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Ag Animal Test 3 > Treatment of Neonatal Diarrhea > Flashcards

Treatment of Neonatal Diarrhea Flashcards

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1
Q

What will eventually kill neonates with diarrhea?

A
  • Fluid, electrolyte, acid/base derangements***
  • Bacteremia, septicemia, toxemia
  • energy deficits
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2
Q

TBW % of body weight

A
  • 55-75%
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3
Q

What is ICF % of TBW?

A

2/3 (intracellular)

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4
Q

What % is ECF Of TBW? What % is plasma and interstitial fluid?

A
  • 1/3 TBW
  • 20% of that is ECF
  • 80% of that is ECF
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5
Q

Where is most body water?

A
  • Inside of cells
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6
Q

Where is most ECF water?

A
  • Outside the vascular tree
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7
Q

Where is the deficit with dehydration?

A
  • Extra-vascular primarily
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8
Q

Clinical signs of dehydration

A
  • Skin tent is increased
  • Eyes are sunken
  • Mucous membranes are tacky
  • Eyes are “dry”
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9
Q

Where is the deficit with decreased perfusion?

A
  • INTRAvascular
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10
Q

Clinical signs of decreased perfusion

A
  • HR is increased
  • CRT is decreased
  • Temp is decreased
  • Pulse strength is decreased
  • MM color is pale
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11
Q

When can calves maintain perfusion even while dehydrated?

A
  • Early diarrhea
  • Gut will still be functional
  • CLinical signs associated with decreased bicarbonate and potassium
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12
Q

By the time you notice decreased perfusion, how significant are the deficits usually?

A
  • Quite significant
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13
Q

What are 7 questions to consider with fluid therapy?

A
  • Is it indicated?* (first)
  • Cost? (first)
  • Route?
  • Volume?
  • Rate?
  • Type?
  • Duration?
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14
Q

What do you need to know to determine if fluids are indicated?

A
  • History
  • PE
  • lab analysis
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15
Q

At what % of dehydration can we recognize it clinically?

A

5%

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16
Q

At what % of dehydration is the animal at risk of death?

A
  • 10-12%
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17
Q

What do you use to estimate fluid deficits with dehydration?

A
  • Increased skin tenting
  • Tacky mm
  • Sunken eyes
  • Dry eyes
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18
Q

What do you use to estimate fluid deficits with poor perfusion?

A
  • Tachycardia
  • Weak pulse
  • Increased CRT
  • Pale mm
  • Decreased temperature
  • Decreased muscle tone!*
  • Recumbent!*
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19
Q

How do you come up with a decision for estimation of dehydration?

A
  • Typically based on a conglomeration of all (or some) of the available information
  • The more the better
  • Not all parameters will be present or coincide 100%
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20
Q

Laboratory analysis that can be performed to assess dehydration (in adjunct to physical exam)

A
  • PCV
  • TP
  • Na
  • Osmolarity
  • etc.
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21
Q

