FLUID THERAPY & ROUTE OF ADMINISTRATION OF DRUGS IN ANIMALS

FLUID THERAPY & ROUTE OF ADMINISTRATION OF DRUGS IN ANIMALS

Definition of Route of medication- It is the way by which a drug/fluid/poison/other substances are administered to body through Tropical( over the body surface)/Sub-mucosal/Intra-dermal/Intra Muscular/Intra venous/Intra-arterial/sub-lingual/intra-synovial/intra-cardial/per-rectal/intra Ruminal/intra-abdominal  etc. for different proposes like healing( surface wounds),cure( body recovery from disease),palatable ( just sustain life for more few days)therapy, preserve the cadaver( extracting blood from Artery & injecting preservatives through Artery(as heart is not functioning-so not through vein)

Definition of Drugs- ( taken from French word means “dry hurb”)A medicine or other substance ( except food) which has a physiological effect when ingested or otherwise introduced to body to prevent ,diagnose, treat, relieve symptoms of a disease or abnormal condition ,even for painless death (euthanasia) including change of mood, awareness, thoughts ,feelings ,behaviour  etc.

Definition of abuse of Drugs– The use of illegal drugs( non-medical purpose) or without prescription, over the counter drugs for the purpose they are meant to be used or excessive amount of drug intake etc.

Drugs administered for better effect–

1-Cycling-At regular interval

2-Stacking-combines other medication for maximum effect

3-Pyramiding-Initialy gradual increasing to a maximum point then reducing

4-Tappering-Gradually reducing the dose of medication

Routes of Drugs Administered-

1-Tropical/cutaneous route- Ointment(), liniment(rubbing on body) ,powder, crystals, sprays , Gel, cream, shampoo  etc.

2- a-Oral-Electuary(Honey/sweet mixed medicine), Bolos, Tablets( enteric coated or plane),granules, Suspensions, liquid( syrup/elixirs), capsules etc.

  b-Buccal route- in between cheek & gum- Hydrocortisone tab –for Mouth ulcer/prochlorperazine maleate/chewing gum

3-Intra-Nasal(Inhale/pulmonary route)-Spray, Nasal drop- Nasovion-S. Otrivin-S ,inhaler(inhalade), nebuliser(oxygen therapy through inhalation)

4- Intra-Ocular (eye)—i-Tropical-  Eye drops-Pataday-once daily/Systane/moxi Grev-K/moxifloxacin/Brixmox-KT/eye ointments—Chlormphenicol(Aplicab),Prednisolone acetate (Predsol), Moxi+ Prednisolone(apdrops), /pupil dilator  drop-2 drops-(Tropicamide/dilation eye drop)

ii-Inside eye ball

5- Intra-Aural-(otic) Ear drop(Ciplox/Zenflox)

6-Sub-Cutaneous- (Angel 45=if grasp 2 inch of skin & Angel 90 =if grasp 1 inch of skin

7- Sub-Lingual (Ugesic)- Tab( no residue but dissolves within 4-8 minutes)—(should not be chewed or swallowed)-piroxicam(Feldane/Aloxicam/amida/axicam)—NSAID-10 mg/20 mg ) –at sub-lingual relieves pain/Also keep water ice cubes at sub-lingual reduces temperature during heat stroke/Nitro-glycerine tab(nitro stat)-used in –  angina (glycerine tri nitrate SL tab or spray) @ 1 tab at 5 minutes interval for maximum of 3 doses,captopril(diuretic),nifedipine,prazosin /ondansetron tab–anti emetic / Ergotamin(regomar)_ tab-

—Tongue colour vs disease-

a- Light Pink–Normal

b-Black—hair presence/drug side effect/tobacco use/Radiation therapy/dark liquid medication/DM2 ( rare)

c-White-Fungal, Luko-plakia-smoker patches ( below or above tonugue)

d-Purple–poor blood circulation, Kawasaki Disease may also red some times( in children)-fever, COVID,

e- Red–( may be red spot)_Vit-B deficiency, High fevaer, Allergy reaction

f- Grey—( scaling)- Eczema,Oral unhygiene

g-Yellow– ( may be yellow patch)-jundice ,bacterial infection,DM2

h-Orange–Food poisonng,AB side effect, poor Oral unhygienic

i-Green- –Bacterial infection, Fungal, poor hygiene

j-Blue—Lack of O-2 in Blood/may death within 15 minutes- snake bite/poison/

**BLUE TONGUE DISESE (Malarial catarrhal fever)IN SHEEP– (By Blue tong Virus-BTV- through midges/ Tick(Culicoidis sonorensis) bite & mosquito-in Ruminants including Sheep—it is notifiable disease in UK

Symptoms-Vit-B—2 deficiency, non–contagious ,Fever(41.5 C=107 F), haemorrhage of nose & mouth( cause blue colour), profuse- (salivation, nasal discharge, diarrhoea within 3-5 days)swelling/eruptions of-( lips, tongue, jaw, dental pad), lameness ( inflammation of coronary band above hoof), weakness, pneumonia(pulmonary oedema), mortality=2-90 % within 7-9 days, dyspnoea, milk drop, feed in kneeling posture,

Treatment- Attenuated & inactivated quadrivalanet Vaccine, Tick repellent, tic side drug ,ecto parasite treatment ,symptomatic treatment ( as it is a viral diseases),green succulent fodder, salt lick, isolation, Antiseptic bath

