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Equine Medicine Field Tactics 103: Procedures and Therapies for Fluid Therapy
R.P. Franklin
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Introduction
IV fluid therapy in the field or in a limited staff clinic should be aimed at stabilizing patients in shock, treating mild dehydration and providing therapy for medical disorders. ‘Maintenance’ fluids and replacing severe deficits in the field may be both infeasible and probably a time sump on the veterinarian and the horse. Knowing what service you can provide is as important as instituting it.
Fluid Choices
Colloids
Hetastarch, Plasma, Whole Blood
Crystalloids
Hypertonic saline, Normosol-R, Lactated Ringers Solution (LRS), Physiologic Saline Solution (PSS), Hartmann’s Solution
Replacement
Hypertonic saline, Normosol- R, LRS, PSS, Hartmann’s
Maintenance
0.45% Saline w/ 5% dextrose, 0.225% Saline w/ 5% dextrose, Plasmalyte 56 w/ 5% dextrose
Physiology of Fluid Distribution
Colloids
These protein-containing fluids when administered are restricted to the intravascular space and provide the best results for restoring cardiovascular function. Provision of antibodies, red blood cells and clotting factors are additional benefits some colloids contain. Colloids, liter for liter, provide 4 times the intravascular support compared to isotonic crystalloid fluids.
Crystalloids
These are sodium-containing fluids that typically distribute to all the body’s fluid spaces in varying degrees. They are indicated for rapid replacement of intravascular volume and maintenance depending on their sodium concentrations.
Replacement
These fluids contain equal or larger amounts of sodium as blood and are meant to provide for dehydration, gastrointestinal losses (reflux or diarrhea) or shock therapy. Their effects are limited to the intravascular (25%) and interstitial (75%) spaces because the sodium content prohibits the fluids from entering the cell (intracellular space: 2/3 of the body’s water).
Maintenance
These fluids contain less sodium than blood and are balanced to isotonicity by the addition of dextrose. They are indicated for providing maintenance fluids to animals that are incapable of drinking or absorbing fluids from the gastrointestinal tract. Maintenance fluids effectively hydrate all of the body’s fluid compartments.
Fluid Calculations
Fluid rates can easily be calculated when 3 factors are considered: maintenance, deficit and ongoing losses.
- Maintenance:
- Adults: 5% body weight
- Adolescents: 7.5% body weight
- Neonates: 10% body weight
- Deficit:
- Mild dehydration: 6% body weight
- Moderate: 8% body weight
- Severe: 10% body weight
- Ongoing losses:
- Diarrhea: Estimate losses
- Refluxing: Calculate losses
Deficits should be replaced by administering ½ the volume quickly and then adding the rest to the 24-hour total.
24-hour total = Sum of Maintenance, Remaining Deficit, Ongoing losses.
Important Note: This basic calculation should provide you with initial volume needs. This information should tell you what sort of impact your fluid therapy is having on the patient’s needs and if you can actually meet these needs without getting the horse to your clinic or a referral hospital.
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