5.Fluid therapy: the chptr that never ends

Question 1

Which of the following is true regarding fluid therapy?
a.Albert Landere and Rudolph Matas pioneered fluid therapy for management of
surgical patients in the 20th century
b.All compartments have the same osmolarity of 290-310mOsm/L
c.There is a decrease in total body water in emaciated pets
d.NaK/ATPase takes K out of the cell and transports Na into the cell

Answer 1

B is correct

a.pioneered fluid therapy in the 19th

c. INCREASE in total body water in emaciated pets, very young and pregnant animals - decrease is in aging animals, acute exercise, obese animals, and chronic exposure to high altitudes
d. NaK/ATPase takes NAout of the cell and transports K into the cell

Question 2

Which of the following is false regarding body fluid composition?
a.Water comprises 60% of body weight in a normal adult dog or cat
b.Intracellular fluid comprises 66% of total body water and therefore 40% of body
weight
c.Extracellular fluid comprises 20% of total body water and 33% body weight
d.Plasma makes up 25% of extracellular fluid

Answer 2

c. Extracellular fluid comprises 33% of total body water and 20% body weight
(opposite)

Further broken down into plasma and interstitial fluid

Question 3

Which of the following is true?
a.Fluid deficits are replaced over 12-24 hours
b.Loss of hypotonic fluids lead to decrease in extracellular fluid tonicity and shifts
fluids from extracellular to intracellular
c.Maintenance fluid rates range from 1-3ml/kg/hr and take into account normal
body losses of urinary, fecal, salivary fluid, respiratory, and cutaneous losses
d.Ongoing losses include vomiting, diarrhea, polyuria, and burns

Answer 3

D is correct(additionally, third spacing and blood loss)

Deficits replaced over 6-24

b. Loss of hypotonic fluids lead to INCREASED TONICITY
c. Maintenance 2-4 ml/kg/hr

Question 4

1. Which is true?
   a. Isotonic crystalloids are maintenance crystalloids.
   b. All isotonic crystalloids contain a bicarbonate precursor, such as lactate, acetate, or gluconate.
   c. Replacement crystalloids are hypotonic.
   d. Acetate is metabolized most often in muscle tissue, whereas gluconate can be metabolized by most cells in the body.

Answer 4

D is correct

maintenance = hypotonic

0. 9% NaCl does not and tends to be acidifying, the rest do contain a buffer
   c. Replacement crystalloids= isotonic

Question 5

2. Which is false?
   a. Surgical patients with head trauma should be resuscitated ideally with LRS.
   b. Following the intravenous infusion of isotonic crystalloids, rapid equilibration of electrolytes and water between the intravascular and interstitial space ensues over 20 to 30 minutes.
   c. 75% of the volume infused redistributes to the interstitial space.

Answer 5

A
head trauma should be resuscitated w/
(0.9% NaCl because this fluid has the highest sodium concentration and therefore is least likely to cause a decrease in osmolarity and subsequent water movement into the brain interstitium)

Question 6

Which is true concerning hypertonic saline?
a.Rates exceeding 0.5 mL/kg/min may result in osmotic stimulation of pulmonary
C-fibers, which leads to vagally mediated hypotension, bradycardia, and
bronchoconstriction and should be avoided.
b.The osmolarity of mannitol is about half that of hypertonic saline.
c.Dehydrated patients warrant treatment with hypertonic saline.
d.If hypertonic solutions are administered in small peripheral veins, hemolysis and
phlebitis can result because of the Cl content of the fluid.

Answer 6

B is correct

> 1 mL/kg/min –> osmotic stimulation

use contraindicated in dehydration - these patients are interstitially volume depleted,
thus limiting the effectiveness of the fluid and predisposing to further dehydration)

Hemolysis/phlebitis due to the hypertonicity of the fluid, not the Cl content

Question 7

What is not a commonly described characteristic of Hydroxyethyl starch solutions?

a. Degree of substitution
b. Weight average molecular weight
c. Concentration
d. Medium weight average molecular weight
e. Low​ weight average molecular weight

Answer 7

E

(High)​ weight average molecular weight

Question 8

True​ or false: Lower weight average molecular weight hydroxyyethyl starches like Vetstarch are thought to be better because of more rapid clearance and minimized contact with factor VIII and
vWF which may result in less coagulopathies.