{Blue Gray Calf-offspring of Galloway Bovine breed//Blue Nose-discoloration of muzzle & nose of Horse by eating some plant//Blue Comb-in birds//Blue –Green-Algae//Blue Ear-Pig- Swine reproductive respiratory disease-agent –Lelystad -airborne- Cyanosis of extremities, ear, premature farrowing, abortion, neo-natal death(88%), }

8- Intra-Dermal- below epidermis-(5-15degree)-generally -0.5 ml of injection-ex-TB test –

9-Epi-Dural( intra spinal-epidural)- lower abdominal area but not hind leg motor nerve(so can be kept standing if motor nerve of hind leg affected then ataxia & decumbency)-( 17-18 gauze needle with 3.5 to 6 inch long-(15 to mid line)- Usually epidural-anaesthesia( with pup sound) at L2 Vertebrae in others at inter Coccygeal space of  S5-Co-1 or Co 1-2 in cattle/buffalo/camel(Drug–.o22-0.5 mg/kg  or  bupivacaine—0.125 mg/kg  or ropivacine-0.11 mg/kg  or xylazine(Alpha-2 agonist)-0.05 mg/kg/ketamin-0.3 -2.5 mg-{it can be given at L6-S1)/kg/tramadol-1mg/kg  -. In Median or para-median approach-after passing of ligamentum flavum the free flow of anaesthesia takes place. Local anaesthesia ( Lignocane HCl( lidocane/Xylocaine-2%/chloroprocane/bupivacane below skin)-1%  may relieve pain of pushing injection and also syringe with 0.2 ml Air or NSS is beneficial to widen the intra-vertebral space  for easy passage of Epidural Anaesthesia(Xylocaine -2% commonly used)./Epidural steroids injection– also given-for pain relieve ( usually in LIC settlement as very much costly)

-Also Xylocaine 2% is used in catheters before introducing to relieve pain/also gels at teeth or locally.

-{{I/V anaesthesia- propofol/etomidate/ketamine)}

-MgSO4-can be used s anaesthetics with 2% lidocane +10% MgSO4 (act as Cacium antagonist-so during Calboral administrative shock can be prevented by 10% unsaturated MgSo4 –S/C -10 100ml

-Anaesthesia in use KX( Ketamin-Anaesthetics–@ 5-16 mg/kg+ Xylazine-muscle relaxant–100-200 mg/kg

10- (a)Intra Cardial ( inject at apex of Left Ventricle) in Cardiac arrest-Adrenalin (Epinephrine) is given as in heart failure there is no blood circulation so starts CPR after injection.

(b)- Intra osseous-at ephyphisis of long  bone area through long needle ( not at synovial joint site)-Adrenalin in cardiac arrest and also fluid therapy during hypovolumic of body fluid condition.

(c)-Intubation(endo tracheal tube)-to lungs in cardiac arrest –Adrenalin is given

11- Sub-Mucosal-(30-45)-Drugs as per specification

12-Intr-Muscular-(45=if less sub-cutaneous tissue & 90 =if more subcutaneous tissue)- Drugs in form of injection

13- Intra-venous-(<45-generally 25 )-IV Push(rapid one time push  time)/IV Infusion(slow drip)- Fluids/Drugs etc.

14-Intra –Arterial-(25)– Embalming-Preservatives are injected intra-arterially to cadavers after extracting blood for long time preservation usually when owner/relatives are in foreign & requires time for arrival. Rigor continues up to  from 24 hr to 72 hours after death but can be preserved under A/C for 7-10  days.

15- Intra-cardial-(30-45)- Adrenalin injection directly to apex of Left Ventricle during cardiac stroke.

16- Per-Rectal- Laxatives– like Sodium phosphate enema/ defecation softener-oil/ Saline when Vesicular injection response is poor as Rectum is the best site for absorption

17-Intra Ruminal-(90)-AH( anti histamine+AB( Oxytetracyclin is also  Ruminal protozoa friendly)-in Tympani . Also dewormer of solution or bolos from .

18-Per-Vaginal- Bolos( sulpha/stecline etc.)/ solutions of Povidine Iodine/spirit acriflavin/other AB for metrites treatment /Die infusion for testing patency of Oviduct/pessaries/creams/vaginal rings

19-Intra-abdominal-(90)-AB+AH in peritonitis or fluid extraction in Ascities

20-Intra-Testicular( intra-epididymal0- (90 )- injection to Rete testes-Zeuterine injection-/ intra-epididymus for sterilisation in male dog(>3 months of age) & Cat after 2 months of treatment- Calcium chloride ( 20% CaCl-2 with 0.5 % Dimethyl sulphoxide @ 10-20 mg/kg BW or 0.25 ml  with chlorohexidine antibiotic application over tsetse before injection)/Zinc gluconate(Neuter sol/Esterilsol/Infertile)(13.1 mg/ml of NSS/ @ 0.2  to 1 ml as per size of tsetse – normal sperm count=10x 10 to the power 6 / ml of semen –in all species( dog/Cattle)- ( In Male &  female dog S/C implant of  Desolorelin ( 5 mg Suprelorin implant below skin)-GnRH agonist( suppress Pituitary function , so cease production of gametes-sperm & ovum) –may reveal 1^st oestrus but there after no oestrous.

