabolic alkalosis in equine??

Endurance racing —> loss of Cl- in sweat (Bicarb is reabsorbed to maintain electroneutrality) GIT disease: choke, impaction, anterior enteritis Chronic salivary loss

What is the treatment of metabolic alkalosis?

Acidifying solution (NaCl)

What pattern of electrolyte disturbances do you see in endurance horses??

Loss of Na, CL Hypocalcemia and hypokalemia Result in retention of HCO3 (metabolic alkalosis)

What pattern of electrolyte disturbances do you see in choke??

Loss of Cl- (loss of saliva) Hyper Na Retention of HCO3- —> metabolic alkalosis

What pattern of electrolyte disturbances do you see in a horse with severe diarrhea???

Dependent of cause of alteration Sodium and potassium loss —> hyponatremia, hypochloremia, hypokalemia, metabolic acidosis

What pattern of electrolyte disturbances do you see in horses with intestinal accidents (eg volvulus to intussusception ??

Hypovolemia | Metabolic acidosis

What pattern of electrolyte disturbances do you see in horses with peritonitis/pleuritis??

Volume -WNL Hypovolemic due to 3rd space sequesteration Large protein loss (Can also be endotoxemic)