Colic signs in a cow due to Intestinal obstruction

         Frequently kicking of the abdomen and shifting of legs
         in this case suggestive of colic due to intestinal obstruction.

Stomach tube for sheep and goat 

Mouth gag

Evacuation of rumen fluid by stomach tube in acidosis

Manual Support of Downer cow with pole after lifting

Hip Sling

Downer cow lifted with Hip sling for diagnostic purpose

Downer cow lifted with Hip sling for diagnostic purpose

Movable sling for Downer cows - Therapeutic management

Movable sling for Downer cows - Therapeutic management

Chest Sling 

Chest sling

Chest sling

Movable downer cow sling

Peroneal nerve paralysis

Manual lifting or recumbent cow

Tibial nerve paralysis

Gastrocnemius muscle rupture

Stifle dislocation

Radial Paralysis

Oral Rehydration  Therapy for Downer cow with electrolytes and fluids

Sciatic nerve with peroneal nerve paralysis

Radial nerve paralysis

Obturator nerve paralysis with Adductor muscle paralysis

Obturator nerve Paralysis

Both the hind limbs extended towards the elbow

PRACTICAL FLUID THERAPY

by

Dr. S.Sivaraman, M.V.Sc.,Ph.D

                                                           Assistant professor

                                            Dept of Veterinary Clinical Medicine

Veterinary College and Research Institute, Namakkal-637001

            The aim of the fluid therapy is to replace the losses and to maintain the fluid and electrolyte balance in the body for normal cell and organ function. The fluid compartments in the body exchange fluid to compensate for losses thereby the fluid lost initially from one compartment results in a loss from all compartments. Before administration of fluids a veterinarian should able to access the level of dehydration, what type of fluids to be administered and the quantity of the fluid. Simply to say What fluid? How Much to be given? And  Why?

            In an adult animal around 60% of its body weight is comprised of water, which is distributed throughout the intracellular (ICF) and extracellular ( ECF) compartments. About two-third of the total body water (around 40% of Body weight ) is of Intracellular fluid. the remaining one-third ( 20% ) constitute of the  extracellular fluid volume which comprises three sub compartments like interstial fluid, intravascular fluid and transcellular fluid.

DISTIBUTION OF BODY FLIUDS

                                        60% of Total Body wt comprised of Water.

 

                                       ICF 40%                                   ECF 20%

                                                                                                

                                                                                                                          Transcellular fluid

                                                                                                       Plasma        ( csf, synovial, bile,)

                                                                                                                                     <1%

                                                                        Interstial                5%                 

       Fluid 15%

Classification of fluids

1. Colloids

2. Crystalloids.

3. Whole blood and blood products

Whole blood is used in cases of:

• Severe haemorrhage

• Severe anemia

I. Colloids:

            Colloids are a group of fluids containing large molecules designed to remain in the intravenous space longer than crystalloid fluids. Colloids are able to expand and maintain the vascular volume more effectively. Their osmotic potential is so great that colloids draw fluid out of the interstitial and intracellular spaces into the plasma, hence they   are commonly termed  Plasma Volume Expanders. Colloids are used in cases of shock where cardiovascular function and the circulation is to be improved rapidly.

Indications:

• Hemorrahage

• Shock

• Hypovolemic shock.

Examples: Dextrans, Gelatins ( Haemaccel™)      

II. Crystalloids:

            Crystalloids are a group of sodium-based electrolyte fluids. They enter the extracellular fluid (ECF) and from there equilibrate with other fluid compartments in the body to restore fluid balance. The most commonly used crystalloids are similar to plasma water in composition. In patients where renal function is normal, crystalloids will be excreted in the urine .these fluids are divided into three groups: isotonic, hypertonic and hypotonic.

           

            An isotonic crystalloid fluid is a balanced electrolyte solution as equivalent to the same osmolality of blood plasma. Ex: Ringer lactate, Normal Saline, Dextrose Normal saline.

            A hypertonic crystalloid fluid has higher osmolality than that of the blood plasma. It causes a fluid shift that will draw fluids from the interstial and intracellular spaces into the vascular system. Ideal conditions are shock, Gastric Dialation and Volvulus etc.

Ex : Hypertonic saline (7.8% or 9% sodium chloride), Hypertonic Dextrose solutions 20%,50%.  

           

            A hypotonic crystalloid solution has lower osmolality than that of blood plasma. Hence they donot  cross readily the membranes and draws fluids into the cells. Ex: 5 % Dextrose in water, 0.45%sodium chloride

                 

                  

a. Lactated Ringer’s solution:

            This contains electrolytes in very similar concentrations to those in the extracellular fluid (ECF). Sodium (Na_), potassium (K_), calcium (Ca__), chloride (Cl_) and lactate are present.

Ringer lactate is indicated in cases of fluid and electrolyte losses. The lactate present is metabolized to bicarbonate in the liver and  is used in the body to overcome situations of metabolic acidosis, which occur in many clinical conditions like enteritis.

b. Normal Saline (0.9%Nacl):

            This solution contains sodium (Na_) and chloride (Cl_), but no potassium (K_). 0.9% It is indicated in fluid and electrolyte losses, particularly when plasma potassium levels are increased due to underlying disease and additional administration of potassium must be avoided during fluid therapy. It is indicated in vomition cases.

c. Dextrose 5%

            5% dextrose, also referred to as 5% glucose, is basically water with a small amount (50 mg/mL) of glucose added in order to make it isotonic, thus enabling it to be administered intravenously. This solution contains no electrolytes so provides the body with water and a very small amount of glucose. It  is indicated in situations of primary water loss, where the animal is unable to take in oral fluids, and in cases of hypoglycemia. The amount of glucose present is too little to make a significant contribution to the energy intake of the animal.