21-Intra-Sinivial-(intra-joint)–somemedications(Anti-inflammatory/steroids/Oestrogen Hormone/lubricants/AB etc. )

22- Intra-Amniotic-(some Hormone/medication/growth factor/Blood Group antigen/fluid extract for different examinations  etc)

23-Nerve Blocks– Different sites for different Nerve Block

24-Intra-Coccygeal-( Epidural in Tailed animals)

25-Sub-Acrchnoid – Anaesthesia & others in cranial surgery.

Fluid Therapy– ( I/V infusion  or S/C or Intra-rectal)- Right selection of type of fluid, dose(amount) & time  is important)-Improper selection may result peripheral,/pulmonary /Brain oedema)

–Osmomolality-Osmotic pressure generated by a solution—mainly Sodium ion(present in extra-cellular fluid) – (in Miliosmoles per Kg of H2O), opposes moment of water across a membrane( cell membrane)

—Tonicity—Ability of the solution to move  water across the cell membrane depends on Osmomolality of solution rather than the intercellular Osmomolality called tonicity.

—Colloid Osmotic Pressure-(COP)/Oncotic pressure-Proteins are the only dissolved substance in Plasma & interstitial fluids that do not cross the capillary ( blood vessel capillary)membrane & responsible for osmotic pressure of capillary membrane called COP/Oncotic Pressure.

Osmotic-( Iso-tonic Fluid)— where solute( Na or Glucose) determines the Osmomolality & tonicity of solvent (water) amount in a solution(ex- RL/NSS-0.9% Na) So, used in  rapid infusion considering dehydration degree or in combination with drugs or other fluids  for maintainace of extra cellular fluid volume with electrolyte balance.

Hyper tonic Fluid— where solute( Na or Glucose) amount is more than solvent (water) amount in a solution(ex-5%D/ 10% D)-here solute draws/brings water into blood vessels. So, used in  rapid infusion considering dehydration degree or in combination with drugs or other fluids  for maintainace of fluid volume @ 50% of Na ( some times K also) level in Plasma concentration. Ex-Burn/severe dehydration etc .It should be avoided in interstitial dehydration.

 Hypotonic Fluid—-where solute amount is less than solvent (water) amount in a solution(ex-5% DNS)-here solute is completely metabolised then water is distributed uniformly in all fluid compartments. So, used in  slow infusion considering dehydration degree or in combination with drugs or other fluids  for maintainace of fluid volume.

Crystalloid Fluid— Are Fluids  having water base solution  with small molecules (micro)that are permeable through Capillary membrane of Blood Vessels  that  replace & maintains extra cellular volume (in normal animal/human if given I/V then diffuse to extra vascular space within 1 hour)

Colloid Fluid- Are Fluids  having crystalloid solution  with large molecules( macro) that are not easily permeable through Capillary membrane of Blood Vessels. Used as intra-vascular replacing fluid volume. Ex-Plasma therapy/ whole Blood infusion/Albumin( dextra-70/25% albumin/oxyglobin)/Starch therapy(Hydroxy ethyl startches-hetastarch/pentastarch)

a–Natural colloids— Naturally available in the Body fluid—ex-Albumin/RBC/Ant thrombin/coagulative protein etc.

i-25% Albumin fluid available or numan which is also used in animals(D/C) for hypoalbuminemic cases of Oedema/burn etc.

ii-RBC therapy- used after cross-match- Use within 6 hours with measurement of serum calcium level, if more blood content is administered then may cause dilution of coagulopathy.

iii-Whole blood transfusion- used after cross-match-In Cattle- blood loss,Theileria where Hb level is < 6 mg/dl. In Dogs if urgency then inject the dog with Dog Erythrocyte Antigen( DEA) before blood transfusion.

b-Synthetic colloids— Synthesized in laboratory —-used with Whole blood or plasma when natural colloids are insufficient–ex-dextra-70/25%/Starch therapy(Hydroxy ethyl startches-hetastarch/pentastarch)

Haemoglobin based oxygen carriers (HbOC)-ex-Oxy Hb- Increase O2 saturation in Pulmonary capillary-@ 30ml/Kg/hour with 40 mm of Hg of PO2(Oxygen Pressure inside Lungs) with monitoring of volume overload.

Fluid Selection for Treatment–

1-NSS(extra cellular)=Na+Cl==—isotonic-308 osmomolality(mOsom/L)—no buffer-Hyperkalemea(I^K)/Hypochloremea( decrease Cl)/alkalosis—

2-RL-(extra cellular==Na+Cl+K+Ca+Lactate== isotonic-275—lactate buffer-Initial stage of treatment but not with citrate containing fluids or as maintainace volume

3-Pasmalyte-A—(extracellular)- isotonic-294- Na+Cl+K+Mg+Acetate/gluconate–

4-Normosol-R-extracellular- isotonic-295- Na+Cl+K+Mg+Acetate/gluconate

5-5-D( 5% Dextrose)—intracellular—hypotonic-252—Dextrose-no buffer-maintainace volume or carrier dose for constant required infusion

6-3%  free Amine –iii(3% amino acd solution)== extracellular– Na+Cl+K+Mg+Acetate/gluconate—partial anorexic condition

7-Whole Blood(fresh/stored)—contains RBC+albumin+fibrinogen+globulin+alpha macroglobulin+coagulative protein+ clotting factor F- 5 & 7+ Platelets – platelets present only in fresh blood- (but platelets absent in stored blood)—intravascular—isotonic-300– Na+Cl+K+Dextrose-0.4%–no buffer—anaemia, blood loss due to injury, <Hb6% ( Theileria), Thalesemia in human, Sickle shape anaemia in human etc.

