GOALS OF LECTURE. Focus on. Review PE signs of dehydration Review appropriate fluid types Review routes of administration for fluid rehydration

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1 D E H Y D R AT I O N A N D R E H Y D R AT I O N I N A V I A N A N D R E P T I L E P A T I E N T S C V M A K R I S TA A K E L L E R, DV M, D I P L A C Z M A S S I S TA N T P R O F E S S O R O F Z O O L O G I C A L M E D I C I N E U N I V E R S I T Y O F I L L I N O I S C O L L E G E O F V E T M E D GOALS OF LECTURE Focus on Common companion avian species Common companion reptile species Review PE signs of dehydration Review appropriate fluid types Review routes of administration for fluid rehydration AVIAN PATIENTS PE signs of dehydration Appropriate fluid types Routes of administration for fluid rehydration All images/vids are mine unless otherwise indicated 1

2 ASSESSMENT: ULNAR REFILL TIME How to find the ulnar vein Hand on ventral aspect of the wing Palpate over the ELBOW Spread feathers with alcohol Locate the vessel Same spot as IVC for anesthesetized patients ASSESSMENT: ULNAR REFILL TIME How to perform the ulnar refill time Digital pressure over the vein Watch for blanching ULNAR REFILL TIME How to interpret the ulnar refill time NOT ABLE TO BLANCH Normal animal with normal perfusion ABLE TO BLANCH Animal with poor perfusion that requires fluid resucitation/rehydration NOT the same as capillary refill time of mammals 2

3 ENOPHTHLAMIA Dehydrated chicken Euhydrated chicken SKIN TURGOR Video of skin turgor testing in cockatoo ADR/FLUFFED Presentation: ADR/Fluffed ASSUME decreased intake 3

4 FLUID TYPES No limitations Crystalloids (60mL/kg/d - non passerines) Balanced isotonic commercially available fluid LRS, Norm R, Plasmalyte Colloids (5mL/kg bolus, <20mL/kg/d) Hetastarch/Vetstarch Presentation Mild scary factor Medium scary factor VERY scary factor Mild dehydration Moderate dehydration Severe dehydration/ hypovolemia QAR Depressed Recumbency/ minimal responsiveness Oral fluids Single SQ fluid Multiple SQ fluids IV or IO fluids ORAL ROUTE DO NOT FORGET THIS ROUTE! Many birds can be enticed to eat something sweet or nut flavored! PROS: Most physiologic No restraint required! Cl can do at home CONS: Inappropriate for mod-severe dehydration May be more labor intensive Requires patient buy in 4

5 SQ ROUTE Anatomy Inguinal fold between the stifle and body Video of inguinal fold in a GYFA SQ ROUTE Anatomy Inguinal fold between the stifle and body DANGER: Do not allow needle to go too deep (drowning danger!) Prevention Point laterally (away from the body) Stay superficial Stabilize, stabilize, stabilize SQ ROUTE Video of SQF in a cockatoo 5

6 SQ ROUTE PROS Can given large volumes of fluid at once Well absorbed Can be done on outpatient Not labor intensive CONS Restraint (pot stress) required Possibility of drowning patient if done incorrectly Not appropriate to teach client how to perform Anatomy Distal ulna Proximal tibiotarsus DANGER: Do not catheterize pneumatized bones Humerus Femur IO Catheter in Ulna Dorsal recumbency Remove feathers, clean Palpate the dorsal ulnar condyle on the DORSAL aspect of wrist Enter the medullary cavity using a 25/22g needle Bone plugs are common Harris. Therapeutic Avian Techniques Atl Coast Vet Conf 6

7 Miranda Sadar, DVM, Dipl ACZM Miranda Sadar, DVM, Dipl ACZM IO Catheter in Tibiotarsus Dorsal/sternal recumbency Remove feathers, clean area Palpate cnemial crest and patellar tendon Enter medullary cavity using a 25/22g needle without injuring the patellar tendon Bone plugs are common Harris. Therapeutic Avian Techniques Atl Coast Vet Conf 7

8 How to tell if IO catheter is in place? Flush Blanch the ulnar vein (ulnar IO) Flush easily Does not expand the SQ tissues Move needle circumfrentially within the medullary cavity Cannot feel needle in SQ tissues Orthogonal radiographs Gretchen Kaufman, DVM, Dipl ACZM PROS Able to given bolus and CRI fluids Directly into vascular system CONS Technically challenging Requires restraint vs anesthesia vs poor mentation state Labor intensive (+ labor intensive maintenance) IV ROUTE Anatomy Ulnar vein Any bird has a great one! Medial aspect of the elbow 8

9 IV ROUTE Anatomy Medial metatarsal vein Best in larger birds Exception: Waterfowl! Running medial to cranial at proximal tibiotarsus Miranda Sadar, DVM, Dipl ACZM IV ROUTE Protecting IV lines Lots of tricks available! If they are feeling well enough to investigate PROS Able to given bolus and CRI fluids Directly into vascular system CONS Technically challenging to place and maintain Requires restraint vs anesthesia vs poor mentation state Labor intensive (+ labor intensive maintenance) 9

10 REPTILE PATIENTS PE signs of dehydration Appropriate fluid types Routes of administration for fluid rehydration ENOPHTHALMOS 10

11 ENOPHTHALMIA SALIVA VISCOSITY FLUID TYPES Crystalloids (10-30mL/kg/d) Any balanced isotonic will do Need more species specific research Some controversy with the use of lactated ringers Colloids (10-20mL/kg/d max anecdotally) 11

12 Reptile considerations Poikilotherms require external heat to drive metabolism This includes metabolism required to absorb parenteral fluids! Thermal support is just as important as fluid support!! CLOACAL DRINKING Reptile can drink through cloaca Pros Cons Water absorption takes place bladder/colonic mucosa LOW TECH! LOW STRESS! Client can do at home Giving free water Keep them warm! Not appropriate for debilitated animals ORAL PROS Most physiologic No restraint required (most species) Cl can do at home CONS: Inappropriate for mod-severe dehydration May be more labor intensive Requires patient buy in Wont work for snakes/chelonians 12

13 ORAL SQ ROUTE PROS Can given large volumes of fluid at once Can be done on outpatient Not labor intensive CONS Restraint (pot stress) required May be appropriate to teach client how to perform SQ ROUTE VIDEO OF SQF in a tortoise and a BEDR 13

14 Anatomy Humerus, femur, tibia, ulna Bridge of shell in turtles, tortoises PROS Able to given bolus and CRI fluids Directly into vascular system CONS Technically challenging Requires restraint vs anesthesia vs poor mentation state Labor intensive (+ labor intensive maintenance) 14

15 IV ROUTE Anatomy Most vessels are BLIND and require cut downs Chelonians: Jugular Lizards: Cephalic, ventral coccygeal, +/- tail PROS Able to given bolus and CRI fluids Directly into vascular system CONS Technically challenging Requires restraint vs anesthesia vs poor mentation state Labor intensive (+ labor intensive maintenance) IV ROUTE IV ROUTE Mader s Reptile Medicine and Surgery

16 IV ROUTE Mader s Reptile Medicine and Surgery