Fluid therapy

oppose

pH to return to normal

Compensation of Acid base disterbances will ____ the primary disorder and will rarely cause ___?

+ = - IONS

What is the law of electroneutrality?

1. Replace losses

2. Correct electrolyte and acid/base abnormalities

3. Maintain restored fluid balance

What are the three goals of fluid therapy?

Volume = Bw x % (decimal)

What is the replacement deficit calculation?

80-100ml/kg/day

What is fluid maintenance for a neonate?

50ml/kg/day

What is fluid maintenance for adults?

1-4x

How fast can you run the rate for maintenance?

Enophthalmos

Skin tent

Dryness of MM

Labs (protein, hematocrit, Na+)

What are signs of dehydration on PE?

Volume = Bw x % (decimal)

Volume = 45kg x 0.10

Volume = 4.5L

Given a 2w old, 45kg Charolais bull calf w/ diarrhea who is 10% dehydrated. Calculate the replacement fluids?

80-100ml/kg/day = volume

100ml x 45 = 188ml/hr

24

Given a 2w old, 45kg Charolais bull calf w/ diarrhea who is 10% dehydrated. Calculate maintenance?

Volume = Bw x % (decimal)

Volume = 600kg x 0.08

Volume = 48L

Given a 4-year-old 600kg Holstein cow w/ diarrhea who is 8% dehydrated. Calculate the replacement fluid?

50ml/kg/day = volume

50 x 600 = 1,250ml = 1.25L/hr

24

Given a 4-year-old 600kg Holstein cow w/ diarrhea who is 8% dehydrated. Calculate the maintenance fluid?

80ml/kg

What is the shock rate of a cow?

80ml x 45kg = 3,600ml = 3.6L over 1hr

- start w/ 15 mins and check so don't overload

Given a 2w old, 45kg Charolais bull calf w/ diarrhea who is 10% dehydrated. Calculate the shock rate?

80ml x 600kg = 48,000ml = 48L

Given a 4-year-old 600kg Holstein cow w/ diarrhea who is 8% dehydrated. Calculate the shock rate?

IV

Identify if the cow should get IV or Oral Fluids given:

Severe dehydration/ hypovolemia of >8%?

IV

Identify if the cow should get IV or Oral Fluids given:

Unable to stand/ suckle

IV

Identify if the cow should get IV or Oral Fluids given:

Hypothermia?

Oral

Identify if the cow should get IV or Oral Fluids given:

Mild to mod dehydration

Oral

Identify if the cow should get IV or Oral Fluids given:

GI motility present

Fluids composed of numerous electrolytes that mimic physiologic norms

What is a balanced fluid?

LRS, Norm-R plasmolytes

What are examples of Balanced fluids?

280-306mOsm/L

What is a ruminants electroneutrality?

Severe dehydration/large cows that need to be rehydrated fast

- draws fluid from intersitial space to intracellular

Why would we give hypertonic fluids?

Administer isotonic fluids - otherwise will quickly run out of water b/c hypertonic fluids dont replace fluids just move them

What MUST be done after giving hypertonic fluids?

Alkalizing

Acidifying

fluids with an SID of above 40mEq/L like NaHCO3 are _____ and Fluids w/ SID of 0 like NaCl are _____?

Decrease (all)

A metabolic acidosis will see a ____ in pH a ____ in PaCO2 and a ___ of HCO3?

Bicarb = 10

should = 24

24-10 = base deficite

14 = base deficit

Given the following blood gas, what is the base deficit that needs to be corrected?

Bicarb = 5

should = 24

24-5 = base deficite

19 = base deficit

Given the following blood gas, what is the base deficit that needs to be corrected?

Base disterbance x 0.6 x wt = total mEq of HCO3

How do you calculate the total mEq of the base (HCO3) that needs to be given to correct acidosis in a NEONATE?

Base disterbance x 0.3 x wt = total mEq of HCO3

How do you calculate the total mEq of the base (HCO3) that needs to be given to correct acidosis in an ADULT?

Base disterbance x 0.6 x wt = total mEq of HCO3

14 x 0.6 x 45 = total mEq of HCO3

380mEq of HCO3

Given a 2w old, 45kg Charolais bull calf w/ diarrhea who is 10% dehydrated with the following BG analysis. Calculate the total mEq of base (HCO3) needed to correct the acidosis.

Base disterbance x 0.3 x wt = total mEq of HCO3

19 x 0.3 x 600

3,420mEq of HCO3

Given a 4-year-old 600kg Holstein cow w/ diarrhea who is 8% dehydrated and the following BG analysis. Calculate the total mEq of base (HCO3) needed to correct the acidosis.

1.3% -> 156mEq of Bicarb

What is the percentage of isotonic NaHCO3?

3-5mEq/kg/24hrs

(max 69mEq/L at rate of 3ml/kg/hr)

You should not exceed ____ mEq/kg/24hrs of potassium?

20-40mEq/L for 1-2x

What is generally a safe amount of KCl for mild to moderate hypokalemia?

NaHCO3 may cause secondary hypokalemia b/c it pulls more K+ into the cells

Why do we give KCl when we give NaHCO3?

4-5ml/kg

What is the recommended dose of hypertonic saline for severe dehydraion or endotoxemia?

5ml/kg over 5 mins (1ml/kg/min rate)

What is the recommended dose of hypertonic bicarbonate 8.4%?

Calves w/ resp dz - cant breath off CO2

What calves should not receive hypertonic bicarbonate 8.4%?

PO NEVER IV will cause hemolysis

How should hypotonic fluids be given?

Sufficent sodium

Facilitate absorption of H20 and sodium while being alkalizing

Dont interfere w/ milk clotting and provide energy

Repair damaged intestine epithelium

What are ideal characteristics of Oral fluids in neonates?

Rumen absorbes isotonic/ hypoosmoloar

(NEVER HYPEROSMOLAR!!!)

In an adult ruminant where are most fluids absorbed and which kinds should be given?

40ml/kg/hr

What is the max rate of isotonic fluids for an adult cow?

Heart dz

Renal dz

When would we want to be more cautiious w/ giving fluids to an adult cow?

Plasma

What kind of Colloid is most easily given in ruminants?

FPT

When are colloids like plasma most commonly given?