8-Plasma( fresh/frozen)—contains–albumin+fibrinogen+globulin+alpha macroglobulin+coagulative protein+antithrombin+ clotting factor F- 5 & 7-(clotting F-5 & 7 present in fresh plasma but  absent in frozen plasma)— —intravascular- isotonic-300– Na+K+Dextrose-0.4%–no buffer—

9-25% Albumin—–intravascular– isotonic-300– Na+K–no buffer—used for hypovolumic, oedematous conditions

10- 6% Hetastarch—Half life 25 hours—–intravascular– isotonic-310— Na+Cl–no buffer—I ^  plasma amylase & coagulating time—

11- 10% pentastarch–intravascular- Half life 2.5 hours – isotonic-326– Na+Cl–no buffer– I ^  plasma amylase & coagulating time

12-Dextron-70—intravascular– Half life 25 hours– isotonic-310– Na+ Cl–no buffer— I ^   coagulating time –

13-Haemoglobin blood oxygen carrier—(HBOC)-(stromafree haemoglobin(–ex-Oxyglobin- Half life 30-40  hours – intravascular– isotonic-300– Na+Cl+K+Ca— lactate buffer—Higher dose affect plasma colour ,urine analysis, serum analysis—

14- PCV-(<6% />60%)—administered for  RBC/HBOC requirement—cause hyperviscoicity—used  in haemodilation case-

15- Total Protein( <5/>9 gm/dl)– administered with Hetastarch for maintainace  requirement—

16- Glucose( <60—with 5% Dextrose/>400 mg/dl)—slow infusion to avoid cerebral oedema & decrease plasma Osmomolality—

17-Sodium(< 130/>175 mEq/L)—use in small amount with NSS for maintain volume

18- Potassium (< 2/2-5.5/>8/>175 mEq/L)-à8% in case of oligo urine with NSS/<2 in respiratory muscle fatigue for volume maintain/2-5.5 for maintain volume

19-Total Ca(>13 mg/dl)—use with NSS for calciuresis

20-Bicarbonate –for pH balance—metabolic alkalosis if patient is Hypochloremea( decrease Cl) wityh NSS  // –metabolic acidosis if acidosis( carbohydrate engorgement in Bovines)

21-Calcium borogluconate –described in Hypocalcaemia

22-Mifex-described in Hypomagnesaemia

23- Haemacil- described in hypothermia

RESUSCITATION-(revive from fluid loss)-

• Perfusion(infusion through blood vessels)_–

Indication-,Hypovolumic, Low BP, Rectal temperature pale mm, dehydration, low pulse rate,

Treatment-

• Crystalloid-( contains no protein)-Rapid infusion- through I/V or Intra osseous rote—amount of fluid infusion depends on PCV ,total protein, serum glucose, Na, K, Ca, etc.—controlled infusion required as rapid infusion cause extracellular fluid accumulation( oedema)-crystalloids(NSS/RL/Plasma-A etc. followed slow infusion of D-5/D-10 as maintainace volume is infused without colloids(Albumin-Dextran-70, Starch solution-Hetastarch/pentastarch, 25% albumin, Oxyglobin whole blood, plasma etc..)—

b-Crystalloid with Colloid(colloids contain plasma protein) ( usually in 50:50 ratio)—slow infusion-requires less volume with quick achieving resuscitation,–usually larger size collides(Hetastarch/pentastarch/Stroma free Hb etc.) than pore size of blood vessel is infused to check oedema with rate of infusion of colloid is reduced to nearly 50 %(40-60)

c–Whole blood/PCV– is infused- when <6 .0 Hb%—Whole blood should accompany antithrombin /albumin, Ant clotting Factor etc. if required.

2-Rapid I/V fluid resuscitation-(preferred in Dog but contraindicated in  shock  of Cat)–

Indication-Specifically Hypovolumic due to blood loss-(accident)–,hypovolumic shock due to trauma / non traumatic mal distribution of blood flow etc.

Treatment-1-Whole blood rapid infusion in equal proportion to blood loss followed by Colloids.

3-Small volume  I/V fluid resuscitation—(Hypertensive cats may be given but hypothermic cats block cardio-vascular fuid infusion resuscitation response )

Indication– Hypovolumic due to closed trauma haemorrhage-Closed cranial trauma, pulmonary contusion carcinogenic shock, oligarch renal failure, hypernatremea(I^ Na), hyperglycemias(I^ serum Glucose ),

Treatment—( Aimis to >Rectal temperatre >98 F with 30 minutes of infusion along with external warming –hot fomentation/wrap with cotton( thermo insulated ) cloths etc. to maximise catecholamine receptor response)

1–Crystalloids(10-20 ml/Kg/) with synthetic colloids(3-5 ml/Kg)—If no cardiac diseases– when dose of Dextran-70 or Hetastarch/pentastarch exceed @ 40 ml/Kg/Day in Dog & exceeds @ 20 ml/Kg/Day in Cat but not achieved the resuscitation then in Dog infuse Plasma or Stroma free Hb @ 30 ml/Kg/Day still then if Dog Arterial BP remains <70 mm of Hg then administer with constant rate infusion of Dopamine/Stroma free Hb(if not used earlier infusion) @ 5-15 micro gm/Kg/min for vassopressure effect.