Mild dehydration

A

5-7%

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22
Q

Moderate dehydration

A

8-10%

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23
Q

Severe dehydration

A

> 10%

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24
Q

Relative cost of IV vs oral costs

A
  • $150-250 for IV and $20-60 for oral meds
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25
What three things do you need to think about with route of fluisd?
- Status (Stable vs critical) - Nature of the case (locale, environment) - Economic constraints
26
What are the two broad categories of route of fluids?
- Central | - Peripheral
27
Central route examples
- IV ONLY
28
Peripheral route examples
- Oral, subcutaneous, intraperitoneal, intraosseous
29
Oral route - what does it require?
- Requires a functional or well-perfused gut - physiologic and natural approach - Gut is often functional in the face of intestinal disease
30
Oral fluid ingredients to consider
- Na - Glucose (energy and helps with glucose/Na co-transporter) - K - Cl - Alkalinizing agents (HCO3, citrate, acetate) if metabolic acidosis - Glycine to enhance glucose absorption - Maybe geling agents?? (probably not)
31
Homemade oral fluid sample recipe
- 1 tsp light salt - 2 tsp NaHCO3 - Pectin - 1 can beef consume
32
SC route benefits
- Convenient - No volume overload - Owner administer - Helpful for maintenance - 50-200mL/site
33
When not to do SC route?
- Critical cases!
34
Intraperitoneal benefits
- Large volumes can be given
35
Intraperitoneal caveats
- Must use isotonic fluids - Risk of peritonitis - Don't put glucose in there
36
Intraosseous catheter location
- Tibial tuberosity, trochanteric fossa of the femur and wing of the ilium
37
Benefits of intraosseous
- Rapid uptake
38
Caveats of intraosseous catheters?
- Risk of osteomyelitis
39
IV - which cases?
- CRITICAL cases
40
Benefits of IV
- rapid correction of deficits - Large volumes - Hypertonic tolerated
41
Drawbacks of IV
-Catheter management
42
During severe circulatory shock, which is the ONLY route that is not considered peripheral?
- IV
43
What clues on PE might suggest that an animal is a poor candidate for peripheral fluid therapy?
- Cold extremities | - Difficulty ambulating
44
What are three factors to consider with volume replacement?
1. Deficit 2. Maintenance 3. Ongoing losses
45
How to calculate deficit volume?
BW (kg) x % dehydration = deficit in liters e.g. 100 kg x 0.08 = 8 L
46
What should maintenance fluids account for?
- Sensible losses (urine, feces) | - Insensible losses (skin, respiratory)
47
Maintenance requirements
mL/lb/hr - OR 80 mL/kg/day
48
What do ongoing losses relate to?
- Disease - Vomiting - Diarrhea - POlyuria - Burns and wounds
49
What is the total fluid requirement plan?
- Deficit + maintenance + ongoing losses
50
How fast can a deficit be corrected?
- Generally 1/2 the deficit can be corrected IV quite rapidly - Often in teh first hour with the remainder in the next 4-6 hours or longer - Guidelines vary for species
51
How rapidly can calves with diarrhea have the deficit corrected?
- 2-4 hours
52
How quickly can you correct other species?
- Take 24 hours approximately
53
What multiple of maintenance is it generally considered okay to go?
Up to 4x maintenance - More than that you need to pay attention to signs of overhydration
54
Shock rate of fluids
- 90 mL/kg/hR
55
Signs of excessive fluid flow rates
- Pulmonary and cerebral edema - Ascites, chemosis (conjunctival edema), diarrhea - Consider the cardiopulmonary state at high flow rates - If at a high flow rate, consider measuring CVP
56
How to determine type of fluids?
- Based on history, PE, lab data | - Clinical experience and other non-measured parameters will guide the decision
57
Criteria for choosing a fluid
1. Fluid is needed to correct the VOLUME deficit 2. Correct electrolyte deficits or excesses 3. Address acid/base problems
58
What are the polionic fluids?
- Lactated Ringers - Normosol - Plasmalyte
59
What is in D5W?
- 50g/L glucose
60
What is in 10% dextrose?
100 g/L
61
What is in D2.5%, NaCl 0.45%?
- 25 g/L dextrose 77 Na and 77 Cl
62
What's in NaCl 0.9%?
- 154 Na | - 154 Cl
63
What's in LRS?
- 130 Na - 109 Cl - 4 K - 3 Ca - 28 Buffer lactate
64
What is in plasma?
- 1 g/L glucose - 145 Na - 105 Cl - 5 K - 10 Ca - 24-28 HCO3 buffer
65
What are the polyionic fluids?
- LRS - Plasmalyte - Normosol
66
What can happen if you choose 5% dextrose?
- Diuresis
67
What can happen if you choose 0.9% saline?
- Acidifying
68
Bicarbonate deficit formula
- HCO3 def = BW (kg) x deficit x (0.3-0.6)
69
Normal bicarbonate
30 mEq/L - If they are at 10 mEq/L that's a 20 deficit
70
How to calculate deficit
Normal HCO3 (30) - existing HCO3
71
What is the 0.3-0.6 in the equation for calculating deficits?
- % of body water interchangeable with HCO3
72
Look at the examples for a calf with a deficit
- Just do it
73
What happens if you add NaHCO3 to LRS?
- High sodium and osmolality | - We can push the sodium too high
74
What should you add NaHCO3 to keep sodium and osmolarity okay?
- Use 1.3% NaHCO3 added to water
75
What is a good rule of thumb in minimal deficit situations?
- Simply correcting the hydration status will allow correction of the deficit via renal and respiratory pathways - The dumbest kidney is still smarter than the smartest clinician
76
Base deficit estimate for a calf that is still drinking <8 days and > 8 days
- 0 if <8 days | - 5 if >8 days
77
Base deficit estimate for a calf that is standing but having diarrhea <8 days and > 8 days
- 5 if <8 days | - 10 if >8 days
78
Base deficit estimate for a calf that is sternal but laying down <8 days and > 8 days
- 10 if <8 days | - 15 if >8 days
79
Base deficit estimate for a calf that is totally recumbent <8 days and > 8 days
- 10 if <8 days | - 20 if >8 days
80
Goal for duration of therapy
- Get calves back to oral fluids - Monitor hydration parameters, mentation, temperature, suckle, etc. - Realize that hydrating a calf with a history of severe diarrhea will often times result in the diarrhea returning
81
When should fluid therapy be dc'ed?
- When hydration is accomplished - Animal is capable of maintaining fluid balance - Hours to days - Switch from IV to oral - Clinical response

Ag Animal Test 3 (7 decks)

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