Answer 8

TRUE

Question 9

Which of the following has been shown to benefit from hypertonic, hyperoncotic small-volume resuscitation?

a. GDV
b. Pyometra
c. Burns
d. Hemorrhagic shock
e. All of the above

Answer 9

E all

Question 10

What percentage blood volume can animals tolerate losing acutely?

a. 8-10%
b. 10-15%
c. 16-20%
d. 20-24%

Answer 10

B 10-15%

Question 11

True o​r false:​ Canine blood donors should be dog erythrocyte antigen 1 and 7 ​positive​ if possible.

Answer 11

FALSE

negative

Question 12

Extracellular K concentration is strictly regulated as is between:

a. 2.6-3.4
b. 3.5-5.5
c. 5.6-7.4
d. 7.5-8.4

Answer 12

b.3.5-5.5

Question 13

Which is not true concerning hyperkalemia on an ECG?

a. Spiked T waves
b. Prolonged PR interval
c. Prolonged PT interval
d. Widened QRS
e. P waves disappear

Answer 13

c.Prolonged PT interval - False - hypokalemia

Question 14

What is true about calcium homeostasis?
a)Acidoses shift ionized calcium to the protein-bound calcium form
b)Hypoalbuminemia can make total serum calcium appear artificially high
c)Hypoalbuminemia makes ionized calcium lower
​d)Hypoalbuminemia has no effect on ionized calcium

Answer 14

D is correct

a) acidosis shifts from protein to ionized form)
b) Hypoalbuminemia can make total serum calcium appear artificially LOW

Question 15

What the most common cause of hypercalcemia in cats? 
a)Hypercalcemia of malignancy 
b)Chronic renal failure 
c)Lymphoma 
​d)Idiopathic

Answer 15

D idiopathic

Question 16

3) What is true regarding ECG changes in the hypercalcemic dog?
a)Prolonged Q-T interval
b)Shortened P-R interval
​c)Wide QRS complex
d)Atrial fibrillation

Answer 16

C correct

a) Q-T interval (shortened)
b) P-R interval (prolonged)
d) (ventricular fibrillation)

Question 17

Which of the following is false regarding hypermagnesemia?
a. Reported causes include renal failure, hypoadrenocorticism, hyperparathyroidism, hypothyroidism, and iatrogenic
b.Clinical signs are seen with magnesium concentrations greater than or
equal to 3mg/dL
c.Clinical signs include hypotension, weakness, abnormal clotting and coagulation, ECG changes (i.e. prolonged PR interval, prolonged QRS complexes, heart block and asystole)
d.Treatment mainly includes fluids and furosemide (loop diuretic)

Answer 17

b.

Clinical signs are seen … greater than 4mg/dL

Question 18

True or false: in canines there is a phosphorous dependant red blood cell regulation system which is the underlying cause for hemolysis secondary to severe
hypophosphatemia

Answer 18

(False, that is only true for those of Japanese or Korean origin)

worry more about hemolysis with hypophosphatemia in Jap and Kor breeds

Question 19

Which of the following is true?

a. Corrected chloride calculation for dogs is [C] corrected = [Cl} measured x156/[Na] measured
b. Hypochloremia is <117mEq/L in dogs
c. Hyperchloremia is >123mEq/L in cats
d. Potassium bromide is a cause of hypochloremia

Answer 19

C is correct

A and B is cats
pseudohyperchloremia from KBr therapy

Question 20

Which of the following is true regarding glucose?

a. Hypoglycemia is BG < 65mg/dL
b. Hand held glucometers work best on serum
c. Pseudohyperglycemia can be seen with samples run on polycythemic patients
d. Whipple’s triad entails low blood glucose concentration, concurrent clinical signs of hypoglycemia, and resolution of clinical signs when glucose returns to normal

