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 ‡ To recite µexpected¶ abnormalities for common diseases

Fluid therapy considerations
‡ ‡ ‡ ‡ volume (water) tonicity (osmolality) pH (hydrogen ion concentration) ion concentration (Na, Cl, K, Ca)

‡ ECF is 20% of b. ‡ interstitial ~ 75 l ‡ plasma ~ 25 l .w.Where is the water? 500 450 400 350 300 250 200 150 100 50 0 ‡ if 500 kg body weight ‡ 60% is water ‡ ICF is 40% of b.w.

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 .

liters of water µlost¶ = body weight in kg x est. % dehydrated (500 kg x 6% = 30 liters) .

Laboratory Evaluation of Dehydration ‡ ‡ ‡ ‡ Packed cell volume (PCV) Hemoglobin Total plasma protein BUN .

PCV and TPP 60 50 40 30 20 10 0 ‡ useful to monitor progress ‡ pre-existing anemia may mask actual increase in PCV due to dehydration ‡ loss of protein may not reflect water loss .

the horse is still 8% dehydrated How can this be?? .How much fluid to give??? 500 kg horse @ 8% dehydrated has a 40 liter deficit 40 liters of fluids are administered upon re-exam.

³Snapshot´ of hydration status ‡ existing deficits ‡ maintenance needs ‡ continuing losses .

diarrhea. profuse sweating) .g.How can this be? ‡ Patient is anorexic and not taking in water ‡ Patient has continuing losses (e.

What routes should I use? ‡ ‡ ‡ ‡ IV Subcutaneous PO IP .

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? ‡ base on actual measurement of electrolytes and blood gases ‡ make an ³educated guess´ .

What choices of fluids? ‡ balanced polyionic ‡ isotonic water ‡ alkalinizing ‡ acidifying .

Which fluid should I choose? ‡ If no laboratory. chose balanced polyionic .

³New´ Acid-Base ‡ Respiratory ± pCO2 ‡ Non-respiratory ± water ± strong ions ‡ measured (Na.Cl) ‡ unmeasured ± protein .

Acid-Base Regulation pH Respiratory Non-respiratory pCO2 Base Excess SID Protein Water Strong - [Prot] [Na] [Cl-] [UA-] .

Using the µnew¶ acid-base ‡ ‡ ‡ ‡ ‡ ‡ Free water 0.5-[Prot]) = ________ Unidentified anions = ______________ Total observed Base Excess = ________ .3([Na]-140) = ________ Chloride 102-([Cl]x 140/[Na] = ________ Protein 3(6.

no effect dilution (low [Na]) results in acidosis concentration (high [Na]) results in alkalosis .3([Na]-140) = ________ normal [Na] .Using the µnew¶ acid-base ‡ ‡ ‡ ‡ Free water 0.

Using the µnew¶ acid-base ‡ Chloride abnormalities 102 .[Cl-]corr = ____________ ‡ normal [Cl] .no effect ‡ loss of Cl .alkalinizing effect ‡ increased hyperchloremia .acidifiying .

5-[Prot] = __________ normal [Prot] .alkalinizing increased protein .Using the µnew¶ acid-base ‡ ‡ ‡ ‡ Protein 3(6.no effect loss of protein (loss of acid) .acidifiying .

Using the µnew¶ acid-base ‡ Unidentified anions = __________ ‡ Calculated from measured values ‡ Equivalent to anion gap when protein is within normal range .

Using the µnew¶ 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 = ________ .

µThumb Rules¶ ‡ µeducated guesses¶ for common conditions .

Severe Diarrhea ‡ dehydration ‡ metabolic acidosis ‡ hyponatremia ‡ hypokalemia .

Intestinal obstructions/displacements ‡ similar to diarrhea because sequestered fluid equivalent to loss by diarrhea ‡ µhigh¶ obstructions similar to vomiting with loss of acid .

Exhaustion ‡ Loss of chloride in sweat ‡ alkalosis ‡ hypochloremia ‡ hypokalemia ‡ hypocalcemia .

Exertional Rhabdomyolysis ‡ Hypochloremia ‡ Metabolic alkalosis ‡ Pigmenturia ‡ Azotemia .

Ruptured Urinary Bladder ‡ Hyponatemia ‡ Hypochloremia ‡ Hyperkalemia .

Summary ‡ ‡ ‡ ‡ ‡ How much? (dehydration) What route? How fast? What kind? Best guess .

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