How to Choose Your ‘First Bag’ of Intravenous
Fluids
Pamela A. Wilkins, DVM, MS, PhD, Diplomate ACVIM-LA, ACVECC
Author’s address: University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive,
Champaign-Urbana, IL 61802; e-mail: pawilkin@illinois.edu. © 2013 AAEP.
1. Introduction
There are many intravenous (IV) fluid choices avail-
able to equine practitioners. Deciding which of
these fluids to carry in inventory and in the truck
will depend in part on the types of emergency cases
most commonly seen in practice that require IV fluid
intervention. Having information on hand regard-
ing IV fluids most commonly chosen in different
emergency settings will aid practitioners in making
economical and practical decisions regarding which
IV fluids to stock and carry. “First bag” choices for
IV fluids may need to be made with limited clinical
pathology data available but are generally aimed at
restoring various fluid compartments within the
body (Fig. 1). Follow-up, longer-term IV therapy is
generally more directed and is based, at least in
part, on recognized electrolyte and acid-base abnor-
malities. This presentation is aimed at aiding the
practitioner in deciding what to administer initially,
the first bag.
2. Materials and Methods
A brief e-mail survey was sent to veterinarians with
specialty board certification in Large Animal Inter-
nal Medicine (via the ACVIM-LA list) and/or Emer-
gency and Critical Care (by direct e-mail request).
The survey presented nine distinct clinical situa- tions in which intravenous fluid administration
might rationally be part of the initial therapy:
fi Ten-minute-old foal delivered from a pro-
longed dystocia ( \13
120 minutes) with an
APGAR score of 6
fi Obtunded, hypothermic minimally responsive
24-hour-old foal
fi Six-day-old foal with diarrhea
fi Three-day postpartum mare presenting as
mild to moderate colic with foal at side and in
shock, heart rate 72; mucous membranes (mm)
pale; CRT, 3 seconds; slow jugular fill; extrem-
ities cold
fi Two-year-old Thoroughbred filly with a head
injury from falling backward on its poll, no
epistaxis
fi Four-year-old Quarter Horse with frequent
pipestream diarrhea, depressed, approxi-
mately 8% dehydration, has been on antibiot-
ics, mucous membranes injected, heart rate 80
fi Ten-year-old Arabian mare, badly tied up after
an apparently energetic trail ride, not making
urine
fi Twenty-two–year-old Morgan horse with mild
colic and palpable pelvic flexure impaction
fi Eight-year-old Thoroughbred broodmare 338
452 2013
fiVol. 59fiAAEP PROCEEDINGS
HOW-TO SESSION: FIELD ANESTHESIA AND PAIN MANAGEMENT
NOTES