Term
| What is the daily water requirement for a 500kg horse? |
|
Definition
50-75 ml/kg/day
(25 L or 6 gallons a day) |
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Term
| How does increased protein in the diet effect hydration and water use? |
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Definition
| Increased protein = increased urine output. |
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Term
| What effect does fiber have on water use and hydration? |
|
Definition
| increased fiber = increase fecal water output |
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Term
| What effect does calcium have on water use and hydration? |
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Definition
| Increased calcium = increase urine output |
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Term
| What are the three most common ways horses loose their water? |
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Definition
Gastrointestinal loss (diarrhea)
Exercise
ambient weather conditions |
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Term
| In intracellular fluid, which ion has the highest concentration: K+, Na+ Cl-? |
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Definition
K+ is in the highest amount
(then Na+, then Cl- being the least) |
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Term
| In extracellular fluid, which ion has the greatest concentration: K+, Na+, Cl-? |
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Definition
Na+ has the greatest concentration
then Cl-
and K+ is in the lowest concentration |
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Term
| What are the relative concentrations of Na+ and K+ in hay? |
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Definition
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Term
| What causes hypokalemia during fluid therapy? |
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Definition
| When crystalloids are administered they are similar to plasma concentrations (high Na, Low K), but the urine output is increased, giving you an increased net loss of K+. If the animal is anorexic, K+ will continued to be lost in the urine without being replaced in the diet. |
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Term
| How is calcium excreted from the body? |
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Definition
| in the form of calcium carbonate crystals in the urine (which give the urine a turbid coloration) |
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Term
| When you suspect dehydration which lab test should you preform? |
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Definition
CBC - TP, CVT to check for hemoconcentration
Blood urea nitrogen
Creatinine
Lactate
Urinalysis and specific gravity |
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Term
| As dehydration percentage increases, heart rate: increases or decreases? |
|
Definition
Increases
IN horses that are 12% dehydrated you might find HR of 100bpm+ |
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Term
| What electrolyte abnormalities would you expect to find in a horse that is undergoing long term use of Crystalloid fluid therapy? |
|
Definition
Hypernatermia
HYPOkalemia
Hypomagnesemia
Hypocalcemia |
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Term
| Why should lactated ringer solution be avoided in liver disease? |
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Definition
| The liver is unable to metabolize lactate when diseased. |
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Term
| What are the effects of Lactated ringers solution? |
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Definition
>high sodium, low potassium
alkalinizing agent |
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Term
| What are some complications that can occur with administration of lactated ringers solution? |
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Definition
Lactic acidosis - when poor perfusion of tissues occurs
Liver disease - unable to metabolize lactate
Long term - hypernatermic, hypokalemia, hypomagnesemia, hypocalcemia |
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Term
| What are the relative concentrations of ions found in lactated ringers solution? |
|
Definition
High Sodium
low potassium
low calcium |
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Term
| What is the difference between Normosol and lactated ringer solution? |
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Definition
Normosol contains magnesium instead of calcium (no maintenance of calcium or potassium)
normosol metabolized by muscle |
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Term
| When would Dextrose 5% be used for fluid therapy? |
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Definition
| To replace water loss only and no loss of electrolytes |
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Term
| What are the side effects when large amounts of Dextrose 5% are given ? |
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Definition
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Term
Which of the following is not true regarding 0.9% saline solutions in fluid therapy?
