BasicFluidTherapyinHorses：在马的基本液体疗法.ppt

BasicFluidTherapyinHorses JillMcClure DVM MSDiplomateACVIM ABVP EducationalObjectives TorecognizeclinicaldehydrationToknowacceptableroutesoffluidadministrationToselectacceptableratesofadministrationToselectappropriatefluidsTorecite expected abnormalitiesforcommondiseases Fluidtherapyconsiderations volume water tonicity osmolality pH hydrogenionconcentration ionconcentration Na Cl K Ca Whereisthewater if500kgbodyweight60 iswaterICFis40 ofb w ECFis20 ofb w interstitial 75lplasma 25l Recognitionofdehydration drymucousmembranessunkeneyeslossofskinturgormild4 6 2 3secondsmoderate7 10 4 8secondssevere11 12 8seconds ofbodyweight litersofwater lost bodyweightinkgxest dehydrated 500kgx6 30liters LaboratoryEvaluationofDehydration Packedcellvolume PCV HemoglobinTotalplasmaproteinBUN PCVandTPP usefultomonitorprogresspre existinganemiamaymaskactualincreaseinPCVduetodehydrationlossofproteinmaynotreflectwaterloss Howmuchfluidtogive 500kghorse 8 dehydratedhasa40literdeficit40litersoffluidsareadministereduponre exam thehorseisstill8 dehydratedHowcanthisbe Snapshot ofhydrationstatus existingdeficitsmaintenanceneedscontinuinglosses Howcanthisbe PatientisanorexicandnottakinginwaterPatienthascontinuinglosses e g diarrhea profusesweating WhatroutesshouldIuse IVSubcutaneousPOIP HowfastshouldIgivefluids 3 12ml lb hr 6 25ml kg hr 3 12liters hrinadults1liter hrmaintenance Whatkindoffluidstouse baseonactualmeasurementofelectrolytesandbloodgasesmakean educatedguess Whatchoicesoffluids balancedpolyionicisotonicwateralkalinizingacidifying WhichfluidshouldIchoose Ifnolaboratory chosebalancedpolyionic New Acid Base RespiratorypCO2Non respiratorywaterstrongionsmeasured Na Cl unmeasuredprotein Acid BaseRegulation Usingthe new acid base Freewater0 3 Na 140 Chloride102 Cl x140 Na Protein3 6 5 Prot Unidentifiedanions TotalobservedBaseExcess Usingthe new acid base Freewater0 3 Na 140 normal Na noeffectdilution low Na resultsinacidosisconcentration high Na resultsinalkalosis Usingthe new acid base Chlorideabnormalities102 Cl corr normal Cl noeffectlossofCl alkalinizingeffectincreasedhyperchloremia acidifiying Usingthe new acid base Protein3 6 5 Prot normal Prot noeffectlossofprotein lossofacid alkalinizingincreasedprotein acidifiying Usingthe new acid base Unidentifiedanions CalculatedfrommeasuredvaluesEquivalenttoaniongapwhenproteiniswithinnormalrange Usingthe new acid base Freewater0 3 Na 140 Chloride102 Cl x140 Na Protein3 6 5 Prot Unidentifiedanions TotalobservedBaseExcess ThumbRules educatedguesses forcommonconditions SevereDiarrhea dehydrationmetabolicacidosishyponatremiahypokalemia Intestinalobstructions displacements similartodiarrheabecausesequesteredfluidequivalenttolossbydiarrhea high obstructionssimilartovomitingwithlossofacid Exhaustion Lossofchlorideinsweatalkalosishypochloremiahypokalemiahypocalcemia ExertionalRhabdomyolysis HypochloremiaMetabolical