It's critical – Managing the colic patient (Proceedings) - Veterinary Healthcare
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It's critical – Managing the colic patient (Proceedings)


CVC IN KANSAS CITY PROCEEDINGS


What are we managing?

• Hydration

• Dehydration

• Ongoing losses

• Ingesta

• Inflammation

• Pain

• Distention

• Motility and ileus

• Endotoxemia

Hydration

• Decrease in hydration status decreases motility

• Fluid circulation shifts from gut

• Colonic fluid used to increase circulating volume

• With impactions ingesta becomes dehydrated

• Ongoing losses need to be accounted for

• Especially important in ileus

Fluid therapy

• Oral fluid therapy

o Used in impactions + diarrhea

o More effective for hydrating ingesta over IV fluids (Lopes et al AJVR 2004;65: 695-204)

o Use indwelling N-G tube

o Small or large bore

o Continuous or intermittent

o Water plus balanced electrolyte solution most effective for hydrating colonic ingesta

• Per liter

• 5.37g NaCl (table salt)

• 0.37g KCl (lite salt)

• 3.78g NaHCO3 (Baking Soda)

o Epsom salts most effective for softening small colon ingesta

• Osmotic cathartic

• 1g/kg SID or BID

o CRI

• 1-2 L/hr

• More rapid rate can make them colicky

• Set-up

• Used 5 L fluid bags

• Large IV Set

• Small bore NG tube (foal)

o Intermittent boluses

• 2-3 L Q2-3hrs

Crystalloids

• Importance:

o Maintain cardiovascular status

o Maintain electrolyte balance

o Horses may have ongoing losses of fluids due to:

o Ileus and reflux losses

o Diarrhea

o Leaky capillaries from damaged gut resulting in extravasation of fluids

• Cautions:

o Due to decreases in plasma volume and total protein, rapid administration can cause edema formation in lung, digit, brain, intestine, periphery

• Normosol R, LRS, 0.9% NaCl , Plasmalyte

o Prefer balanced solutions over 0.9% NaCl to avoid hypernaturemia

• 0.9% NaCl in HYPP horses

• Replace as 10-20 L bolus

• Maintenance – 2 ml/kg/hr

• Calculate % dehydration (% dehydration X bwt in kg = L of replacement) and ongoing losses (amount lost in reflux or diarrhea)

• Monitor hydration: avoid over-hydration


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