Fluid Therapy in Equine Patients Flashcards
What are the 5 levels of dehyrdation? What is seen at each stage?
- <5% = NSF
- 5% = dry/tacky membranes, mild depression
- 7% = moderate skin tent, tachycardia, slow jugular refill
- 10% = moderate to marked skin tent, decreased pulse pressure, cold extremities, depressed
- 12% = marked skin tent, signs of shock, obtundation
Estimating volume loss:
CRT not as sensitive in eqiune patients
What are the 3 goals of fluid therapy?
- restore intravascular volume
- improve tissue perfusion
- overcome regional circulatory deficiency
When is the emergency phase of fluid therapy recommended? What doses are used? In foals?
10-12% dehydration —> shock!
- shock dose of 60-90 mL/kg
- 1/4 to 1/3 dose and reasses
- 10-20 L bolus
1L bolus
What is replacement fluid therapy? How is deficit volume calculated?
deficit + maintainence + continuing loss
% dehydration x BW (kg)
What maintaining fluids are used in adult and foals?
2-4 mL/kg/hr
3-5 mL/kg/hr (including oral!)
A 400 kg horse presents for diarrhea nad is assessed to be 8% dehydrated. What is the fluid deficit?
0.08 x 400 kg = 32 L fluids
What is the general 24-hour plan for approaching fluid therapy?
- FIRST HOUR = fluid bolus to address shock
- 3-4 HOURS = address replacement and ongoing loses with 50% deficit
- NEXT 12 HOURS = address remaining deficit
- REST = address maintenance and losses
monitor and reassess after 24 hours
A 400 kg horse presents for diarrhea nad is assessed to be 8% dehydrated. Make a fluid plan for this horse over the next 24 hours.
0.08 x 400 kg = 32 L fluids to address deficit
- FIRST BOLUS OF 50% over 3 hours = 32L x 0.5 = 16 L
- 16 L left to give over 12 hours = 16L/12hr = 2.3 L/hr
- MAINTENANCE = 60 mL/kg/day x 400 kg = 24 L/day = 1 L/hr
What are the 3 most common sites for IV catheter locations in horses for fluids?
- jugular*
- lateral thoracic
- cephalic - hard to maintain large amounts of ongoing fluids
14 g IVC
What are the 2 types of IV catheters?
- over the needle - short, Abbocath (polyurethane made for short-term 24-48 hrs), Mila (polytetrafluoroethylene for long-term up to 14 days)
- over the wire - Sialastic = flexible, common in foals with 1-2 lumens
What type of extension set is recommended for IV fluids set up in horses?
larger bore —> too small = rate limiting
- recommended to wrap in horses, older ones tend to leave them alone
What is the difference between administration and transfer sets?
ADMINISTRATION = “stat” set, has coil to allow movement of horse, attaches 2 bags
TRANSFER = connects up to 4 fluid bags
How are administration sets attached?
- braided into horses mane
- attached to catheter
- hangs 2-4 5L bags = 10-20 L total
Crystalloid fluids, composition:
What 3 fluids are most commonly used for rehydration?
- Normosol-R
- Plasma-Lyte
- LRS (+maintenance)
What use does 0.9% NaCl have?
- hyperkalemia
- hyponatremia
- hypochloremia
What use does 0.45% NaCl and 2.5% dextrose have?
- neonates
- hypernatremia
What use does 5% dextrose have?
water deficit
What are the 3 most common uses of hypertonic saline?
- rapid, transient increase in blood volume - 4x normal dose, shorter duration (45 mins), depletes intracellular volume
- increase BP, and CO/O2 delivery
- decreased ischemic/reperfusion injury
How can the intracellular fluid deficit caused by hypertonic fluid administration be corrected?
administer 10L of isotonic fluid per L of hypertonic fluid
What 3 actions do colloids have? What are the 3 major indications?
- restores effective circulating volume
- supports oncotic pressure (albumin!)
- expands plasma volume
- TP < 4 mg/dL
- albumin < 3 mg/dL
- COP < 12 mmHg
What is the purpose of administering plasma? How is it used?
source of albumin and clotting factors (COP = 20 mmHg)
10 L plasma required to increase TP by 1.0 g/dL
How is the amount of plasma to be administered calculated?
0.05 x BW x ([desired TP - patient TP]/donor TP)