A) typically used for initial fluid resuscitation
B) Chloride higher than plasma
C) drives hyperchloremic metabolic acidosis
D) Used in cases of hyperkalemia (like a ruptured bladder) |
|
Definition
Answer: A) is false
0.9% saline is not typically used as an initial fluid resuscitation
the rest are correct |
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Term
| What is the primary use of 0.9% Saline in fluid therapy? |
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Definition
Used to Treat Hyperkalemia
examples: ruptured bladder, renal failure, hyperkalemic periodic paralysis
Alkalosis treatment |
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Term
| What type of fluids would have a concentration of Cl- closest to plasma? |
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Definition
ringers solution (plasma= 102-114, LRS= 109)
Normosol has LESS CHLORIDE
Saline 0.9% has MORE CHLORIDE |
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Term
| Which of the following provides Calcium closest to maintaining normal plasma concentration levels: LRS, Saline 0.09%, Normosol? |
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Definition
None of the above even come close - normal is 10.6-12.8
LRS is the only one that even contains any calcium but it is only around 3 |
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Term
| Which of the following provides Magnesium closest to maintaining normal plasma concentration levels: LRS, Saline 0.09%, Normosol? |
|
Definition
Answer: Normosol
the others do not have any magnesium in them |
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Term
| Which of the following provides Potassium closest to maintaining normal plasma concentration levels: LRS, Saline 0.09%, Normosol? |
|
Definition
normal plasma = 2.7-4.8
LRS - 4 (closest)
Normosol - 5 (close)
Saline - 0 (none) |
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Term
| What is the equation for calculating Bicarbonate mEq? |
|
Definition
| Base deficit X bwt (kg) X 0.5 |
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Term
| Sodium bicarbonate should not be administered with what other types of fluids? |
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Definition
| Do not give with calcium containing fluids (ie. LRS) |
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Term
| What are the uses of sodium bicarbonate fluids? |
|
Definition
Correcting acid/base abnormalities
Treating acute metabolic acidosis
only when serum bicarbonate <15 mEq/L |
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Term
| 1 gram of NaHCO3 = how many mEq of Na+ & HCO3- ? |
|
Definition
| 1gm NaHCO3 = 12 mEq Na+ & HOC3- |
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Term
| What action does hypertonic saline solution have in the blood? |
|
Definition
It has 8 times the tonicity of plasma and will pull fluid from the interstitium into the vasculature
This expands the ECF by 2-3 times teh volume given!! |
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Term
| What is the appropriate dosing of hypertonic saline solution? |
|
Definition
2-4 ml/kg
****Give large amount of fluids before and after administration**** |
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Term
| What is the action of colloids in fluid therapy? |
|
Definition
Exert oncotic pressure to slow redistribution of fluids in ECF
*can cause increased bleeding times* |
|
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Term
| What are the natural and synthetic colloids available? |
|
Definition
| Plasma, hetastarch, albumin, dextran 40 |
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Term
| What is the appropriate dosing of Colloids? |
|
Definition
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Term
| When would fluid additives be used? |
|
Definition
When fluid therapy extends past 24-48 hours,
in critical patients that are anorexic, experiencing large electrolyte losses |
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Term
| How much 23% calcium gluconate would be added to compensate for Ca deficit to a 5L bag of lactated ringers solution? |
|
Definition
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|
Term
| How much potassium can be added per liter of lactated ringers solution? |
|
Definition
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Term
| Which type of catheter could be kept in longer: Teflon or Polyurethane? |
|
Definition
Polyurethane (2-3 weeks)
where teflon, although most common is only 2-3 days |
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Term
| What are the primary sites for placement of IV catheters in horses? |
|
Definition
JUGULAR VEIN
lateral thoracic vein
cephalic vein
saphenous vein |
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Term
| What are the advantages and disadvantages of eternal fluid administration? |
|
Definition
Advantages:
Cheap
Can give larger volumes of fluid
stimulates intestinal motility
Disadvantages:
Requires repeat nasogastric intubation
labor intensive
*gastric reflux* |
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Term
| What conditions would allow for enternal fluid administration? |
|
Definition
horse with mild-moderate dehydration
functioning GI tract |
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Term
| How do you measure total fluid replacement? |
|
Definition
In case you forgot from a few days ago...
calculate dehydration (% X BW) +
Maintenance (BW X 60ml/kg) +
ongoing loss |
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Term
| What are the structures within the corium ? |
|
Definition
Vasculature
Nerves
papillae
*connects the basement membrane of derma-epidermal junction to periosteum |
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Term
| What is the growth rate of laminar epithelial cells? How long does it take them to reach the ground? |
|
Definition
cell division every 8 hours
epidermal cell to ground = 8-12 months |
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Term
| What controls the remodeling of the hoof? |
|
Definition
Metalloproteases!