• If I^ of Na, Glucose without any cardiac complications—Crystalloid @ 10-20 ml/Kg with Colloids @ 5-15 ml/Kg
• If Arterial BP is < 60-80 mm of Hg the additional Crystalloid @ 10-20 ml/Kg with Colloids @ 1-5 ml/Kg till Aterial BP is 80-100 mm of Hg

4-Rehydration—Fluid therapy in  I/V, Intra osseous, S/C route preferred

Indication–Fluid deficit in  extra vascular space ( may be intracellular & interstitial area or both)- Sever dehydration leads to perfusion of fluid from intravascular to interstitial area.

Treatment-

• In Acute dehydration–Isotonic crystalloid fluid( RL) or plasma as per requirement @ within 1-4 hours

2-In Chronic dehydration ( lungs/heart/brain)- slow rate resuscitation of Isotonic crystalloid fluid( RL) or plasma as per requirement @  within 4-12 hours

5-End-point resuscitation—quantities of fluid required for specific end point–

Indication—Total fluid with rate of infusion is calculated basing on physical ,haemodynamics,chemistry of parameters for fluid deficit & vital organ function of a patient-

Treatment–

• In hypovolumic & systemic inflammatory response( ex-Parvo in Dog) shock without lungs & brain hampering- Normal fluid therapy with aim to increase oxygen
• In hypovolumic & systemic inflammatory response( ex-Parvo in Dog) shock with involvement of complications of lungs & brain( ex-brain haemorrhage) – Hypotonic fluid therapy with aim to prevent dislodging of clot.

6-Maintainnance —-

Indication—Defecation, renal output, skin pinch response, if urinate during fluid infusion then fluid status is achieved  to discontinue fluid therapy for that time etc.

Treatment—

1-Isotonic Crystalloids @ 40-60 ml/Kg/Day–( RL/Albumin/Glucose etc.) with cardiac complications but hypothermia, hypotension, bradycardia present till Temperature >98F & BP >40 mm of Hg  & if BP not reached at >40 mm of Hg then infuse Hetastarch @ 2-5 ml/Kg

2-  Isotonic Crystalloids @ 10-15 ml/Kg/Day–( RL/Albumin/Glucose etc.) if no cardiac complications but hypothermia, hypotension, bradycardia present till Temperature >98F & BP >40 mm of Hg if BP not reached at >40 mm of Hg then infuse Hetastarch @ 2-5 ml/Kg

Fluid therapy for resuscitation during different Cardiac conditions–

(Normal Range—Heart rate/minute-D-60-120 & C-170-200,mm colour-pink, capillar

• Compensatory shock-

–Isotonic crystalloid –   usually reached End point Resuscitation(EPR) if not then follow

Or—isotonic crystalloid +  colloid—if not then use pain killer

2-Early decompensatory shock–

–Isotonic crystalloid +pain killer—rapidly correct hypothermia –   usually reached End point Resuscitation(EPR) if not then follow

Or—isotonic crystalloid +  colloid +pain killer —if not then use pain killer Dextran-70/Hetastarch/pentastarch( not to dehydrated /Lung/Cardiac complication patients) @ 0.8 ml/Kg/hour

3--Late decompensatory shock–

–Isotonic crystalloid +pain killer—rapidly correct hypothermia –   usually reached End point Resuscitation(EPR) if not then add vasopressin /oxyglobin @ 5 ml/kg/dog up to 30 ml/kg/dog if EPR not achieved then follow

Or—isotonic crystalloid +  colloid +pain killer+7% Dextran-70%/ Hetastarch/pentastarch —if not then use pain killer Dextran-70/Hetastarch/pentastarch( not to dehydrated /Lung/Cardiac complication patients) @ 0.8 ml/Kg/hour constantly

4—Acute Haemorrhage – (PCV<25% & Hb<8% gm/dl)–

–Whole Blood transfusion+ anticoagulants( already smeared in Blood collecting pouch)  

Or— PCV ( RBC infusion)+anticoagulant( already smeared in Blood collecting pouch) + isotonic saline/plasma/Dextran-70 or Hetastarch or pentastarch—if EPR not achieved the Oxyglobin / more red cell transfusion

5-Hypovolumic (pulmonary/head injury/cardiac insufficiency

– Isotonic crystalloid —   usually reached End point Resuscitation(EPR) if not then add isotonic saline/plasma/Dextran-70 or Hetastarch or pentastarch  @ 0.8 ml/kg/hour .

6-Low plasma albumin-( albumin<2 gm/dl)

– Fresh Plasma— till albumin level >2 gm/dl-  usually reached End point Resuscitation(EPR) 

7- Coagulopathy-( low antithrombin with > PT/PTT)

– Fresh Plasma— till albumin level >2 gm/dl with normalisation of clotting time-  usually reached End point Resuscitation(EPR) if frozen plasma the add clotting factor 5 & 7 or natural anticoagulant like heparin if no coagulating factor.

