Fluid Therapy

Dr. Adarsh Kumar

Why give fluids?

Replace intravascular volume

Improve tissue perfusion

Replace fluid deficits (dehydration)

Meet maintenance in patient

Replace ongoing losses (V, D, burns, etc.)

Fluid diuresis to eliminate toxins

Anesthetic and surgical support

Replacement of specific components (blood,

plasma)

Nutritional support (TPN)

The ruminant is a special case, because of the large fluid filled rumen.

If oneexcludes the rumen, these percentages are correct.

TBW 60-70% of BW

ICF 40% BW ECF 20-30% BW

Plasma -5% BW

Interstitial -15% BW

Lymph -5%

Transcellular -5% transcellular(1-3% BW, refers to water in GIT,

CSF, aqueous, synovial, peritoneal and pleural).

Examples of Fluid Loss

Puregastric vomiting: loss of HCl; volume

causes hypochloremic metabolic alkalosis (Cl

decrease limits re-adsorption of HCO3 in

kidneys

Bilious vomiting: loss of K, HCO3, Na; causes

hypokalemia, acidosis (Color of vomit is

important!)

Panting: loss of free water; no electrolyte loss

PD: free water gain; dilution and diuresis

promote ion loss

Diarrhea: volume; Na, K, HCO3

Ketoacidosis (starvation, diabetes mellitus,

pregnancy toxemia, lactation ketosis)

Lactic acidosis (circulatory shock, fever,

seizures, hepatic dysfunction, grain overload)

Lower intestinal obstruction

Paralytic ileus

Renal failure

What volume of the fluid to be replaced?

Clinical approach: Based on % dehydration

Fluid deficit(ml) = % Dehydration X B.Wt. X 10 (Factor)

= (5 – 15) % X B.Wt. X 10

Assessment of dehydration

History: Water intake, GIT losses, Urine output,

Hemorrhage, Fever, etc

Physical examination: Skin pinch, Mucus

membrane moistness, Eyeball position and

orbit, CRT

Laboratory estimation: PCV, TPP, USG, Serum

electrolytes (Na+, K+), Bicarbonate or total CO2

Physical examination

Dehydration skin pinch

The percentage of loss of fluid can be assessed by the

following “Rule of Thumb’

Loss of skin turgor 5%

Loss of skin turgor with sunken eye balls 5-7 %

Loss of skin turgor with sunken eyeballs and slow

capillary refill time 7-10%

Hypovolaemia and shock 12-15%

Dry mucous membrane will also indicate dehydration,

but panting can also cause dryness

Sunken eyes

Route of infusion to be used

Route depend upon severity and nature of disease

Per os: In mild dehydration, if severe vomiting and diarrhea not present

Intravenous :in critically ill patients, can give isotonic, hypertonic or hypotonic solutio. Jjugular, cephalic and saphenous veins

Intra peritoneal : sterile isotonic fluids, blood transfusion in pups

Intra osseous : blood, isotonic and hypertonic fluids in neonates but complication is sepsis

Sub cutaneous : useful in minimally dehydrate animals, not in shock,. Don’t administer 5% dextrose as there is delayed absorption

RATE OF ADMINSTRATION OF FLUID

Rate will be parallel to severity of dehydration. First

rapidly then slowly.

First hour: 13-14ml/kg/hour until urine flow

restored .First 40-60 minutes.

Second hour: 10ml / kg/hour – continuously.

If urine is not voided within 60 minutes, reduce the

rate approximately 1/3rd i.e. 9ml/kg for second hour.

Third hour: 5ml/kg

Fourth hour and subsequently: 2ml/kg.

Rate of infusion

Example:

B.Wt. = 25 kg

Dehydration = 10%

Fluid deficit = 2500 ml

Maintenance required @ 22 ml/kg/day

= 550 ml

Total requirement = 2500+550 = 3050 ml/24 hr

Rate of admn./hr = 3050 ml/24 hr = 127 ml/hr

Drops/min. = rate per hr x drops/ml

60

= 127 x 20 (say) = 42 drops/min

60

= 1.5 drops/sec.

DEXTROSE

To prevent (1) Dehydration (2) Excess tissue

catabolism (3) Depletion of liver glucose and (4)

Ketosis.

In hepatic, renal, cardiac and gastro-intestinal diseases.

Promote sodium excretion

Contra-indications.

Do not give in case of milk fever.

Do not give in case of intracranial haemorrhage.

Do not give following blood transfusion.

Do not give in over hydration.

Sodium Chloride solution: Sodium chloride preferred as 0.9% solution with Dextrose.

But, 5% solution preferred in severe depletion up to 1.5

litres.

Indications:

Vomition

Severe sweating

Severe salivation in “Panters” and digestive disorders.

Alkalosis due to fluid loss.

Pyloric obstruction.

Abomasal disorders.

In heat stroke.

Contra- indications: In oedema and ascites

Ringer’s solution:

Dehydration

Mild alkalosis or Hypochloraemia.