Answer 20

D is correct

hypo= < 60
they are made for whole blood
anemic patient –> pseudohyperglycemia

Question 21

.Which is true?
a.Hypoglycemia due to decreased intake of glucose is common in adult animals because glycogenolysis and gluconeogenesis do not
provide adequate production of glucose to keep up with metabolic demands during fasting.
b.Approximately 50% of hepatic function must be lost before glucose levels are
Affected.
c.Sepsis is thought to decrease BG by decreasing circulating levels of cytokines
(e.g.tumor necrosis factor-a, interleukin-6).
d.Sepsis is thought to decrease BG by decreased hepatic responsiveness to
counter-regulatory hormones (catecholamines, glucagon, glucocorticoids,
and growth hormone).

Answer 21

D is correct

A(is NOT common
70%)
Increases levels of cytokines, which causes increased utilization of glucose by the tissues.

Question 22

Which is false?
a.Stress hyperglycemia was found to occur in 16% of critically ill dogs and in 54%
of critically ill cats
b.Hyperglycemia has been correlated with decreased morbidity in dogs
presenting with congestive heart failure.
c.Hyperglycemia can have adverse effects on cellular hydration by pulling fluid
from the intracellular space to the extracellular space with its osmotic force.
d.Hyperglycemia can have adverse effects on cellular hydration by spill over of the
excess glucose spills into the urine, causing an osmotic diuresis and preventing
normal reabsorption of fluid from the renal tubules.
e.Glucose does not readily diffuse across cell membranes.

Answer 22

B

increased

Question 23

Which is false?
a.At supraphysiologic pH, carbonic acid readily dissociates to bicarbonate
and a hydrogen ion.
b.Normal hydrogen ion concentration is 40 nm/L.
c.Concentrations of hydrogen ions that are compatible with life range from 16 to
160 nanomol/L (pH = 6.8 to 7.8).
d.Carbonic acid is the only significant volatile acid in the body.

Answer 23

A

carbonic acid comes from carbon dioxide, then goes to bicarb and H+ at physiologic pH

Question 24

Which is false?
a.The law of mass action states that the velocity of any reaction is proportionate to
the concentration of the reactants.
b.An acid, by definition, is a substance that can donate a hydrogen ion.
c.A chemical buffer is a weak acid and its conjugate salt that can accept or donate
a proton to minimize changes in fluid pH after the addition of a strong acid or base.
d.The primary buffers in the body include bicarbonate, carbohydrates, and
phosphate.

Answer 24

D

proteins, not carbs

Question 25

Where is 95% of filtered HCO3- reabsorbed?

a. Loop of Henle
b. Proximal Tubule
c. Distal tubule
d. Collecting duct

Answer 25

b.Proximal Tubule

Question 26

Which of the following statements is true?
a.Base excess refers only to the metabolic component, and a positive base excess value represents a base deficit, or nonrespiratory acidosis.
b.Law of electroneutrality is the basis for the anion gap, which states that UA-UC =
Cl and K - Na and HCO3.
c.Carbonic anhydrase converts CO2 and H2O back into H2CO3 in the renal
tubular cell for transport with Na+ into the tubular fluid
d.Ammonium ions are formed from metabolism of glutamine and then
combined with Cl- or exchanged for Na+ to adapt to an acid load

Answer 26

D is correct

(​negative​ –> deficit–> nonresp acidosis

​(Na+ + K+) - (Cl- + HCO3-)

HCO3- and Na transported across basilar membrane into interstitium

Question 27

3.True​ or False: Clinical signs of respiratory acidosis include tachyarrhythmias,
hypertension, and increased cardiac output due to catecholamine release.

