A kumar fluid thearpy and blood transfusion

1. Fluid Therapy
Dr. Adarsh Kumar

2. 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)

3.  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).

4. 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

5.  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

6. 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

7. 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

8. 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

10. Sunken eyes

12. 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

13. 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.

14. 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.

15. 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.

16. 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

17. Ringer’s solution:
 Dehydration
 Mild alkalosis or Hypochloraemia.
 Dose: 30ml/kg /hour.
 Contra-indications:- Do not use in milk
fever cases.

18. 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.

19. 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

20. 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.

21.  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.

22. 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 Creatinine
400 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-

24. Simple approach for fluid resuscitation in
cattle
 Cattle are not the most efficient species at absorbing water
from ingested material.
 A cow with horse-like faecal material has been
experiencing a high level of dehydration for a significant
amount of time.
 Dehydration is an often overlooked clinical sign of a sick
animal.

25.  Focus on correcting the degree of dehydration, but
also consider the animal's maintenance fluid
requirements.
 Adult ruminants rarely develop metabolic acidosis.
Therefore alkalinizing fluids….. XXXXX
 Except in cases of grain overload, hepatic lipidosis
and in occasional cases of choke

26. Oral Fluids
 Cheap and easy to administer.
 Since most dehydrated cattle have a metabolic
alkalosis,.
 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 CaCl2
in 20 liters a non-alkalinizing oral electrolyte solution
for adult ruminants

27. Intravenous Fluid Therapy
 Saline or Ringer's solution: In cases of severe
dehydration, these isotonic, non-alkalinizing solutions
are generally recommended for replacement of large
fluid volumes in adult ruminants.
1. If mild to moderate hypokalemia is present,
potassium chloride can be added at a rate of 20 to 40
mEq/L during routine fluid administration (1to 1.5
gram of KCl /lt of NSS)
2. If mild to moderate hypocalcemia is suspected, a 500
ml bottle of calcium gluconate can be added to 20 liters
of fluids intended for intravenous administration.

28. Hypertonic Saline:
 Hypertonic saline contains 7.2gm of sodium chloride in
100ml sterile water and should be given to ruminants at 4
to 5 ml/kg administered slowly over a 4 minute period
 Cattle should be immediately given a supply of fresh
water after treatment and most animals will drink 5-10
gallons over the next 10 minutes.
 Cattle that do not drink water within 10 minutes of
hypertonic saline should have 5 gallons (One gallon is
equal to 4.5 liter) of water pumped into their rumen.
 Hypertonic saline should never be given alone without
providing the animal fresh water to drink or oro-ruminal
administration of water.

29.  Dextrose
 Often indicated for cattle in early lactation with
severe ketosis, hepatic lipidosis, or hypoglycemia.
 Glucose as a 5% solution can be administered at a
slow rate for several days; however this delivers free
water and can cause dilution of serum electrolytes.
 In general, it is preferable to add 2.5 to 5% glucose
to a non-alkalinizing fluid type (i.e., Ringer's) and
administer a slightly hypertonic solution than to
administer isotonic dextrose by itself.