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CLINICAL MEDICINE Department of Internal Medicine, Veterinary Faculty, Uludag University, Bursa, Turkey Effects of A Hypertonic Saline Solution and Dextran 70 Combinationin the Treatment of Diarrhoeic Dehydrated Calves S. S ¸ entu¨rk Address of author: Department of Internal Medicine, Veterinary Faculty, Uludag University, 16190 Bursa, Turkey;Corresponding author: Tel.: +90 224 234 7655; fax: +90 224 2346395; E-mail:
[email protected] 2 tables Received for publication: January 28, 2003 Summary Thirty dehydrated diarrheic calves aged 2–45 days were usedto study the effects of small volume intravenous 7.2% hyper-tonic saline and 6% dextran 70 solution in combination withalkalinising oral fluids and to compare this therapy with thelarge volume intravenous isotonic saline with alkalinising oralfluid treatment. This study included a total of 30 diarrhoeicdehydrated calves aged 2–45 days. After routine clinical andhaematological examinations, the calves were allotted to twotreatment groups. Isotonic saline solution (32 ml/kg, i.v.) withan oral electrolyte solution (22 ml/kg, p.o.) were administeredto group I (control), and the combination of 7.2% hypertonicsaline in 6% dextran 70 solutions (HSD) (4 ml/kg, i.v.) with anoral electrolyte solution (50 ml/kg, p.o.) were administered togroup II (test). Additionally, an oral electrolyte solution(50 ml/kg, p.o.) was readministered to both groups at 12 h of the study. The clinical and haematological examinations of allcalves were performed both before and after the treatment atthe 1/2, 1, 2, 4, 12 and 24 h. The capillary refill time, peripheralpulse quality, dehydration degrees, mental status, haematocritrates, haemoglobin and plasma values after treatment werefound to be statistically different compared with the valuesbefore treatment. In comparison with group I, group II isobserved to have shorter capillary refill time at 1, 4 and 12 h( P < 0.001) and better peripheral pulse quality at 1/2( P < 0.05), 1, 2, 4 and 12 h ( P < 0.001). Moreover, thedegree of dehydration in group II, was significantly improvedat 2 ( P < 0.01), 4 and 12 h. Results of the study indicated thatadministration of low volumes of hypertonic sodium chlorideand dextran 70 solution combinations with oral electrolytesolutions was concluded as quicker, practical, economical andmost importantly an effective way for the treatment of dehy-drated diarrhoeic calves. Introduction Diarrhoea of neonatal calves is a serious welfare problem andan important cause of economic loss because of high mortality,treatment costs and poor growth in the cattle industry.The aetiology of calf diarrhoea is multifactorial and involvesa wide range of infectious (bacterial, viral, protozoan) andnon-infectious (enviromental, nutritional, etc.) factors (Bloodand Radostits, 1989; Hall et al., 1992). Fluid and electrolyteloss induced by diarrhoea results in dehydration and metabolicacidosis (Hall et al., 1992; Barrgy, 1994; Lofstedt and Collatos,1997). A major goal of treatment is correction for dehydrationand acidosis using oral or intravenous electrolyte solutions(Blood and Radostits, 1989; Hall et al., 1992; Barrgy, 1994).Advantages of orally administered fluids include ease, the speedof delivery and low cost (Simmons et al., 1985; Kurtdede,1987). Unfortunately, orally administered fluids have minimalbenefit if the animal has poor gastrointestinal tract absorption,impaired circulation or severe dehydration. As a general guide,if faeces are acidic or contain sugar, oral electrolyte solutionsmay be ineffective (Hall et al., 1992).Intravenous admistration of fluids is considered to be thebest method for treating severely dehydrated and depressedcalves with diarrhoea (Simmons et al., 1985; Naylor, 1990;Hall et al., 1992; White, 1994; Nappert et al., 1997); however,administration of large volumes of isotonic fluid is difficult andexpensive to accomplish in on-farm situations, because itrequires catheterization of a vein, appropriate restraint, adelivery apparatus and periodic monitoring. A rapid, inexpen-sive, effective method for fluid administration in severelydehydrated calves would be advantageous. This goal is bestaccomplished by using a combination of colloids and crystal-loids (Kramer et al., 1986; Duval, 1995; Walker et al., 1998).Hypertonic saline (7.2% NaCl) solution and 6% dextran 70solution have been used successfully to resuscitate sheep,horses, dogs, cats, humans, calves with hypovolaemic andendotoxaemic shock (Constable et al., 1991a, 1996; Haskins,1992; St Jean et al., 1993; Tyler et al., 1994; White, 1996;Arnold et al., 1997). Administration of 7.2% hypertonic salineand 6% dextran 70 solutions (HSD) solution rapidly increasesplasma