Neonatal D+: Individual Treatment Flashcards
what is your #1 priority when treating a neonatal D+ case?
fluid therapy!
what is the goal of fluid therapy?
to restore normal hydration status, replete the lost electrolytes, correct any hypoglycemia and correct metabolic acidosis
T/F: the fluid deficit is the amount you will give to the animal
false; the current fluid deficit is only part of the total fluid needs for the animal; have to consider needs from metabolism, fecal/urinary/respiratory losses: need enough fluids to support normal bodily functions
how do you calculate fluid deficit?
fluid deficit (L) = bodyweight (kg) x %dehydration (expressed as a decimal)
ex: “no tag”: 40kg x 0.1 (10% dehydration) = 4L fluid deficit
what are ongoing losses?
volume of fluids that continues to be lost in D+
what is the most accurate way to measure ongoing losses?
- once animal rehydrated (given its estimated fluid deficit) the animal should be weighted
- this is the weight of the animal under normal hydration.
- then administer fluids at maintenance rates while weighing them 2-4 times a day
- if large volumes of D+ lost, this will reflect in loss of body weight
if your patient is in need of 8L of fluids, how do you administer this in a day?
not going to give all at once in a large bolus- distribute over time by putting rules on rate of fluid administration = cc’s put into the calf/unit of time
what is ORT?
oral rehydration therapy: standing + intact suckle response
your patient is in need of fluids and is standing and has an intact suckle response. what method will you be administering fluids by?
ORT: oral rehydration therapy
why would you not use ORT in a recumbent, weak patient?
the GI tract will not be well-perfused and ORT fluids may just sit in gut lumen minimally absorbed
use IV fluids to “resuscitate” animal and then switch to ORT in next few hours/day
your patient is in need of fluids and is recumbent, has a poor suckle response and severely dehydrated. how do you administer them?
IV fluid therapy to resuscitate, then ORT until D+ resolves
what about SC or intraperitoneal fluids?
same as ORT: if pt severely dehydrated, visceral/peritoneal lining will not be well-perfused and absorption rates are slow
what very critical ingredient in ORT is necessary to counteract metabolic acidosis?
some sort of base: sodium bicarbonate or sodium acetate (latter is converted to bicarb in liver)
oral rehydration therapy ingredients
- water, Na+, Cl-, K+, glucose
- source of base: NaHCO3 or Na acetate
if your ORT has glucose in it, is this beneficial or not?
if it has glucose in it, more sodium can be absorbed from the gut, thus water will follow, and you will get a greater rehydration potential than an ORT product that doesn’t have glucose/glycine in it/
many ORTs have the D-isomer of glucose in them. what is this?
dextrose: glucose!
mechanism of glucose in ORTs for rehydration
enhances sodium absorption, and thus water absorption, from the gut. further it helps to correct any hypoglycemia that may exist
in a case with clostridium perfringens, why would you want to not give ORTs with glucose?
want to give IV with glucose, because the glucose can create an environment for it to grow!
ORT methods
- nipple bottle or esophageal feeding tube
- feed them milk to try and meet caloric/nutrient needs
what amount of milk should you feed for ORT?
aim for 10% of bodyweight in milk to maintain
can you mix ORT with milk?
is discouraged: mixing ORT with milk impairs formation of the milk clot in the abomasum because acid and calcium are required for that protein/fat clot to form, and both Ca2+ and H+ can be bound by the base in the ORT
how can an impaired milk clot formation negatively impact the patient?
Ca2+ and H+ required for formation, and in ORT mix with milk the base will bind it
- results in slug of fat and protein hitting damaged intestine, rather than a slow trickle that occurs as a well-formed milk clot dissolves
- try to space ORT and milk feedings apart by 2 hours or more!
how far apart should ORT times and milk feedings be spaced?
2 hours + to keep formation of milk clot proper
disparities in ways to achieve fluid therapy
many different formulas/ways, most of the time depends on if the patient is hospitalized vs managed in field