 Types of Fluids-

• Saline–

i-Normal Saline Solution ( NSS)_( 0.9 % Na Cl–neutral)-(100ml/500 ml/1000ml)- dehydration-vomition, diarrhoea, heat stroke. Wound washing, dilution of injection(diluents), Maintain water balance–2000 ml/3000ml –within 24 hour)—as per patient condition( basing on dehydration)—not in hypertension

ii- Ringer’s Lactate( RL)-( mixture of electrolytes-Nacl+KCl+Na-Latate)- 9500-1000ml )   500-1000ml within 24 hours-In ectrolyte imbalance, dehydration, during surgery ( blood loss) Burning, Nutritional deficiency, Hypotension, Not to DM-2 Patients

iii- Dextrose Normal Saline( DNS)-( Allergic to corn also allergic to Dextrose) Dextrose-5%+NSS(500 ml/1000ml)-2500—3000 ml in 24 hour – Dehydration, Hypotension, insulin shock( hypoglycaemia),accidental condition, suitable for DM-2 Patients

iv-D-5/D-10/D-25-Dextrose-5 %/10%/25%/50%—( gm/100ml)—provide extra water & carbohydrate,(100ml/500 ml)—2000-3000 ml within 24 hours —Dehydration/dizziness/hypoglycaemic patient/insulin shock/

v-Haemaccel– ( keep at  <25C) ( @ 500 ml bottle-NaCl-4.25gm+KCl-0.20 gm+CaCl-0.0466 gm+Nitrogen-0.63gm)- 1ml/Kg- 500 ml/1000 ml—for diuretics ,restore normal brain activity, electrolyte imbalance , shock cure, haemorrhage, burns ,peritonitis, pancreatitis, cautiously in DM2/peripheral oedema/hypokalemia,pulomary oedema.

• Platelet ( thrombocytes)Therapy(PRP-Platelet Rich Plasma)-(platelet count=3 x 10 to the power 11 with 300 ml of unit)in injury, joint pain, hair loss( scalp injection)n , Dengue fever, Wasting disease ( TB),tennis elbow or Golfer elbow- Corticosteroid injection & Goat milk increases Platelet count-decrease inflammation, sports medicine,
• Blood transfusion-(2ml/minute=120ml/hr for 1t 15 minutes then 150-250 ml/hr for rest 1-2 hr not exceeding 4 hr)-( 1 packet of Blood contains-200 ml RBC with WBC+100 ml additive solution+30 ml Plasma+>10gm/dl of Hb with 30& Haematocrit(golden 10/30 rule)==55% soild+45% liquid)–( contain RBC+ WBC+ Plasma+ Platelets)-serious injury resulting blood loss, anaemia, Sickle shape anaemia( weekly once of 250 ml blood, Haemophilia, Thalesemia, cancer patients if required, women durin delivery, (In Animals- if Hb is <6 mg/dl, anaemia, Theileria, Babesia( red urine),injury causing blood loss,
• Plasma Therapy(dextran)– 30-40 ml/Kg-used in other patients by collecting from recovered patients for immunity ground, COVID, kidney disease, thrombocytopenia, neurologic disorder, metabolic disease
• Calboral Liquid- 500ml package-(Vet)-( Calcium Boro-Gluconate-2.7% W/V but 23 % calcium—i.e. 19.78 mg of Ca /L)_ S/C or I/V @ 1ml/Kg –( Hypocalcaemia—Milk fever/parturient paresis-C/B/S/G)—(Ratio of Ca,Mg,P4 is to be maintained for absorption)- Cattle & Buffalo-250-350 ml of two doses in a day followed by two doses of Oral calcium bolos at 12 hr interval, do not give I/V Calcium even  if sub-normal hypocalcaemia( no sign exhibited) because decrease Ca level in long run. Decrease Potassium level also cause hypocalcaemia as Ca is not absorbed due to change in blood pH.

{Hypocalcemea (<7.5 mg/dl) ( usually > 2nd Lactation)(Also in Horse-stiff gait)—administer slowly @ 20 ml/minute as cardiotoxic- ( cow requires 20-30 gm of Calcium daily for colostrums )(1^st stage-stand & excitability, tremor, ear twitching, head bobing,2^nd stage- lie down & lethargy( as Ca is not available for impulse transmission through  nerve),dry muzzle, tachycardia, GIT stasis(no defecation), unable to urinate for smooth muscle paralysis, “S’ shape neck,  , 3^rd stage-coma( survive for few hours),unable for sternal recumbency, unresponsible for stimuli, sever bloat, Heart Rate -120bpm,peripherl pulse undetectable( coma)// cause-dystocia, uterine prolapse, RFM, Mastitis, displaced abomasums, decrease milk, ketosis,//–Sump—down cow with one side flanked head, Temp—99 F ,lethargy, Cold extremities(so  fly sit on body),rumen atone,

Treatment– 1- Calboral –I/V( because immediate Oral Calcium is of less response) @ 250-350 ml/ in one dose of 2 doses in a day followed by Oral Calcium bolos/granules//liquid/500gm of Calcium propionate  with 8-16 litre of propylene glycol, of 12 hour apart.Cacl2-cause metabolic acidosis

—Prepartuent hypoglycaemia in bitches-is normal in bitches but after delivery  treatment with Calcium borogluconate ( Calboral)-calcium therapy as deficiency in calcium during pregnancy result cramping/convulsion of muscles after delivery/collapsed. T-I/V Glucose or calcium therapy after parturition

2–Second Bottle of Calcium Borogluconate in case of  high yielders- –S/C in divided doses for prolong absorption rate

3– With  Magnesium( prevent myocardial infraction in Ca infusion & Parathyroid Hormone(PTH) Secretion),P4,K,analgesic,D-5% Dextrose of 500 ml bottle-I/V(not S/C as irritating & sub cot oedema ,

4– When recovered within 2 hours -eructation,defecation,urination starts with stand up, If no response within 4-8 hr then retreat.

