Question

A 10 years old female cattle called Pooh is presented to your hospital clinic for the first time by Mr. Hasan. he indicates that pooh has been drinking a lot of water and passing more urine than usual for the past six weeks. during this time, pooh has been eating normally and has not lost weight. in the five days prior to presentation, Mr. Hasan tells you that pooh has anorexia with decrease in milk production and lose of weight as well as has been vomiting and has become progressively depressed. the vomiting began on Saturday (two times) and has increased in frequency until by Wednesday pooh vomited six times. Mr. Hasan saw no diarrhea and denies seeing hematuria, and stranguria. the vomitus contained no blood.
physical examination reveals 8% dehydration, moderate depression, slightly pale mucous membranes, and a 2/6 mitral insufficiency (systolic murmur) with a exaggerated vesicular sound over the lung field and slight increasing of pulses. abdominal palpation is unremarkable, percussion between 8th and 10th intercostals space revels tympanic sound.   
initial laboratory evaluation reveal the following: BUN - 150 creatinine - 8.8
urinalysis- specific gravity-1.104 ph-6.5 potassium-5.8 glucose-0 ketone-0 albumin-30 mg% cast 0-1 fine granular1 waxy RBC-0.1 WBC-0 after one day on intravenous fluids the creatinine is now 4.2.
Answer the following questions
   •   From the clinical data given, the diagnosis is most likely
   •   Do you think that the fluid therapy given to Pooh was good or not
   •   What is your treatment in such case

PLEASE BE VERY SPECIFIC

Answer 1

Ans.

Diagnosis -

Dehydrated

Dehydration can lead to serious complications, including:

• Heat injury. ...
• Urinary and kidney problems. ...
• Seizures. ...
• Low blood volume shock (hypovolemic shock).

Symptoms of dehydration in adults and children include:

• feeling thirsty.
• dark yellow and strong-smelling pee.
• feeling dizzy or lightheaded.
• feeling tired.
• a dry mouth, lips and eyes.
• peeing little, and fewer than 4 times a day.

The time it takes for you body to rehydrate depends on how dehydrated you are. If you are severely dehydrated, it's likely that you will be hospitalized and put on intravenous hydration for up to 24 hours to rehydrate your body, or until you're able to drink oral rehydration fluids yourself.

Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water. This can further be divided into intracellular or extracellular as shown below.

Fluid therapy is indicated either when there is a loss of fluid to any part of these compartments or there is a risk of loss of fluid. The severity of the fluid loss, and the compartment from which it has been lost, influence the choice of fluid and the speed at which it needs to be administered. If fluid therapy is performed as a treatment then it is necessary to diagnose and treat the underlying condition.

Indications

• Hypotension
• Hypovolemia
• Electrolyte, metabolic and acid base disorders
• Decreased oxygen delivery
• Geriatric patients at risk of organ failure

When calculating the fluid requirements of a patient, there are 3 elements to consider -

1. Replacement
2. Maintainance
3. Ongoing Losses

Replacements are calculated based on the level of dehydration. Dehydration is based upon clinical assessment of each individual patient. Most commonly, skin tent is used for assessment. To calculate the amount required for replacement within a 24 hour period, the percentage dehydration is used in the following calculation.

Replacement = % Dehydration x Bodyweight (kg) x 10

Maintainance is the basic rate which a patient requires during a 24 hour period. It is commonly calculated as 50ml/kg/24hr, or 2ml/kg/hr.

Ongoing losses are calculated based on a predicted fluid amount lost by a patient within a 24 hour period. Common losses include vomitting and diarrhoea. It is often helpful here if the owners are able to give a detailed history as this makes it easier to predict the pattern of losses. In some patients there may be no ongoing losses and so this step can be skipped. To calculate the fluid requirement, the following calculation is used.

Ongoing losses = Amount per loss (ml/kg) x Bodyweight (kg) x No. of losses

These calculations are then added together to allow for the total fluid requirement in a 24 hour period. It is important to assess these requirements on a daily basis as losses may be increased/reduceed for example.

The calculated fluid requirement is multiplied by the bodyweight of the individual patient to give the total amount of fluid required for that patient as ml/24hr period. This is then further calculated depending on whether a drip pump is used or fluid rate is adjusted manually as shown below.

Requirement per hour (ml/hr) = Requirement per day (ml/24hr) ÷ 24 Requirement per minute (ml/min) = Requirement per hour (ml/hr) ÷ 60 Requirement per second (ml/s)= Requirement per minute(ml/min) ÷ 60 Drops per second = Requirement per second (ml/s)x Giving Set Factor

Treatment

The only effective treatment for dehydration is to replace lost fluids and lost electrolytes. The best approach to dehydration treatment depends on age, the severity of dehydration and its cause.

For infants and children who have become dehydrated from diarrhea, vomiting or fever, use an over-the-counter oral rehydration solution. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes.

Start with about a teaspoon (5 milliliters) every one to five minutes and increase as tolerated. It may be easier to use a syringe for very young children. Older children can be given diluted sports drinks. Use 1 part sports drink to 1 part water.

Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water or other liquids. Diarrhea may be worsened by full-strength fruit juice and soft drinks.

If you work or exercise outdoors during hot or humid weather, cool water is your best bet. Sports drinks containing electrolytes and a carbohydrate solution also may be helpful.

Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room. Salts and fluids delivered through a vein (intravenously) are absorbed quickly and speed recovery.