Fluid Therapy

What are some negative outcomes of neonatal diarrhea?

fluid, electrolyte, acid/base derangements

bacteremia, septicemia, toxemia

decreased energy

-All can lead to death

Donde esta la agua

1. 2/3 TBW are intracellular fluids

2. 1.3 TBW is extracellular fluids (plasma and interstitial)

What are the signs of extra vascular dehydration

associated with decreased HCO3 and K+

1. skin tenting

2. tacky MM

3. sunken and dry eyes

What are the signs of decreased profussion (intravascular)

Increased HR, CRT

decreased temperature, pulse stregth, muscle tone

pale MM

recumbent animals

What are the dehydration criteria (%)

1. Mild = 6%

2. moderate = 9%

3. severe = 12%

What are the 5 main routes we can use to give fluids

1. oral (requires functional GI with adequate profusion)

2. SQ

3. IV

4. intraperotoneal 

5. intraosseus

what are the substances you mix up into oral fluids

1. Na

2. glucose

3. K, Cl

4. alkalizing agents (HCO3, citrate, acetate)

5. glycine (increase glucose absorption)

What are the pros and cons of SQ fluids

1. PROS:

   1. convenient and easy for owner to do

   2. Use in maintnance

   3. Hard to volume overload a patient

2. CONS:

   1. not great for critical patients

50-200 mL/site

How can you use intraperitoneal fluids?

1. give large volumes of isotonic fluids only

2. peritonitis is a risk

How can you use intraosseous fluids?

1. tibial tuberosity, trochanteric fossa of femur, wing of ilium

2. rapid uptake

3. risk of osteomylitis

How can you use IV fluids?

1. critical cases

2. rapid deficit corrections

3. large volumes

4. hypertonic tolerated

How do you calculate Deficit, Maintenance, and ongoing losses

1. Deficit: Bw x % dehydrated = deficit in L

2. maintenance: 100 mL / kg/ day

3. ongoing losses: dz dependent

How do you correct fluid loss

1. give ½ deficit rapidly (in first hour) 

   1. remaining half can be given in following 4-6-24 hours depending on patient response

2. anything over 4x maintenance needs to be monitored for fluid overload

3. Do not exceed 90 mL/ kg/hr (shock rate)

   1. → edema, diarrhea, pulmonary and cardiac issues

What are the easy, non consequential fluids to give

1. LRS, plasmolytes, normosol

Polyionic fluids

How can you calculate and tx bicarb deficit

1. HCO3 def = BW x (30-BE) x (0.3-0.6 range)

2. add to fluids, but consider make up of fluids already administered

When can you stop administering fluids?

1. when hydration is acomplished

2. animal is capable of maintaining fluid balance

3. hours - days

4. switch from IV to Oral

How do you treat diarrhea?

1. fluids with salts and buffers

2. energy and nutrition (whole milk, high value)

3. maybe Abx

4. nursing support