Fluid therapy

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

oppose

pH to return to normal

What is the law of electroneutrality?

+ = - IONS

What are the three goals of fluid therapy?

1. Replace losses

2. Correct electrolyte and acid/base abnormalities

3. Maintain restored fluid balance

What is the replacement deficit calculation?

Volume = Bw x % (decimal)

What is fluid maintenance for a neonate?

80-100ml/kg/day

What is fluid maintenance for adults?

50ml/kg/day

How fast can you run the rate for maintenance?

1-4x

What are signs of dehydration on PE?

Enophthalmos

Skin tent

Dryness of MM

Labs (protein, hematocrit, Na+)

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

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 maintenance?

80-100ml/kg/day = volume

100ml x 45 = 188ml/hr

24

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

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 maintenance fluid?

50ml/kg/day = volume

50 x 600 = 30,000 mL

2 × 60 = 1200 mL/kg/hr

24

What is the shock rate of a cow?

80ml/kg

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

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

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

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

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

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?

IV

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

Oral

What is a balanced fluid?

Fluids composed of numerous electrolytes that mimic physiologic norms

What are examples of Balanced fluids?

LRS, Norm-R plasmolytes

What is a ruminants electroneutrality?

280-306mOsm/L

Why would we give hypertonic fluids?

Severe dehydration/large cows that need to be rehydrated fast

- draws fluid from intersitial space to intracellular

What MUST be done after giving hypertonic fluids?

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

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

Alkalizing

Acidifying

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

Decrease (all)

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

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

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 0.6 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 an ADULT?

Base disterbance x 0.3 x wt = total mEq 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 0.6 x wt = total mEq of HCO3

14 x 0.6 x 45 = total mEq of HCO3

380mEq 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.

Base disterbance x 0.3 x wt = total mEq of HCO3

19 x 0.3 x 600

3,420mEq of HCO3

What is the percentage of isotonic NaHCO3?

1.3%

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

3-5mEq/kg/24hrs

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

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

20-40mEq/L for 1-2x

Why do we give KCl when we give NaHCO3?

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

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

4-5ml/kg

What is the recommended dose of hypertonic bicarbonate 8.4%?

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

What calves should not receive hypertonic bicarbonate 8.4%?

Calves w/ resp dz - cant breath off CO2

How should hypotonic fluids be given?

PO NEVER IV will cause hemolysis

What are ideal characteristics of Oral fluids in neonates?

Sufficent sodium

Facilitate absorption of H20 and sodium while being alkalizing

Dont interfere w/ milk clotting and provide energy

Repair damaged intestine epithelium

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

Rumen absorbes isotonic/ hypoosmoloar

(NEVER HYPEROSMOLAR!!!)

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

40ml/kg/hr

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

Heart dz

Renal dz

What kind of Colloid is most easily given in ruminants?

Plasma

When are colloids like plasma most commonly given?

FPT