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      Intravenous and Oral Fluid Therapy in Neonatal Calves With Diarrhea or Sepsis and in Adult Cattle

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          Abstract

          Optimal fluid therapy protocols in neonatal calves and adult cattle are based on consideration of signalment, history, and physical examination findings, and individually tailored whenever laboratory analysis is available. Measurement of the magnitude of eye recession, duration of skin tenting in the lateral neck region, and urine specific gravity by refractometry provide the best estimates of hydration status in calves and cattle. Intravenous and oral electrolyte solutions (OES) are frequently administered to critically ill calves and adult cattle. Application of physicochemical principles indicates that 0.9% NaCl, Ringer's solution, and 5% dextrose are equally acidifying, lactated Ringer's and acetated Ringer's solution are neutral to mildly acidifying, and 1.3–1.4% sodium bicarbonate solutions are strongly alkalinizing in cattle. Four different crystalloid solutions are recommended for intravenous fluid therapy in dehydrated or septic calves and dehydrated adult cattle: (1) lactated Ringer's solution and acetated Ringer's solution for dehydrated calves, although neither solution is optimized for administration to neonatal calves or adult cattle; (2) isotonic (1.3%) or hypertonic (5.0 or 8.4%) solutions of sodium bicarbonate for the treatment of calves with diarrhea and severe strong ion (metabolic) acidosis and hyponatremia, and adult cattle with acute ruminal acidosis; (3) Ringer's solution for the treatment of metabolic alkalosis in dehydrated adult cattle, particularly lactating dairy cattle; and (4) hypertonic NaCl solutions (7.2%) and an oral electrolyte solution or water load for the rapid resuscitation of dehydrated neonatal calves and adult cattle. Much progress has been made since the 1970's in identifying important attributes of an OES for diarrheic calves. Important components of an OES for neonatal calves are osmolality, sodium concentration, the effective SID that reflects the concentration of alkalinizing agents, and the energy content. The last three factors are intimately tied to the OES osmolality and the abomasal emptying rate, and therefore the rate of sodium delivery to the small intestine and ultimately the rate of resuscitation. An important need in fluid and electrolyte therapy for adult ruminants is formulation of a practical, effective, and inexpensive OES.

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          Most cited references147

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          Mortality after fluid bolus in African children with severe infection.

          The role of fluid resuscitation in the treatment of children with shock and life-threatening infections who live in resource-limited settings is not established. We randomly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5% albumin solution (albumin-bolus group) or 0.9% saline solution (saline-bolus group) per kilogram of body weight or no bolus (control group) at the time of admission to a hospital in Uganda, Kenya, or Tanzania (stratum A); children with severe hypotension were randomly assigned to one of the bolus groups only (stratum B). All children received appropriate antimicrobial treatment, intravenous maintenance fluids, and supportive care, according to guidelines. Children with malnutrition or gastroenteritis were excluded. The primary end point was 48-hour mortality; secondary end points included pulmonary edema, increased intracranial pressure, and mortality or neurologic sequelae at 4 weeks. The data and safety monitoring committee recommended halting recruitment after 3141 of the projected 3600 children in stratum A were enrolled. Malaria status (57% overall) and clinical severity were similar across groups. The 48-hour mortality was 10.6% (111 of 1050 children), 10.5% (110 of 1047 children), and 7.3% (76 of 1044 children) in the albumin-bolus, saline-bolus, and control groups, respectively (relative risk for saline bolus vs. control, 1.44; 95% confidence interval [CI], 1.09 to 1.90; P=0.01; relative risk for albumin bolus vs. saline bolus, 1.01; 95% CI, 0.78 to 1.29; P=0.96; and relative risk for any bolus vs. control, 1.45; 95% CI, 1.13 to 1.86; P=0.003). The 4-week mortality was 12.2%, 12.0%, and 8.7% in the three groups, respectively (P=0.004 for the comparison of bolus with control). Neurologic sequelae occurred in 2.2%, 1.9%, and 2.0% of the children in the respective groups (P=0.92), and pulmonary edema or increased intracranial pressure occurred in 2.6%, 2.2%, and 1.7% (P=0.17), respectively. In stratum B, 69% of the children (9 of 13) in the albumin-bolus group and 56% (9 of 16) in the saline-bolus group died (P=0.45). The results were consistent across centers and across subgroups according to the severity of shock and status with respect to malaria, coma, sepsis, acidosis, and severe anemia. Fluid boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion in these resource-limited settings in Africa. (Funded by the Medical Research Council, United Kingdom; FEAST Current Controlled Trials number, ISRCTN69856593.).
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            Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children

