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Practical Approach to Fluid Therapy

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Practical Approach to Fluid Therapy Practical Approach to Fluid Therapy (Q) n 0 "'O '-< Frank A. Mongini, D. V.M. ......'"i Cotati, California (JQg > 8 I'm sure all of you recognize the necessity of This solution can be made in any quantity and (D ......'"i intravenous fluids as a therapeutic means in the can be autoclaved. When analysed at a laboratory, (") treatment of many disease conditions. The major its composition is as follows: § factors preventing us from utilizing fluids as Table 2 >00 00 frequently as we'd like, is usually either the cost of Composition of Homemade Lactated Ringer's Solution 0 the fluids, or the time and effort spent in (")...... administration. With these problems in mind, we Na 144 mEq/L a...... have attempted and I feel succeeded in arriving at a K 4.0 mEq/L 0 Cl 111 mEq/L ~ 0 fluid that is balanced and a means of adminis­ H-i tration that is efficient. to A comparison price-wise points out the value 0 In searching for the ideal type of fluid, the < economically of the homemade solution. 5· following objectives should be met: a) properly (D Table 3 balanced, b) effective, c) efficiency in preparation, ~ ~ and d) economical. l L 3.0 Gallons (") There are numerous commerical preparations ,-+-...... Eltrad L.A. $0.30 $4.35 ,-+-...... available. In Table 1, I have listed some of the 0 Homemade Lactated $0.13 $1.58 ~ (D common fluids and their relative values. Ringer's Solution '"i 00 Tabk l 0 Our next concern is the administration of these "'O Common Elcctrolytcs-Valucs E:xprcsscd in mEq/L (D fluids. We accomplish this in the following manner: ~ Na K CL HCO3 Tonicity A. Intravenous catheterizabon of all patients. In f:; (") Lactated Ringn's 130 4 111 27* 1 the severely dehydrated scouring calf a venous (D 00 Isotonic Saline 154 0 154 0 1 cutdown is often necessary. After experimenting 00 Lartatl.'d Ringer's 190 4 111 87** 1-1/3 0........ with many catheters, the catheter we've found 00 plus 5.0 grams/L ,-t,- most suitable is E-Z Cath. This is an 8 inch,. 14 '"i NallCO3 gauge teflon catheter easy to insert with a hU!b ~ Fltrad L.A. 140 10 103 55 ~...... *In the form of lactall'. 27 mFq/L of IICO3 available after convenient for suturing in pface. If not available 0 rnl'tabolism of lactall'. from your local supplier, it is manufactu~ed by p **lnl'ludl.'s the 27 mEq of thl' Ringer's Solution plus 60 mEq from Desert Pharamaceuticial Company., Sandy, Utah . 5.0 grams NallC03. The price is approximately $1.50. Of the above fluids, Eltrad L.A. is the most B. As a fluid container, the Scholle bag has economical and therefore the one most used. We proven to be ideal. The Schone bag. is the milk are now using a homemade Lactated Ringer's container used in most milk dispensers in schools, Solution that is very inexpensive ( 1 ). restaurants, etc. They are a double walled! plastic I. Basic I ngrcdicn ts bag available in both 3 ..0 gallon or 6.0 gaUo:n J\. Stuck chluri<lc sulu tion capacity. A cardboard box is also availabfo to place a. Potassium chloride 30 grams the bag in. This isn't always necessary. What makes b. Calcium chloride 22 grams this so handy is you can carry a large number of c. Distilled water, q.s. .. 500 cc these empty bags in your practice veh ru cle, 8. 60'/r· Sodium Lactate Solution . Merck No. 5082 affording you the opportunity to utilize intra­ C. 1.0 gram Sodium Chloride tablets. venous fluids at any time. II. Homemade Lactated Ringer's Solution Our cost of the bag is $.35; with the bag and Rx: Stock chloride solution 5.0 cc 60 cc box $.75. They are available at most creameries or 60'/r Sodium milk processing plants. Lactate 5.0 cc 60 cc C. To deliver the fluids, we prefer the Cutter NaCL tablets () 72 intravenous set .. The procedure is to: 1) Remove Distilled water, the cap from end of intravenous set adop,ted for q.s. IOOO cc 3 gallons bottle. 