load administered with this route will be greater than that of constant rate
infusion as dextrose should not be administered by bolus at large
concentration, i.e. more than 1-2.5%. Care has to be taken if adding
potassium to fluids being administered as a bolus. This approach can
potentially result in sodium overload, but will work well in a foal that is nursing.
The best fluid for bolus use in the author’s opinion is 0.45% saline and 1-2%
dextrose if calories are needed, although this is less than ideal. Magnesium
and B vits can then also be added intermittently.
• Glucose
The normal foal is born before gluconeogenesis begins and a foals’ blood
glucose will trough at approx. 2-4 hrs after birth, until gluconeogenesis is
initiated and enteral feeding provides a glucose source.
Any collapsed foal or foal that has been off suck for > 3 hours will be
hypoglycaemic (<4mmol/l), and possibly hypovolaemic with hypotension.
Fluid therapy and nutritional support must be separated if possible. Nutritional
needs cannot be met with 5-10% glucose solutions. Provision of a 5-10%
glucose solution though will help correct hypoglycaemia.
THESE
SOLUTIONS MUST NOT BE GIVEN AS A BOLUS. If possible and in a
hospitalised environment, monitor blood glucose values every 30-60 mins.
CRI glucose can then be provided.
• Immunoglobulins
Plasma is a very useful fluid. Not only does it provide volume expansion, it
enhances immune function and increases oncotic pressure. J5 plasma (no
longer licensed) also provides core gram negative antibody.
It is recommended that plasma (if financially viable) should be given to any
sick neonate, irrespective of IgG levels. If IgG levels are unacceptably low,
plasma therapy should be aimed at increasing IgG to > 8g/l.
Plasma transfusions have been proven to enhance neutrophil function in
septic foals. It has also been suggested that hospitalized foals have
decreased phagocytic functions. These findings may warrant the use of
plasma in hospitalized foals irrespective of their presenting IgG levels.
If commercial plasma is not available, plasma can be taken from the mare or
local gelding, but there are RISKS with this. Quality cannot be guaranteed
and disease status of the donor needs to be considered. No plasma will be
100% red blood cell free so there is always the risk of NI and anaphylaxis.
• Antimicrobials
It is much better to give antimicrobials to a foal that doesn’t need them
than to not give them to a foal that does.
It is important to use broad spectrum bacteriocidal antimicrobials. If possible
culture and sensitivity should be set up and antimicrobial therapy adjusted
according to results and clinical response. The most practical approach is to
take the blood culture sample upon initial clinical examination when an i.v.
catheter is first being placed in an aseptic manner. Antimicrobial
administration is usually required for a prolonged period (2-4 weeks).
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
202