            To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.
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              Basic concepts and practical equations on osmolality: Biochemical approach

              The terms osmotic pressure, osmotic coefficient, osmole, osmolarity, osmolality, effective osmolality and delta osmolality are formally defined. Osmole is unit of the amount of substance, one mole of nonionized impermeant solute is one osmole. Assuming an ideal solution, osmotic pressure (π) in mmHg is 19.3 times the osmolarity. Osmolarity is defined as the number of milliosmoles of the solutes per liter of solution. Suitable equations are presented for the rapid calculation of the osmolarity of different solutions. The concentrations of electrolytes are expressed by mEq/L that is, equal to their osmolarity as mOsm/L. If the solute concentration (C) is expressed as mg/L, mg/dL and g%, osmolarity is calculated as: C.n' /MW, C.n' (10)/MW and C.n' (10(4))/MW respectively. Osmolality is milliosmoles of solutes per one kilogram (or liter) of water of solution (plasma) and is calculated by osmolarity divided to plasma water. The osmolal concentration is corrected to osmolal activity by using the osmotic coefficient, φ. The salts of sodium (choloride and bicarbonate) and nonelectrolyte glucose and urea are the major five osmoles of plasma. The equation: Posm =2 [Na(+)]+glucose (mg/dL)/18+BUN (mg/dL)//2.8 is also the simplest and best formula to calculate plasma osmolality. The concentration of only effective osmoles evaluates effective osmolality or tonicity as: Eosm =2 [Na(+)]+glucose/18. The normal range of plasma tonicity is 275-295mOsm/kg of water. The difference between the measured and calculated osmolality is called osmolal gap. It is recommended to withdraw the formula of Dorwart-Chalmers from the textbooks and autoanalyzers and to use the simplest equation of Worthley et al. as the best equation for calculating serum osmolality. Furthermore the normal ranges of osmolal gap also must be corrected to 0±2mOsm/L.
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                Author and article information

                Contributors
                Journal
                Front Vet Sci
                Front Vet Sci
                Front. Vet. Sci.
                Frontiers in Veterinary Science
                Frontiers Media S.A.
                2297-1769
                27 January 2021
                2020
                : 7
                : 603358
                Affiliations
                [1] 1Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign , Urbana, IL, United States
                [2] 2Clinic for Ruminants, Vetsuisse Faculty, University of Bern , Bern, Switzerland
                [3] 3Department of Internal Medicine, Faculty of Veterinary Medicine, Kyrgyz-Turkish Manas University , Bishkek, Kyrgyzstan
                [4] 4Tierärztliche Gemeinschaftspraxis Dr. Berchtold & Dr. Taschke , Pittenhart, Germany
                [5] 5Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz , Ahvaz, Iran
                [6] 6Department of Population Health & Pathobiology, College of Veterinary Medicine, North Carolina State University , Raleigh, NC, United States
                [7] 7Foundation, Clinic for Cattle, University of Veterinary Medicine Hannover , Hannover, Germany
                Author notes

                Edited by: William W. Muir, Lincoln Memorial University, United States

                Reviewed by: Allen Roussel, Texas A&M University, United States; Martin Kaske, University of Zurich, Switzerland

                *Correspondence: Peter D. Constable constabl@ 123456illinois.edu

                This article was submitted to Comparative and Clinical Medicine, a section of the journal Frontiers in Veterinary Science

                Article
                10.3389/fvets.2020.603358
                7873366
                33585594
                bd772662-29ab-4e5a-9356-34f7daa492ba
                Copyright © 2021 Constable, Trefz, Sen, Berchtold, Nouri, Smith and Grünberg.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 06 September 2020
                : 22 December 2020
                Page count
                Figures: 13, Tables: 0, Equations: 6, References: 147, Pages: 29, Words: 20417
                Categories
                Veterinary Science
                Review

                osmolality,alkalosis,acidosis,fluid therapy,acid–base balance,oral electrolyte solution

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