volume, cardiac output, and mean arterial pressure inhypovolaemic and endotoxaemic shock (Haskins, 1992; StJean et al., 1993; Duval, 1995; Arnold et al., 1997; Walkeret al., 1998). Administration of the combination of HSD mayprovide a means for effective field resuscitation.The objective of this study was to assess the effects of smallvolume intravenous HSD solution with alkalinizing oral fluidsand to compare this novel therapy with therapy with large U.S. Copyright Clearance Center Code Statement: 0931–184X/2003/5002–0057 $15.00/0 www.blackwell.de/synergy J. Vet. Med. A 50, 57–61 (2003) Ó 2003 Blackwell Verlag, BerlinISSN 0931–184X volume intravenous isotonic saline together with alkalinizingoral fluids. Materials and Methods A total of 30 diarrhoeic dehydrated calves, 22 of which wereHolstein and eight of which were Karacabey Brown, aged2–45 days were randomly assigned to a test and a controlgroup after routine clinical and haematological examination.Isotonic saline solution (32 ml/kg, i.v.) along with oralelectrolyte solution (sodium chloride 2.39 g, potasium chloride1.12 g, sodium bicarbonate 6.72 g, citric acid 3.84 g, glycine2.25 g, water 1 l–22 ml/kg, p.o.) was administered to group I(control group n ¼ 15), and the combination of HSD solutions(4 ml/kg, i.v.) with oral electrolyte solution (50 ml/kg, p.o.)was administered to group II (test group n ¼ 15). Oralelectrolyte solution (50 ml/kg, p.o.) was readministered to bothgroups at the 12 h of study. Additionally, Amoxicilline andclavulanic acid (Synulox Ò , Pfizer Inc., NY, USA; 8.75 mg/kg,i.m.) was administrated to all calves (Barrgy, 1994).The clinical and haematological examinations of all calveswere performed both before and at 1/2, 1, 2 4, 12, 24 h after thetreatment. The body temperature, pulse and respiration rates,capillary refill time (CFT), peripheral pulse quality, dehydra-tion degrees (White, 1994) and mental status were determinedby clinical examination. Haematocrit rates, haemoglobin val-ues and total leucocyte counts determined by a haemocellcounter (Serono, Baker Diagnostics, Pennsylvania, USA).Also, relative change in plasma volume was calculatedfrom haematocrit rates and haemoglobin values (Tyler et al.,1994).Degree of clinical mental status was scored (Walker et al.,1998) as: 0 ¼ clinically normal, 1 ¼ mild signs of depression(calf suckles but not vigorously), 2 ¼ moderate signs of depression (calf is able to stand but has a poor sucklingreflex), 3 ¼ severe signs of depression (recumbent calf with nosuckle reflex). Peripheral pulse quality of the arteria maxillarisexterna was determined. Arteria maxillaris externa is palpatedby sofly pressing with the volor surface of the finger tips.Attention is given to the equality rhythm, amplitude and form,and finally the frequency is counted during at least 15 s. Basedon these parameters peripheral pulse quality was scored asfollows (Yilmaz et al., 2002):Barely palpable, not possible to count 1Feel very weak but possible to count 2Feel week pulse 3Normal pulsation 4In order to detect the significance of the differences of theparametrical values in the control and test groups in differenttimes, Repeated ANOVA test and Tukey test were used, whilethe differences at a given time between the groups weredetected with Student’s t -test. For the detection of thesignificance of the differences of the non-parametrical values(mental status, peripheral pulse quality, dehydration degrees)in the control and test groups in different times Friedman non-parametric repeated measures test, and the Mann–Whitneytest were used for the differences between the groups at a giventime. The Dunn’s multiple comparision test was used as thepost-test. Instat Statistical Program v2.02 (GraphPad SoftwareInc., San Diego, CA, USA) was used for the statisticalanalyses. Results All calves in this study showed mental depression, decrease insucklingreflexanddiarrhoeaindifferentseverity.Anaemiasignsweredetectedinsomecasesclinicallyandhaematologically.Pre-andpost-treatmentclinicalandlaboratarydataofcalvesofbothgroups are presented in Tables 1 and 2.There were statistical differences in respiration rates, capil-lary refill time, peripheral pulse quality, degree of dehydration,mental status, haematocrit rate, haemoglobin concentrationand plasma volume in both the control and test groups.Although there were no significant differences between therespiration rates of two groups, respiration rates in controlgroup were higher at 2 h after treatment compared with testgroup. Also moist rales were detected inauscultation of thelungs of controls.Capillary refill time was shortened in the test group at 1, 4and 12 h compared with controls ( P < 0.001). Peripheralpulse quality in the test group was