basicfluidtherapyinhorses：在马的基本液体疗法

《basicfluidtherapyinhorses：在马的基本液体疗法》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、BasicFluidTherapyinHorsesJillMcClure,DVM,MSDiplomateACVIM,ABVPEducationalObjectivesTorecognizeclinicaldehydrationToknowacceptableroutesoffluidadministrationToselectacceptableratesofadministrationToselectappropriatefluidsTorecite‘expected’abnormalitiesforcommondiseasesFl

2、uidtherapyconsiderationsvolume(water)tonicity(osmolality)pH(hydrogenionconcentration)ionconcentration(Na,Cl,K,Ca)Whereisthewater?if500kgbodyweight60%iswaterICFis40%ofb.w.ECFis20%ofb.w.interstitial~75lplasma~25lRecognitionofdehydrationdrymucousmembranessunkeneyeslossofsk

3、inturgormild4-6%2-3secondsmoderate7-10%4-8secondssevere11-12%>8seconds%ofbodyweightlitersofwater‘lost’=bodyweightinkgxest.%dehydrated(500kgx6%=30liters)LaboratoryEvaluationofDehydrationPackedcellvolume(PCV)HemoglobinTotalplasmaproteinBUNPCVandTPPusefultomonitorprogre

4、sspre-existinganemiamaymaskactualincreaseinPCVduetodehydrationlossofproteinmaynotreflectwaterlossHowmuchfluidtogive???500kghorse@8%dehydratedhasa40literdeficit40litersoffluidsareadministereduponre-exam,thehorseisstill8%dehydratedHowcanthisbe??“Snapshot”ofhydrationstatus

5、existingdeficitsmaintenanceneedscontinuinglossesHowcanthisbe?PatientisanorexicandnottakinginwaterPatienthascontinuinglosses(e.g.diarrhea,profusesweating)WhatroutesshouldIuse?IVSubcutaneousPOIPHowfastshouldIgivefluids?3-12ml/lb/hr(6-25ml/kg/hr)3-12liters/hrinadults1liter

6、/hrmaintenanceWhatkindoffluidstouse?baseonactualmeasurementofelectrolytesandbloodgasesmakean“educatedguess”Whatchoicesoffluids?balancedpolyionicisotonicwateralkalinizingacidifyingWhichfluidshouldIchoose?Ifnolaboratory,chosebalancedpolyionic“New”Acid-BaseRespiratorypCO2N

7、on-respiratorywaterstrongionsmeasured(Na,Cl)unmeasuredproteinAcid-BaseRegulationUsingthe‘new’acid-baseFreewater0.3([Na]-140)=________Chloride102-([Cl]x140/[Na]=________Protein3(6.5-[Prot])=________Unidentifiedanions=______________TotalobservedBaseExcess=________Usingthe

8、‘new’acid-baseFreewater0.3([Na]-140)=________normal[Na]-noeffectdilution(low[Na])resultsinacidosisconcentratio