2) Cut end of cap off. 3} Rep]ace cap on 45 intravenous set. 4) Cut end off rubber tube on 225 mEq + 12 mEq = 18 grams Na Hco3 Scholle bag plug. 5) Insert "cap end" of HCO3 \ (mEq/gram) ( (Q) intravenous set into rubber tube of Scholle bag. 6) needed) n Let fluids run. 0 By adding the 18 grams Na HCO3 to the 5.0/L '"'O Cost for intravenous set is approximately $.75. of lactated Ringer's, you will meet the require­ '-< As you can see we have a very inexpensive ......'"i men ts for rehydration and correction of the (JQg system with a total cost of approximately $3 .00. acid-base problem. Our next step is the selection of the proper type > 8 and quantity of fluid. Before we do that we should There is one more factor to consider, that being (D meeting the caloric requirment. This is usually ......'"i first make ourselves aware of the normal serum ('") electrolyte levels and the changes encountered satisfied by adding 5% glucose to all intravenous § during some clinical conditions. solutions. By using the figures of Table 5, this >00 requirement can be calculated for either a calf or a 00 Table 4 0 cow. ('")...... Plasma Electrolyte Levels a Both Normal and Clinical in mEq/L ...... Table 5 0 ~ Calf with Cow with Caloric Requirement at Resting Metabolism 0 Severe Abomasal 1-i; Normal Diarrhea Ulcers to Body wt. ( Kgm) Kcal/24 hours 0 < Na 138-145 130 145 70 5· K 3.5-4.5 8.1 2.0 5 234 (D Cl 98-105 102 74 10 393 ~ HCO3 25-32 13 48 ~ 50 1316 ('") ph 7.4 7.06 7.52 100 2 I 12 ,-+-...... ,-+-...... 500 7000 0 ~ To determine the fluid requirement: 1) Slight to 1 L of 5% glucose= 200 Kcal. :. 50 Kgm calf= 6.6 L of sr,; glucose (D '"i moderate dehydration represents a body fluid every 24 hours. 500 Kgm cow= 35 L of 5'; glucose every 24 hours. 00 deficit of 6-8%. 2) Severe dehydration represents a 0 '"'O deficit of 10-12%. Therefore, a severely dehydrated We routinely mix 3.0 gallons of electrolytes + (D 50 Kgm calf needs: 10% x 50 Kgm = 5.0 Kgm (5 ~ 5% glucose for all scouring calves and administer it f:; L) at a continuous drip over a 24 hour period. In ('") (D 00 Our HCO3 requirement is determined as such: adult cattle requiring fluids, they will auto­ 00 Formula: matically get 6.0 gallons of electrolytes + 5% 0........ 00 ,-+- HCO3 deficit/L x ECF (L) - mEq HCO3 needed. glucose as fast at the catheter will take it. For the '"i The HCO3 deficit can either be estimated or 14 gauge catheter, this is usually 3 1/:! - 4 hours. ~ determined in a laboratory. As we see in Table 4, a ~...... There is definitely a place for intravenous fluids 0 scouring calf with metabolic acidosis has a deficit in large animal medicine, specifically bovine p of approximately 15 mEq/L. practice. With an efficient and economical Normal HCO3 (28) - actual (13) = 15 mEq. procedure it becomes routine. An estimation of 10-15 mEq will always put you I would like to include a note on the within range. administration of oral fluids, whetlwr tlwsP be The normal animal has a compartment of ECF colostrum, milk, oral electrolytes, or water. The of approximately 30%, .:. ECF = body weight human enema bag is ideally suited to the calf. It (Kgm) x .30. comes in a collapsible 2 L plastic bag and a 2 L In this case, 50 Kgm x .30 = 7 5 L of ECF. cannister container. The flexible tubing provided is Formula: well adapted for passage down the calf's nostril. 15 mEq x 75 L = 225 mEq of HCO3 required This is an excellent way of getting 2 L of HCOi) (ECF) colostrum into calves soon after birth. We instruct ( deficit any client that is willing to learn how to pass the 1.0 gram Na HCO3 = 12 mEq HCO3 stomach tube via the nostril. These clients then 1 teaspoon = approximately 13 grams Na HCO3 tube feed any calf that didn't receive colostrum (baking soda) within a few hours of birth. 46 .
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