Bonds are constantly being broken and formed to move the cells towards the ground
Constant balance |
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Term
| Epidermal cells of the hoof are constantly dividing making them easily effected by infections and other changes. True or False? |
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Definition
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Term
| Where does laminitis originate from within the hoof? |
|
Definition
Bone (corium/dermal lamellae) and Hoof (epidermal lamellae) junction
*lamellar basement membrane * |
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Term
| What is the pathophysiology of laminitis? |
|
Definition
Disruption of supportive apparatus
*lamellar basement membrane*
crushing of arteries, veins and nerves
ischemia
edema
neuritis |
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Term
| What is the theory of inflammation in laminitis? |
|
Definition
White blood cell activation
inflammatory mediators released
SIRS and MODS
(systemic inflammatory response syndrome & multiple organ dysfunction)
Septicemia |
|
|
Term
| What is the vascular theory in the pathogenesis of laminitis? |
|
Definition
| Blood flow disrupted - toxins, endothelin and platelet aggregation, dermal/epidermal necrosis |
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Term
| What is the enzymatic theory of laminitis? |
|
Definition
Toxin exposure-> injury and activation of epithelial cells (laminae) -> release epithelial MMPs -> continued lamellar injury
2) Toxin exposure -> increased blood flow -> WBC MMPs (metalloproteases) -> cytokines released -> TNF, ILs, free radicals -> continued lamellar injury |
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Term
| What are the three main contributing factors that contribute to laminitis? |
|
Definition
Inflammatory
Metabolic (enzymatic)
Vascular |
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Term
| What factors can trigger laminitis? |
|
Definition
Colitis (endotoxemia, carb overload)
MEtritis/retained placenta
Abdominal/thoracic infection
Endocrinopathy (cushings, insulin resistance)
Concussive forces
Supporting limb laminitis
Black walnut toxicity
S. bovis |
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Term
| What is the reason that metabolic stress, Cushings disease, and insulin resistance can cause laminitis? |
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Definition
They cause lamellar glucose starvation.
Hemidesmosomes adhere the epidermal lamella to the basement membrane and they are VERY dependent on glucose. Without glucose the hemidesmosomes release. |
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|
Term
Which is most commonly affected by laminitis:
A) Rear feet
B) front feet
C) All 4 feet
D) Only 1 foot |
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Definition
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|
Term
Irreversible changes have likely occurred by the time a horse starts showing clinical signs of laminitis.
True or False? |
|
Definition
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|
Term
Which of the following is not a sign of acute laminitis?
A) Tachycardia
B) Muscle tremors
C) Rotation
D) Sole pain |
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Definition
| Answer: C) rotation occurs in chronic laminitis |
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Term
| Where does the sum of the mechanical forces on the hoof direct towards? |
|
Definition
Down and back
caudo-plantar |
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|
Term
| What is the definition of rotation in regards to laminitis? |
|
Definition
| loss of parallel alignment of hoof wall and dorsal surface of coffin bone |
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Term
|
Definition
Displacement of the coffin bone towards the sole
*palable depression at coronary band* |
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Term
| What are some physical presentations of chronic laminitis? |
|
Definition
- convex sole in front of frog apex
- divergent growth rings
- flattened sole with widening white line
- WHITE LINE (soft, granular, "seedy toe, susceptible to infection) |
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|
Term
| How do you diagnose chronic laminitis? |
|
Definition
| Clinical signs + RADIOGRAPHIC evidence |
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Term
| What is the treatment for laminitis? |
|
Definition
*treat primary disorder - toxin binding, abx, anti-inflammatories, cryotherapy, fluids
- stabilize forces
- DMSO (free radical scavenger - questionable use) |
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Term
| What is the most effective area of local anesthesia when diagnosing and correcting laminitis? |
|
Definition
ABAXIAL SESAMOID
(palmar digital missed the dorsal hoof wall) |
|
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Term
| What last stitch effort can be made to correct rotation if it persists despite initial therapy? |
|
Definition
Deep digital flexor tenotomy (division of tendon)
this removes the rotational force of the DDF
**only if rotation is >10-15 degrees** |
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|
Term
| What factors would indicate worse prognosis of laminitis? |
|
Definition
coffin bone displacement present
>15 degree rotation
Sinking displacement
comlications such as abscesses, osteomyelitis |
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