5-Calcium diet at pre-parturient period is no advisable as cause Negative Calcium balance with PTH decrease,

6-Incomplete milking after calving prevent Hypocalcaemia & also not give Alpha Alpha grass at prepartum  as contain high Calcium

7-Calboral-S/C on day of Calving or  Oral calcium at calving & 12 hr after

8-DCAD( Dietary Cation Anion Difference)- Decrease Blood pH( also reduced Potassium in diet cause decrease PTH so Blood pH & MgSO4 –oral –reduces blood pH) at prepartum & early post partum resulting reduced absorption of bone calcium, inhibits renal conversion of active calcium by reducing PTH receptor activation

9– ( Low)-0.1% DM Sodium & 0.1 % DM Potassium can be given at prepartum

10 Vit-D3( 10 million IU –I/M or I/V 8days before delivery is effective) & other vitamins @ 20-30 million IU/day during 5-7 days ( if more days then toxicity0prepartum may prevent Hypocalcaemia but if stops > 4 th day of parturition the aggravated( I^ Chance) the condition of Hypocalcaemia

11– Calcium Gel-150 gm  on day before & after &  day of Parturition

12-Magnesium 2 15-20 gm/day /orally with carbohydrate prevents Hypocalcaemia 7 during pregnancy @ 0.4 5 DM in ration,

13-Sudden decrease of Progesterone 7 increase of Oestrogen make decrease of calcium ionisation so hypocalcaemia

DD-Toxic mastitis, toxic metrites, toxic condition, traumatic injury to stifle hip fractured pelvis, spinal compression( prolapse disc),Calving paralysis( injury at  L-6  for sciatic & Obturator paralysis),aspiratory pneumonia,

Normal-Ca Level=Cattle-8.5-10.5 mg/dl,, Mg- 1.8-2.4 mg/dl,,P4-5.2 mg/dl (Ca: Mg; P4=8:2:5 mg/dl)

Dog-Ca-9-11.6 mg/dl, Mg- 1.89 -2.51 mg/dl   P4-2.5-5.5 mg/dl (Ca: Mg; P4=10:2:5 mg/dl)

Pig- Ca-9-13 mg/dl,Mg-2-3 mg/dl.P4-5 mg/dl, Zn-intake 26-46 mg/day for 5-11 kg BW ( Imbalance ratio of Ca to Zn in pig cause Anaemia)

• Mifex Liquid-450 ml package– ( Calcium-Magnesium Borogluconate-(Vet)- ( Mifex Oral suspension(ca-1650mg+Mg-100mg+P4-850mg+Vit-B12-100mcg+Vit-D3-8000IU+Carbohydrate-20 mg)) is also there)used in Hypocalcaemia+ Hypo Magesemia+Hypo Phostemea—( Magnesium-found in 70% in bone, do membrane stability, cardiac, nerves & skeletal muscle function, helps enzyme & calcium metabolism & ratio,

–—-If recurrent Hypocalcemia after 12-18 hr of treatment then use 450 ml Mifex daily for 5-6 day

–—450 l of Mifex+2.5 -3 gm of Progesterone( Duroprogen)—rarely reoccurrence of milk fever .

Hypomagnesemia-(Grass Tetany)-(in Male & female)-

Predisposing cause-succulent grass without dry hay-heavy Nitrogen or potash treated grass, high protein diet with less hay

Symptoms-recumbent, paddling of leg, head extends, frothy mouth, paralysis, sensitive to touch,

Treatment-25% MgSO4-S/C(if I/V may cause death),Mifex,

Prevention- Mg rich supplement 3 weeks before delivery, calcined magnesite rock-lick-60gm/day, solution of molasses with magnesium acetate,

ANTIBIOTICS ACTION MECHANISM by Hampering—

• Cell wall synthesis-B-Lactams (Gm +ve & Gm -ve Bacteria)-Penicillin group, cephalosporin, vancomycin, Fungus-Cell wall have sterols( not present in bacteria)-polyelene AB/Antifungal drugs binds with sterols-amhitericin-B,Nystatin,primaricin( for eye),fosphomycin,fosmidomycin

2-Plasma membrane integrity-polymyxins disrupt plasma membrane causing leakage– Amphotericin ,imidazoles,( Nitroimmidazole/metronidazole-kills protozoa0

3-Nucleic acid synthesis-bind with nucleic acid to check DNA replication by  preventing desired protein synthesis- quinolones- Nitroimidazoles, Rifampin,isoniazides( nicotamine derivative),ethambutol,streptomycin,pyrazinamide