significantly better than thatin the controls at 1/2 ( P < 0.05), 1, 2, 4 and 12 h ( P < 0.01).The degree of dehydration decreased gradually in both groups,differing statistically from 0–1 h ( P < 0.05), to 2, 4, 12( P < 0.01) and 24 h ( P < 0.001) in the control group, andfrom 0–1 h ( P < 0.05) to 2, 4, 12 and 24 h ( P < 0.001) in thetest group. Furthermore, in comparison with the controlgroup, dehydration degrees in test group significantlydecreased at 2 h ( P < 0.01), 4 and 12 h ( P < 0.05).Improvements ( P < 0.01) were observed in mental condi-tion after treatment in both groups. Mental improvement wasmore visible in the test group at 2 and 4 h ( P < 0.05).A significant difference in the haematocrit rates were solelyobserved between baseline and 1 h in the control group,contrarily a significant difference was observed betweenbaseline and all other measurements in the test group( P < 0.05). Total plasma volume was increased in bothgroups after treatment ( P < 0.001). The plasma volume of the control group gradually decreased, and did not fluctuate somuch in the test group. Haemoglobin concentration droppedsharply after treatment in both groups but there were nosignificant differences between controls and tests.None of the calves died during the course of the study andno side-effects were observed during the fluid treatment. Discussion Dehydration and disturbance in electrolyte balance in diar-rhoeic neonatal calves cause various clinical findings and evendeath in some cases (Blood and Radostits, 1989; Naylor, 1990;Hall et al., 1992). All calves in this study showed variousdegrees of depression and dehydration. The administration of intravenous HSD solution and oral isotonic electrolyte solu-tions were effective in resuscitating severely dehydrated calveswith diarrhoea.In the control and test groups, statistical differences wereobserved on the CFT, respiration rates, peripheral pulsequality, dehydration degrees, mental status, haematocrit rate,haemoglobin values and plasma volumes between post- andpre-treatment measurements. The respiration rates in thecontrol group were slightly above the normal level; addition-ally, in the same group respiration rates increased and, wheez-ing and increased breath sounds were detected during thoracicauscultation after isotonic saline solution administration. This58 S. S¸ entu¨rk finding may be connected to an increased fluid in the lungs.As reported before (St Jean et al., 1993; Duval, 1995; Arnoldet al., 1997; Rudloff and Kirby, 1998), administration of large volumes of isotonic crystalloids can decrease the oncoticpressure and increase the hydrostatic pressure because of thedilution of non-permeative protein anions resulting in inter-stitial oedema primarily in the lungs. There was no increase inrespiration rates in the treatment group. This difference can beexplained with administration of small volumes of HSDsolution. Hypertonic saline solution increases plasma osmo-larity (Haskins, 1992; Duval, 1995; Arnold et al., 1997), anddextran 70 increases oncotic pressure and therefore the risk of oedema in lungs and other tissues may be brought down to aminimum (St Jean et al., 1993; Duval, 1995; Constable et al.,1996; Kirby and Rudloff, 1997). In addition to clinicaldehydration, CFT was prolonged and peripheral pulse qualitywas decreased in both groups. The CFT and peripheralpulse quality were restored in all calves after fluid treatment.In the test group, CFT was usually observed to be shorter, andperipheral pulse quality were determined to be better incomparison with the control group. This may be a result of theeffect of hypertonic saline solution (HSS) in decreasing theoedema in endothelial cells in the blood vessels, pre-capillarydilatation and decreasing in vascular resistance (St Jean et al.,1993; Duval, 1995; White, 1996). In the test group, peripheralpulse quality was determined to be improved at 1/2( P < 0.05), 1, 2, 4 and 12 h ( P < 0.001) in comparison withthe control group. The half-life of isotonic crystalloid solutionsare shorter than HSD (Haskins, 1992; St Jean et al., 1993), andhypertonic saline solutions acutely increase plasma osmolarityand osmotically, draw intracellular and interstitial fluid intothe vascular space (Haskins, 1992; Duval, 1995; Arnold et al.,1997), thereby increasing cardiac output, plasma volume andsystemic oxygen delivery (Kramer et al., 1986; Walker et al.,1998). The treatment of severely dehydrated calves withdiarrhoea should aim to rapidly increase plasma volume,thereby increasing cardiac output, and correcting acid–baseand electrolyte abnormalities, and hypoglycaemia (Walkeret al., 1998). Therefore, an alkaline oral electrolyte solutioncombined with isotonic saline solution were administered tothe