Answer 27

TRUE

Question 28

Which is true?
A Hyperkalemia makes the resting membrane potential of cardiomyocytes more negative
B Cardiac changes with hyperkalemia are first seen at 7 mEq/L
C Cardiac changes with hyperkalemia include spiked T-waves and longer QT interval
D Between 10-12 mEq/L, asystole or vfib can occur

Answer 28

D true
a less -
b 5.7
c shortened QT

Question 29

Name the treatments for hyperkalemia and how they function (4or5)

Answer 29

fluid therapy
insulin + dextrose - drives K+ into cells
calcium gluconate - raises threshold membrane potential to restore excitability
NaHCO3 - add a base, counteracts with H+ ions; drives K+ into cells in exchange for H+
B-2 agonists?

Question 30

3 processes that lead to hypocalcemia?

Answer 30

Impaired PTH synth
Impaired vitamin D synth
Chelation/precipitation of calcium

Question 31

Name of vitamin D? What does this do?

Answer 31

25-dihydroxycholecalciferol

Increased Ca2+ absorption from intestines

Question 32

What does calcitonin do? Where is it released from?

Answer 32

Inhibit bone resorption and release of Ca2+

Released from thyroid gland

Question 33

Which of the following is true regarding glucose?

a. Brain cells are unique from all other organs in that they are permeable to glucose and can use it without the aid of insulin
b. If blood glucose levels fall below 60-80mg/dL clinical signs of hypoglycemia may results (including depression, ataxia, seizure, coma)
c. When blood glucose levels are elevated alpha cells of the pancreas secrete insulin to stimulate uptake of glucose in the cells
d. During hypoglycemia glucagon is secreted by beta cells to stimulate glycogenolysis and the release of glucose from the liver

Answer 33

A true
B 30-50 mg/dL
c alpha –> glucogon
D beta–> insulin

Question 34

Where in the body is the majority of HCO3- reabsorbed? And what percentage?

Answer 34

Ninety percent to 95% of filtered HCO − is reabsorbed in the proximal tubule, and the rest is reabsorbed in the loop of Henle, distal tubule, and collecting duct.

Question 35

T/F: Metabolic acidosis can result in a blood pH <7.2, which can alter myocardial contractility and vasomotor tone and can cause cardiac arrhythmias.

Answer 35

true

Question 36

Which of the following is FALSE about metabolic acidosis?
A defined as a low [HCO3−] with a low pH.
B Compensatory hyperventilation is stimulated by peripheral and central chemoreceptors that sense the decreased pH.
C Chronic metabolic acidosis can result in bone demineralization as calcium carbonate is released from bone stores to buffer the acidosis.
D Renal response to an acid load includes increasing H+ excretion by decreasing ammonium ion excretion

Answer 36

D FALSE
A low [HCO3−] with a low pH
B chemoreceptors that sense the decreased pH
C Chronic metabolic acidosis can result in bone demineralization as calcium carbonate.
D renal response to an acid load includes increasing H+ excretion by INCREASING ammonium ion excretion

Question 37

What is the profile for a primary respiratory alkalosis?

Answer 37

A low PaCO2 with an elevated pH is a primary respiratory alkalosis.

Question 38

What is the compensatory response to respiratory acidosis? And how long does it take?

Answer 38

increased renal excretion of H+, which results in increased extracellular HCO −. The compensatory response takes 3 to 5 days to have full effect

Question 39

T/F Neoplasms associated with hypoglycemia include insulinomas, hepatomas, hepatocellular carcinomas, adenocarcinomas, leiomyomas, leiomyosarcomas

Answer 39

True

Question 40

T/F Stress hyperglycemias was found to occur in 16% of critically ill dogs and 54% of critically ill cats

Answer 40

true

Question 41

T/F Approximately 80% of hepatic function must be lost before glucose levels are affected

Answer 41

false (70%)

Question 42

Which of the following is true?
A. clinical signs of hypermagnesemia = ventricular or atrial arrhythmias, hypertension, muscular weakness, hyperesthesia, muscle tremors, ataxia, CNS depression, seizures, nausea or anorexia
B. Clinical signs of hyperphosphatemia are caused from associated hypocalcemia, or from soft tissue mineralization
C. GI losses such as diarrhea result in hypochloremia
D. clinical signs of hypomagnesemia = prolongation of PR interval, widening QRS complex, heart block and asystole, hypotension, interfere with normal clotting and coagulation

