What are we managing?
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Hydration
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Dehydration
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Ongoing losses
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Ingesta
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Inflammation
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Pain
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Distention
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Motility and ileus
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Endotoxemia
Hydration
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Decrease in hydration status decreases motility
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Fluid circulation shifts from gut
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Colonic fluid used to increase circulating volume
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With impactions ingesta becomes dehydrated
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Ongoing losses need to be accounted for
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Especially important in ileus
Fluid therapy
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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
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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
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Osmotic cathartic
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1g/kg SID or BID
o
CRI
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1-2 L/hr
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More rapid rate can make them colicky
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Set-up
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Used 5 L fluid bags
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Large IV Set
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Small bore NG tube (foal)
o
Intermittent boluses
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2-3 L Q2-3hrs
Crystalloids
• Importance:
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Maintain cardiovascular status
o
Maintain electrolyte balance
o Horses may have ongoing losses of fluids due to:
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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
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Replace as 10-20 L bolus
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Maintenance – 2 ml/kg/hr
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Calculate % dehydration (% dehydration X bwt in kg = L of replacement) and ongoing losses (amount lost in reflux or diarrhea)
• Monitor hydration: avoid over-hydration