control group, and alkaline oral electrolyte solution withthe combination of 7.2% saline and 6% dextran 70 solutionswere administered to the test group. Oral electrolyte solutionsare effective for therapy of mildly or moderately dehydratedcalves with diarrhoea (Simmons et al., 1985; Blood andRadostits, 1989; Naylor, 1990; Hall et al., 1992; Nappert et al.,1997). However, intravenous fluid therapy is required inseverely dehydrated and depressed calves with diarrhoea(Simmons et al., 1985; Naylor, 1990; Hall et al., 1992; Nappertet al., 1997). But, resuscitation accomplished by oral admin-istration of electrolyte solutions is slower than that achieved byintravenous administration of fluids (Hall et al., 1992; Walkeret al., 1998). The administration of HSD solution in combi-nation with an oral electrolyte solution causes an immediateand sustained increase in plasma volume and also a decrease inthe degree of dehydration. In this study, plasma volumesignificantly increased only at the first half an hour in thecontrol group, but this increase was transient because thehalf-life of isotonic crystalloid solutions is shorter than that of HSD (Haskins, 1992; St Jean et al., 1993). Contrarily, increasein plasma volume in the test group was continuous at 1, 2 and24 h. Prior to the treatment, the relatively low degree of haematocrit observed in some animals from the 10% dehy-drated animals may be a result of anaemia observed in theseanimals. The dehydration degree in the test group was closer tonormal values at 2 ( P < 0.01), 4 and 12 h than in the controlgroup. Hypertonic saline solution induces its resuscitativeeffects primarily by rapid plasma volume expansion, osmotic-ally drawing intracellular and intestinal water into the vascularspace, thereby increasing plasma volume, cardiac output anddecreasing the degree of the dehydration (Constable et al.,1991a; Haskins, 1992; St Jean et al., 1993; Duval, 1995; Arnoldet al., 1997). The duration of the effect of hypertonic salinesolutions is prolonged by adding dextran 70, which increasesthe plasma oncotic pressure and maintains mobilized fluid inthe intravascular space (Kramer et al., 1986; St Jean et al.,1993; Arnold et al., 1997; Walker et al., 1998).The mental status was observed to improve considerably( P < 0.01) in both groups. However, it was determined that animprovement of themental statewas significantly more obvious( P < 0.05) in the test group than in the control group calves.ThismightbetheresultofthefactthatHSDsolutioncaninducea rapid increase in plasma volume and cardiac output indehydrated calves with diarrhoea by shifting fluid from theintracellular space and gastrointestinal tract (Constable et al.,1991b; Duval, 1995; Kirby and Rudloff, 1997). Moreover,absorption of orally administered fluids can be facilitated byintravenous administration of HSD (Constable et al., 1991b).Hypertonic saline solutions increase serum sodium concen-tration and osmolarity (Constable et al., 1991a; Duval, 1995).Rapid increases in serum sodium concentration may result inneurological signs associated with acute hypernatraemia suchas lethargy, weakness, depression, seizures, coma and death(Haskins, 1992; St Jean et al., 1993; Lofstedt and Collatos,1997). In addition, dextran 70 solution may cause coagulationdisorders and overhydration and anaphylactic reactions(Haskins, 1992; Rudloff and Kirby, 1997), but those problemswere not observed in our study.When the amount of intravenous fluid given and the timesrequired for fluid supplementation were compared in bothgroups, 1.28-l fluid was given to all 40-kg calves in the controlgroup, and 0.16-l fluid was given to all 40-kg calves in the HSDgroup. However, while it took 40–90 min to give the isotonicsaline solution in the control group, the time required toadminister hypertonic saline and dextrane 70 solution was only5–10 min in the HSD group.Result of the study reported here indicated that rapidintravenous administration of low volumes of hypertonic salineand dextran 70 solution combined with alkaline oral electrolytesolutions provided a quick, practical, economical, and effectiveway to treat severely dehydrated calves with diarrhoea. References Arnold, P., P. F. Suter, and A. Hagen, 1997: New aspects of therapy inhypovolaemic and septic shock in small animals. E. J. C. A. P. 7, 49–53.Barrgy, T. B., 1994: Veterinary Drug Therapy. Lea and Febiger,Philadelphia, PA, 185–189.Blood, D. C., and O. M. Radostits, 1989: Veterinary Medicine, 7thedn. Bailliere Tindall, London, 619–632.Constable, P. D., L. M. Schmall, W. W. Muir, G. F. Hoffsis, and E. R.Shertel, 1991a: Hemodynamic response of endoxemic calves totreatment with small - volume hypertonic saline solution. Am. J.Vet. Res. 52, 981–989. 60 S. S¸ entu¨rk
