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Basic Fluid Therapy in Horses. Jill McClure, DVM, MS Diplomate ACVIM, ABVP. Educational Objectives. To recognize clinical dehydration To know acceptable routes of fluid administration To select acceptable rates of administration To select appropriate fluids

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basic fluid therapy in horses

Basic Fluid Therapy in Horses

Jill McClure, DVM, MS

Diplomate ACVIM, ABVP

educational objectives
Educational Objectives
  • To recognize clinical dehydration
  • To know acceptable routes of fluid administration
  • To select acceptable rates of administration
  • To select appropriate fluids
  • To recite ‘expected’ abnormalities for common diseases
fluid therapy considerations
Fluid therapy considerations
  • volume (water)
  • tonicity (osmolality)
  • pH (hydrogen ion concentration)
  • ion concentration (Na, Cl, K, Ca)
where is the water
Where is the water?
  • if 500 kg body weight
  • 60% is water
  • ICF is 40% of b.w.
  • ECF is 20% of b.w.
  • interstitial ~ 75 l
  • plasma ~ 25 l
recognition of dehydration
Recognition of dehydration
  • dry mucous membranes
  • sunken eyes
  • loss of skin turgor
    • mild 4-6 % 2-3 seconds
    • moderate 7-10% 4-8 seconds
    • severe 11-12% >8 seconds
  • % of body weight
laboratory evaluation of dehydration
Laboratory Evaluation of Dehydration
  • Packed cell volume (PCV)
  • Hemoglobin
  • Total plasma protein
  • BUN
pcv and tpp
PCV and TPP
  • useful to monitor progress
  • pre-existing anemia may mask actual increase in PCV due to dehydration
  • loss of protein may not reflect water loss
slide9

How much fluid to give???500 kg horse @ 8% dehydrated has a 40 liter deficit40 liters of fluids are administeredupon re-exam, the horse is still 8% dehydratedHow can this be??

snapshot of hydration status
“Snapshot” of hydration status
  • existing deficits
  • maintenance needs
  • continuing losses
how can this be
How can this be?
  • Patient is anorexic and not taking in water
  • Patient has continuing losses (e.g. diarrhea, profuse sweating)
what routes should i use
What routes should I use?
  • IV
  • Subcutaneous
  • PO
  • IP
how fast should i give fluids
How fast should I give fluids?
  • 3-12 ml/lb/hr
  • (6-25 ml/kg/hr)
  • 3-12 liters/hr in adults
  • 1 liter/hr maintenance
what kind of fluids to use
What kind of fluids to use?
  • base on actual measurement of electrolytes and blood gases
  • make an “educated guess”
what choices of fluids
What choices of fluids?
  • balanced polyionic
  • isotonic water
  • alkalinizing
  • acidifying
which fluid should i choose
Which fluid should I choose?
  • If no laboratory, chose balanced polyionic
new acid base
“New” Acid-Base
  • Respiratory
    • pCO2
  • Non-respiratory
    • water
    • strong ions
      • measured (Na,Cl)
      • unmeasured
    • protein
using the new acid base
Using the ‘new’ acid-base
  • Free water 0.3([Na]-140) = ________
  • Chloride 102-([Cl]x 140/[Na] = ________
  • Protein 3(6.5-[Prot]) = ________
  • Unidentified anions =
  • ______________
  • Total observed Base Excess = ________
using the new acid base20
Using the ‘new’ acid-base
  • Free water 0.3([Na]-140) = ________
  • normal [Na] - no effect
  • dilution (low [Na]) results in acidosis
  • concentration (high [Na]) results in alkalosis
using the new acid base21
Using the ‘new’ acid-base
  • Chloride abnormalities 102 - [Cl-]corr = ____________
  • normal [Cl] - no effect
  • loss of Cl - alkalinizing effect
  • increased hyperchloremia - acidifiying
using the new acid base22
Using the ‘new’ acid-base
  • Protein 3(6.5-[Prot] = __________
  • normal [Prot] - no effect
  • loss of protein (loss of acid) - alkalinizing
  • increased protein - acidifiying
using the new acid base23
Using the ‘new’ acid-base
  • Unidentified anions = __________
  • Calculated from measured values
  • Equivalent to anion gap when protein is within normal range
using the new acid base24
Using the ‘new’ acid-base
  • Free water 0.3([Na]-140) = ________
  • Chloride 102-([Cl]x 140/[Na] = ________
  • Protein 3(6.5-[Prot]) = ________
  • Unidentified anions =
  • ______________
  • Total observed Base Excess = ________
thumb rules
‘Thumb Rules’
  • ‘educated guesses’ for common conditions
severe diarrhea
Severe Diarrhea
  • dehydration
  • metabolic acidosis
  • hyponatremia
  • hypokalemia
intestinal obstructions displacements
Intestinal obstructions/displacements
  • similar to diarrhea because sequestered fluid equivalent to loss by diarrhea
  • ‘high’ obstructions similar to vomiting with loss of acid
exhaustion
Exhaustion
  • Loss of chloride in sweat
  • alkalosis
  • hypochloremia
  • hypokalemia
  • hypocalcemia
exertional rhabdomyolysis
Exertional Rhabdomyolysis
  • Hypochloremia
  • Metabolic alkalosis
  • Pigmenturia
  • Azotemia
ruptured urinary bladder
Ruptured Urinary Bladder
  • Hyponatemia
  • Hypochloremia
  • Hyperkalemia
summary
Summary
  • How much? (dehydration)
  • What route?
  • How fast?
  • What kind?
  • Best guess