Dose: 30ml/kg /hour.

Contra-indications:- Do not use in milk

fever cases.

Ringer’s Lactate Solution.

Indications:

Mild acidosis.

Dehydration.

Restoration of fluid after fracture, burns, infection and peritoneal

disorders.

Metabolic acidosis

After excess use of acidifying solution.

Dose: 5 to 10 ml/kg

Contra-Indications

Hepatic disorders.

Anoxia due to shock.

Congestive heart failure.

Severe acidosis.

Severe metabolic alkalosis.

In Rumen acidosis of cattle.

Calcium Borogluconate 25% Solution

Indication

1. Milk fever. 2. Ruminal atony.

Dose. For milk fever: 3 gm /4.5Kg. Body weight in 75

minutes.

For heavy cows (500-550 Kg) 800-1000ml.

For small cows (325-360 Kg) 400-500ml.

50% of the total dose must be given in I/V and the rest in

S/C.

Low dosage in practice will lead to more complications

than cure.

Subcutaneous injection is preferred in early stage during

restlessness and also in conditions like Septicaemia,

Pneumonia, Metritis, Mastitis and severe toxaemia with the

heart rate of 180/minute and above

Care should be taken

Speed of injection: Initially give 250 ml I/V in 10 minutes

and watch for reaction and then proceed.

Do not give to excited or frightened animal.

When affected animals exposed to sun or hot and humid

atmosphere or heat stroke, the calcium injection leads to

toxicity.

So, before giving I/V injection bring the body

temperature below 103 ºF.

After so many times of calcium injection S/C by others, if

you give even normal dose of calcium in I/V, the animal

will die due to toxicity. This is due to lack of absorption of

calcium during S/C injection due to poor peripheral

circulation.

After I/V Calcium injection, circulation improves and

absorption increases and leads to toxicity.

Antidote for calcium toxicity is Injection of Atropine

sulphate but not Magnesium solution.

1. Total Amount of fluid over 24 hours

A. Maintenance 400 kg x 50 ml/kg/day=20Lt

B. Dehydration Clinical signs suggest at least 5%, dehydration is supported by mild increases in PCV,TP, and Creatinine400 kg x 0.05 = 20Lt

C. Total fluid to give over 24 hours = 20 + 20 = 40 Lt

D. Type of fluid: Want to replace low Cl- and decrease high HCO3-

Simple approach for fluid resuscitation in

cattle

Cattle are not the most efficient species at absorbing waterfrom ingested material.

A cow with horse-like faecal material has beenexperiencing a high level of dehydration for a significantamount of time.

Dehydration is an often overlooked clinical sign of a sickanimal.

Focus on correcting the degree of dehydration, butalso consider the animal's maintenance fluidrequirements.

Adult ruminants rarely develop metabolic acidosis.Therefore alkalinizing fluids….. XXXXX

Except in cases of grain overload, hepatic lipidosisand in occasional cases of choke

Oral Fluids

Cheap and easy to administer.

Since most dehydrated cattle have a metabolicalkalosis,.

By simply adding

NaCl (7 grams/L), KCl (1.25 grams/L) and

CaCl2 (0.5 grams/L) to a liter of water

or

140 grams NaCl, 25 grams KCl, and 10 grams CaCl2in 20 liters a non-alkalinizing oral electrolyte solutionfor adult ruminants

Intravenous Fluid Therapy

Saline or Ringer's solution: In cases of severedehydration, these isotonic, non-alkalinizing solutionsare generally recommended for replacement of largefluid volumes in adult ruminants.

1. If mild to moderate hypokalemia is present,potassium chloride can be added at a rate of 20 to 40mEq/L during routine fluid administration (1to 1.5gram of KCl /lt of NSS)

2. If mild to moderate hypocalcemia is suspected, a 500ml bottle of calcium gluconate can be added to 20 litersof fluids intended for intravenous administration.

Hypertonic Saline:

Hypertonic saline contains 7.2gm of sodium chloride in100ml sterile water and should be given to ruminants at 4to 5 ml/kg administered slowly over a 4 minute period

Cattle should be immediately given a supply of freshwater after treatment and most animals will drink 5-10gallons over the next 10 minutes.

Cattle that do not drink water within 10 minutes ofhypertonic saline should have 5 gallons (One gallon isequal to 4.5 liter) of water pumped into their rumen.

Hypertonic saline should never be given alone withoutproviding the animal fresh water to drink or oro-ruminaladministration of water.

Dextrose

Often indicated for cattle in early lactation withsevere ketosis, hepatic lipidosis, or hypoglycemia.

Glucose as a 5% solution can be administered at aslow rate for several days; however this delivers freewater and can cause dilution of serum electrolytes.

In general, it is preferable to add 2.5 to 5% glucoseto a non-alkalinizing fluid type (i.e., Ringer's) andadminister a slightly hypertonic solution than toadminister isotonic dextrose by itself.