Fluid therapy in small ruminants (Proceedings)

Basics

Catheters

Adult sheep/goats/llamas/alpacas and crias: 16 G 3.25" in jugular

Kids/lambs: 18G 2" in jugular

Intraosseous in neonates if can't get catheter in

Always make stab incision completely through skin with #15 blade, will save time and catheters

Dehydration deficit

BW(kg) x %dehydration = deficit in liters (careful with small ruminants)

ex. 40 goat that 8% dehydrated needs 40 x .08 = 3.2 L

Maintenance

1 ml/lb/hr

Bicarb deficit

Neonate: BW(kg) x base deficit x .6 = mEq bicarb

Adult: BW(kg) x base deficit x .3 = mEq bicarb

Can substitute (normal bicarb - measured bicarb) for BD

mEq bicarb/12 = grams bicarb

Lambs and Kids

Following dystocia

(may look normal initially, but crash 2-4 hours later, be aggressive in therapy)

If depressed: Measure bicarb and correct deficit or use BD of 10

Consider SoluDelta-Dortef (1 mg/lb)

Consider oxygen even if no respiratory difficulty and normal color

Dehydrated non-diarrheic (septic, hasn't nursed, etc.):

May be hypoglycemic

If < 8 % dehydrated, mild depression, still walking:

150-250 mls oral calf electrolytes without bicarb

If > 8% dehydrated, depressed, recumbent:

Correct fluid deficit with balanced electrolyte solution

Add: 20 mEq KCl/L and 20-40 mls 50% dextrose/L (will = 1-2% dextrose in solution)

OR

4 ml/kg hypertonic saline solution (administer over 5 min) followed by oral calf electrolytes without bicarb

• if no response consider acidosis and treat like dystocia above

• may need more glucose if severe hypoglycemia

• follow up with milk

Diarrhea:

dehydrated, acidotic, hyperkalemic, whole body depleted in K+ (not usually hypoglycemic)

For deficit:

If < 8 % dehydrated, mild depression, still walking:

150-250 mls calf electrolytes without bicarb (if available, if not use with bicarb)

If > 8% dehydrated, depressed, recumbent:

bicarb: calculate bicarb needs if blood work available or use BD of 10

8% bicarb = 1 mEq/ml

fluid: make up fluid deficit with balanced electrolyte solution

add: 20 mEq KCl/L and 20-40 mls 50% dextrose/L (will = 1-2% dextrose in solution)

give half first hour then other half over 2 hours

OR

4 ml/kg hypertonic saline solution (administer over 5 min) followed by oral calf electrolytes with bicarb

(do not use HSS if suspect mixing error of oral electrolytes administered by owner)

• follow up with oral calf electrolytes without bicarb (if available, if not use with bicarb) per day as long as severe diarrhea continues

• leave on milk or milk/milk replacer unless chronic diarrhea and use of TPN

• always mix electrolytes according to directions with water, not milk

• always refrigerate calf electrolytes that go unused and discard after 3 days

Adults

usually alkalotic, mild hypokalemia, mild hypocalcemia

If < 8 % dehydrated, mild depression, still walking:

correct deficit with oral fluids unless rumen disease or GI obstruction

can add KCL and calcium gel to oral fluids

If > 8% dehydrated, depressed, recumbent:

IV isotonic fluids with 20 mEq KCl/L and calcium solution at 25-50 ml/L

OR

• 4 ml/kg hypertonic saline solution (~ 2 L per adult cow) administer as fast as possible through 14 G catheter

• follow with oral fluids (will usually drink following HSS) if no GI disease or IV if GI disease

If grain overload:

• calculate bicarb deficit if blood work available or use BD of 10 and administer IV

• follow up with IV fluids (do not give large amounts of oral fluids, already have rumen distension)

• can give some bicarb orally but probably no use if severe (need rumenotomy)

• DO NOT USE hypertonic saline solution (may be already hyperosmolar)

Llamas/Alpacas

• unpredictable electrolyte and acid/base status so always run bloodwork, esp. in crias

• adults get fatty liver commonly when off feed so consider PPN if anorexic for more than a few days

• camelids get hypoproteinemic easily

TPN/PPN

• use formula in back of Smith Large Animal Internal Medicine

• for neonates use TPN

• for adults use PPN since fatty liver is a concern if negative energy balance (just leave out lipids in formula)

• start at 1/4 target rate (in Smith under formula), if glucose 150-200 in six hours leave at current rate, if > 200, slow rate slightly, if < 150, increase rate by another 1/4 (these are basic rules, try not to change rate drastically and give them time for insulin to increase

• keep increasing until get to target rate (I have never gotten to target rate, but always see benefits even at low rate)

• monitor glucose/PCV/TP q 6 hours, electrolytes/acid/base status daily (watch out for hypokalemia)

• wean off slowly

• MUST BE administered with fluid pump

OR

• for adults

• 5L normosol + 500 ml 50% Dextrose + 1 Liter Aminosyn + K and Ca as needed + 20 ml B vitamins at rate of 5% body weight per day

Insulin is recommended in camelids with TPN or above fluid regimen (0.4 u/kg ultralente SQ q24hrs). Stop insulin 24 hours before stopping fluids.

Tips

If on continuous fluids consider bolusing q 3 hours. (have better control of rate in animals with long necks and thick skin that cause kinking of catheters)

NOT appropriate if glucose content is > 2% or for PPN/TPN

• 1 level teaspoon is approximately 5 grams of most salts

• NaHCO3: 1 gm = 12 mEq so 240 mEq = 20 grams or ~ 4 tsp.

• Isotonic saline: 9gms/L non-iodized table salt,

• 2 tsp NaCl/L water is isotonic saline

• Supplement potassium:10-20mEq/L or 1gm/L(14mEq/L)

• half a tsp. lite salt/L water (lite salt is half sodium chloride and half potassium chloride)