4-Ribosomal function-blocks RNA Synthesis-(Gm+ve & Gm-ve)aminoglycosides,tetracycline,chlomphenicol,erythromycin,clindamycin ,

5-Folate synthesis-block Folate for DNA synthesis- sulphonamides, trimethoprim

6-Chemotherapy-for cancerous patient-kills cancer cells-( surgery, Radiation, immunotherapy, target therapy)- Alkylating-(Nitrosoureas)/Antimetabolites/Topoisomerase inhibitor/ Miotic inhibitor/Anti-tumor AB(Anthracyclin)/

Bacterial resistance– resistance factor encoded in plasmids /chromosome-causing decrease entry of AB or change receptor site

Adverse effect of B– Toxic nature of AB, kill intestinal flora, diarrhoea,

Degrees of Dehydration-( normal water intake Human @ 35 ml/Kg BW but Livestock-50ml/Kg BW)-Fluid level is 60%(40% intracellular+20% extracellular) of Body weight. But Blood volume is 10 % of BW.1 Unit(pint) of Blood==525 ml.

Character	Mild(3-5%)	Moderate(6-9%)	Sever(>10-12%)	Remarks/disease condition
Behaviour	Irritable, thirsty,	Irritable, extremely thirsty	Drowsy, unconscious	Anamnesis of vomition/diarrhoea/lack of water intake
Mood	normal	depressed	Strikingly depressed, dull	Perfusion deficit present
Eyes	normal	sunken	Sunken, dull cornea
Mucus membrane	Normal wet, Sticky mm	Dry mm, lack of moisture	Very dry, furry
Skin turgor/Skin pinch( normal<2 second)	Recedes immediately(>2 second)	Recedes slowly (< 3 to 4 seconds)	Recedes  very slowly(>4 seconds)	Old people/animla skin pincing revival time is = 20 seconds even if no dehydration//Oedema & over wt skin pinch recedes immediately even if dehydrated.
Respiration rate	normal	rapid	Very rapid
Heart Rate	normal	Rapid & feeble
Urine colour	>Straw/light yellow	Deep yellow	Coffee colour

(Normal Range== Behaviour( mentation)-alert, Heart Rate /minute- D-60-120 & C-170-200( as per breed), mm colour-pink , capillary filling time— 1-2/second , mean arterial BP- –80-100 mm of Hg, central venous pressure—0-2 cm of H2O, Urine out put —  > 1.67 ml/kg/hour, SpO2–  > 97 %,  PCV—D-40-55% & C-30-45%, Hb—13.8-21.4 gm/dl, Albumin—2.6 -3.9 gm/dl, Colloid Osmotic Pressure—D-21-25 mm of Hg & C—23-25 mm of Hg, Rectal temperature—100-102.5 F

HUMAN—Fluid therapy—in & out fluid( normal 400 ml/day)

1–Hypovolumic-Defined as reduction in circulating blood volume may be due to hyponatremea, blood loss ,vomiting, diarrhoea, excessive sweating ,burn, excess diuretic, mineral corticoid deficiency, renal tubular disorder, bowel obstruction, peritonitis, pancreatitis, fasting, post operative , acute illness , fever etc. manifested by dizziness, weakness etc.

Treatment—( Aimed at Balance of Water—35-45 ml/kg with Na—1.5-2 mmol/kg & K—1.0 -1.5 mmol/kg)—check plasma Na for water balance, K for extra cellular fluid balance, HCO3 for acid-base balance, urea & creatinin for renal function balance etc—

1-Crystalloid fluid( contain no protein) –{{ If colloids ( contain protein ) then renal failure}}—as per requirement on testing parameter

• Crystalloid–RL(Hartmans solution)—containNa-131, Cl-111, K-5,Ca-2,Lactate-29

b-NSS –Na-154, l-154

2-Hypervolumic-( excess body total Na but serum Na level normal due to retention of fluid & K –serum level normal except Hyperadenocorticosim) )It indicates excess fluid in interstitial compartments by leaking from blood vessels indicated (rarely in Cardiac & renal normal function as kidney) in primary renal disease, Hyperadenocorticosim(cushion’s disease-cause Na reabsorption),CHF, Liver disease, nephritic syndrome, malnutrition, oedema, renal artery stenosis, hypertension ,hyperkalemea etc.

Treatment—( metabolic water production -400ml/daily,,800ml/daily- water loss through faeces +respiration+ sweat ,, 3 litre through urine/daily )

1-ACE inhibitor in Hypertension/heart failure

2-gluco corticoids in minor renal change

3-control dietary Na (NaCl-table salt) intake to 50-80 mmol/24 hr

4-Diuretics-

a-Furosemide(lasix/serotonin)-loop of Henle(LoH) Diuretic-inhibit Na Reabsorption excrete Na, K,& H2O through urine

• Osmotic diuretics( short term diuretics)-Manitol-mainly used in brain oedema-
• Thiazide-distal convoluted tuble- in metabolic alkalosis as cause hypocalciurea
• Dapagliflozin-( short acting diuretics)act on PCT(proximal convoluted tubule) –prevent Na & Glucose absorption –used in DM-2 patients.

Prepared & presented by Dr.Keshaba Chandra Samantaray ,M. V. Sc. (Gynaecology), Gold Medallist, OUAT, Bhubaneswar

CONCEPT OF FLUID THERAPY IN ANIMALS