Fluid and electrolyte therapy in ruminants

Five important questions always must be asked and answered regarding fluid and electrolyte therapy in ruminants: (1) Is therapy needed? (2) What type of therapy? (3) What route of administration? (4) How much should be administered? and (5) How fast should the solution be administered? Food animal veterinarians routinely should carry the following commercially available crystalloid solutions and have the knowledge of how to use the products appropriately: Ringer's solution, 1.3% NaHCO3, acetated Ringer's solution, HS (7.2% NaCl), 8% NaHCO3, 23% calcium gluconate, calcium-magnesium solutions, and 50% dextrose. Ruminants with a blood pH less than 7.20 should be treated intravenously with 1.3% or 8.0% NaHCO3, and those animals with a blood pH greater than 7.45 should be treated intravenously with Ringer's solution. Oral electrolyte solutions or intravenous acetated Ringer's solution should be administered to ruminants with a blood pH greater than 7.20 but less than 7.45, and acetated Ringer's solution is preferred to lactated Ringer's solution. HS solution should be administered whenever rapid resuscitation is required. Oral administration of electrolyte solutions is underused in neonatal and adult ruminants. The optimal solution for oral administration to neonatal ruminants has a sodium concentration between 90 and 130 mmol/L; a potassium concentration between 10 and 20 mmol/L; a chloride concentration between 40 and 80 mmol/L; 40 to 80 mmol/L of metabolizable (nonbicarbonate) base, such as acetate or propionate; and glucose as an energy source. The optimal formulation for adult ruminants is unknown, but such a solution should contain sodium, potassium, calcium, magnesium, phosphate, and propionate to facilitate sodium absorption and to provide an additional source of energy to the animal. Acidemia is treated best by intravenous or oral administration of NaHCO3. Alkalemia is treated best by intravenous administration of Ringer's solution and oral administration of chloride-rich electrolytes such as KCl; the latter provides a physiologically more appropriate treatment than oral administration of vinegar or acetic acid solutions. Hypocalcemia is treated best by administering intravenous calcium borogluconate solutions or oral CaCl2 gels. Hypomagnesemia is treated best by intravenous or subcutaneous administration of combined calcium and magnesium solutions. Hypophosphatemia is treated best by oral administration of feed-grade monosodium phosphate. Hypokalemia is treated best by oral administration of feed-grade KCl; hyperkalemia is treated best by intravenous administration of 8.0% NaHCO3 or HS. The major challenges in treating fluid and electrolyte disorders in ruminants are making treatment protocols more practical and less expensive and formulating an optimal electrolyte solution for oral administration to adult ruminants.