.

d. Hypertonic saline (7.8% or 9% sodium chloride):

            Hypertonic saline is under-used in small animal intravenous fluid therapy, but is more widely accepted in large animal fluid therapy. when this type of sodium chloride is administered intravenously, its high osmotic potential causes fluid from the intracellular space to move

into the vascular space. This causes a sudden rapid increase in circulating volume that is needed in cases of severe hypovolaemia. Hypertonic saline is indicated in situations such as: gastric dilation and volvulus (GDV), equine colic, severe hemorrhage . Typically, a 7.8% solution of hypertonic saline is administered intravenously at a rate of

4–5 mL/kg.

e. Potassium supplementation:

            Potassium may be added to a crystalloid fluid in cases of hypokalaemia. Hypokalaemia becomes important when plasma levels fall below 3.5 mmol/L. Patient potassium levels should be measured and potassium supplementation administered accordingly in ‘at risk’ patients 
Potassium supplementation doses of 0.5meq/L/kg/hour should not be exceeded due to risks of hyperkalaemia and cardiotoxicity.

If potassium is added to a bag of crystalloid fluid( Normal Saline)  it must be mixed thoroughly by inverting the bag of fluid several times.The speed to be administered is very very very slow otherwise it will lead to cardiotoxic and arrythmia and the animal may die.
         Instead of iv adminstration oral administration is very effctive. Commercially Available Potassium chloride syrup (Potklor) can be used.@ 200 to 30 ml can be given
       Potasssium chloride lab grade powder is also availbel which can be given @ 100 to 150gm orally to hypokalemic cows.
    Care should be taken to avoid over administration of Potassium chloride as K will condition and impair the absorption of Magnesium whcih will lead to hypomagnesemia

Common causes and signs of hypokalaemia:

Causes                                  Signs

Vomiting                            Weakness

Diarrhoea                           Lethargy

Renal disease                     Anorexia

Anorexia                            Ileus

Diet low in potassium

Aggressive diuretic therapy

Clinical situations requiring fluid therapy

            When presented with a clinical case, a decision must be made as to which fluid to use to treat the animal’s condition. Generally we try to ‘replace like with like’. This simply means that where blood is lost, replace the deficit with blood; where water is lost, replace with water; and where water and electrolytes are lost, replace water and electrolytes.

Blood loss

            Blood loss reduces the circulating volume and perfusion, and therefore reduces   the oxygen carrying capacity of blood. A low packed cell volume (PCV) indicates this. In severe blood loss oxygenation of the tissues is significantly compromised. If the PCV falls below 20% then a blood transfusion is necessary. Anemia and bleeding disorders can be an indication for blood transfusion.

Primary water loss

            This is loss of water with little or no loss of electrolytes. In this situation, water only needs to be replaced. Common conditions causing this include fractured jaw, panting, neglect by owners and unconsciousness. Crystalloids are the fluids of choice: 5% dextrose or 0.18% sodium chloride and 4% glucose are used.

Loss of water and electrolytes

            This occurs as a result of conditions such as vomiting and diarrhea. A crystalloid containing both water and electrolytes must be used to replace the deficit. An important consideration in deciding which crystalloid to use is whether potassium is being lost or is accumulating in the body. This ion is important for normal metabolism and plasma potassium concentration must remain stable within narrow limits in order for body cells to function normally.

Fluid Indications:

Clinical Condition	Name of the Fluid
Vomiting	Normal Saline
Diarrhea	Ringer Lactate
ECF expander	Normal Saline
Electrolyte Loss	Ringer Lactate
Metabolic acidosis	Bicarbonate , or RL
Anorexia	Dextrose  5%, 20%
Hypoglycaemia,Ketosis	20%  Dextrose
Ruminal Acidosis	Sodium Bicarbonate with Normal saline

How to Determine the degree of Dehydration?

Calculation of the Fluid requirement:

    ( Deficit )  Formula :  % of Dehydration x Body weight x1000 = ? ml of fluid required

ECF requirement = 1/3 rd of the fluid required

Plasma requirement = ¼ th of ECF 

     ( Maintanence) Fluid loss:  50- 60 ml/ kg B.Wt

20 ml / kg / day – Urine loss

20 ml / kg / day – Fecal loss

10 ml / kg / day – insensible loss ( respiration,sweat…)

Ex: 100 kg means 100 x 60 ml = 6000 ml fluid loss

Rate of Infusion:

Crystalloids – 10 ml / kg B.wt /mt

Colloids        - 10 – 20 ml / kg B.wt. /mt

Shock           -   90 ml kg B.wt / mt 

Clinical Signs of ECF Depletion and Overload:

FLUID DEPLETION SIGNS	FLUID OVERLOAD SIGNS
Increase temperature	Restlessness
Weak rapid pulse	Cough
Pale,dry mucous membrane	Sc edema
Poor skin elasticity	Increase in respiration
Sunken eyeballs	Ascites
Reduced Urine output	Exophtalmous, chemosis
Letahrgy	Increase in urine output
Weakness	Serous nasal discharge
Increase in CRT	vomiting
TREATMENT: Give required Fluids	TREATMENT: Administer DIURETICS