Terapia fluida nel cavallo con coliche

Introduction: Horse colic designates various gastrointestinal diseases responsible for abdominal pain. The underlying disease process often results in disturbances of patient’s hydration and acid-base status, along with electrolytes abnormalities. The use of fluid therapy is a common practice to address fluids disturbances in horses. The present literature review aimed at analyzing the different types of fluids available in equine practice, along with the different routes and administration protocols that can be used. Special emphasis was put on the place of fluid therapy in the treatment of medical and surgical colic. Results: Most colic horses that require fluid support receive intravenous administration of a balanced crystalloid fluid such as Ringer’s Lactated Solution as first-line treatment. However, a good understanding of the underlying disease process is mandatory as it allows the correction of hemostasis disruptions that are specific for each pathogenesis. Fluid therapy should therefore be adapted to the patient’s condition and guided through the use of both clinical and laboratory examination parameters. Although the intravenous route is the recommended way in horses that present a non-functional intestinal tract and during the perioperative period, the enteral route has proven to be most efficient when it comes to solving impactions. The choice among crystalloid fluids should be made according to patient’s electrolyte and acid-base disturbances, and special supplementation should be added if necessary. Synthetic colloids are controversial as they can be of use in the preoperative period or in hypoproteinemic horses, but their adverse effects in horses are poorly documented and caution is still advised. Administration of fluids is a cornerstone treatment when it comes to medical colics. In impaction colics, fluids therapy aims at overhydrating the intestinal content to soften the feces through oral administration of balanced isotonic solutions often coupled with laxative administration. In horses suffering from proximal jejunitis or colitis, intravenous administration of isotonic crystalloids is necessary to replace the major fluid and electrolytes losses induced by reflux or diarrhea and avoid hypovolemic shock. In surgical colic, pre-operative fluid resuscitation is mandatory to correct shock and avoid the negative consequences of hypovolemia during the intervention; and can rapidly be achieved using hypertonic saline, colloids or a combination of both through the intravenous route. Intraoperative fluid administration consists mainly in maintaining the vascular volume and tissue perfusion during the surgery using isotonic crystalloids at a slow rate. While during the post-operative period, fluid administration is used in the anorectic patient to maintain its hydration status and eventually support caloric intake through the use of parenteral nutrition. Fluid therapy is also an essential treatment to eventual complications that might arise following colic surgery ( diarrhea, ileus). Conclusion: Fluid therapy is a core treatment of both medical and surgical colics. As there is no current guideline or consensus for fluid administration in colic horses, the administration protocol and fluid’s choice is at the practician’s discretion. To be effective, the fluid plan should always be customized to each colic patient and regularly reevaluated and adjusted d to best fit his needs.