Answer 42

B true
A hypO
C proximal GI/Vomiting –> hypochloremia (diarrhea –> Na loss and relative hyperkalemia)
D HypER

Question 43

Which of the following is true?
A. Most of phosphorus is hydroxyapatite in bone, 70%
B. Most dogs use a phosphorus-dependent RBC regulation system
C. Chloride has a reciprocal relationship with sodium and that is why there is a corrected calculation with Na
D. Acute or chronic renal failure is the most common cause of hyperphosphatemia

Answer 43

D true
A 85%
B P IN-dependent
C Cl-/ HCO3- and free water balance –> correction with Na

Question 44

Which of the following is most true?
A Serum magnesium is in 2 forms: protein bound and ionized
B Insulin therapy can result in hypermagnesemia by pulling Mg out of cells
C Hypocalcemia and hypokalemia may be refractory to therapy until Mg concentrations are restored
D Intestinal malabsorption and excretion is the most common cause of hypermagnesemia

Answer 44

C true
A 3 forms: chelated, ionized, protein bound
B hypOmg (as well as excess catecholamines (sepsis, trauma)
D renal failure –> hypERmg

Question 45

Which of the following is true regarding potassium in the body?
A It is a major intracellular cation that maintains a net negative resting membrane potential of -70mV
B The most common cause of hyperkalemia is due to altered distribution to extracellular fluid
C Clinical signs associated with hypokalemia are noted after <2.5mEq/L
D C/s due to hyperkalemia are due to decrease in the resting membrane potential of cardiac myocytes

Answer 45

D true
A -90
B (decreased potassium excretion is most common)
C (<3 mEq/L)

Question 46

Which of the following is true regarding hypernatremia?
A It is associated with hyposmolarity
B Pure water loss is typically secondary to DI, inadequate water intake, increased insensible loss, heatstroke and burns
C Clinical signs are seen if sodium is >175 mEq/L in dogs and >170mEq/L in cats
D Clinical signs are secondary only to intracranial hemorrhage

Answer 46

B true
A always hyperosmolarity
C > 170 in dogs and >175 cats
D (neuronal dehydration and intracranial hemorrhage)

Question 47

What is the breakdown of water in the adult dog/cat?

Answer 47

What is the breakdown of water in the adult dog/cat?

Total body = 60% water

Intracellular = ⅔ (40% BW); extracellular = ⅓ (20% BW)

Extracellular: plasma (intravascular) = 25%; interstitial = 75%

Question 48

What is the most important transporting pump?

Answer 48

What is the most important transporting pump?

Na+-K+/ATPase (kicks out Na+ and imports K+ into cell, active & consumes ATP)

Question 49

Which of these does not freely diffuse across the glycocalyx of the capillary wall?

1. Glucose
2. Bicarbonate
3. Lactate
4. Oxygen & CO2
5. Ions
6. Proteins

Answer 49

Which of these does not freely diffuse across the glycocalyx of the capillary wall?

6. Proteins

These do:

1. Glucose
2. Bicarbonate
3. Lactate
4. Oxygen & CO2
5. Ions

Question 50

Define oncotic pressure & hydrostatic pressure.

Answer 50

Define oncotic pressure & hydrostatic pressure.

Oncotic pressure = osmotic pressure generated by proteins

Hydrostatic pressure = pressure within the vascular space determined by blood volume, vascular resistance, and blood pressure

Question 51

What are some differences between hypotonic fluid loss vs isotonic vs hypertonic fluid loss?

Answer 51

What are some differences between hypotonic fluid loss vs isotonic vs hypertonic fluid loss?

Hypotonic (pure water loss):
Tonicity of extracellular fluid increases, shifting H2O from intracellular to extracellular & causing intracellular dehydration
Can see cerebral obtundation, hypernatremia/hyperosmolarity

Isotonic:
No fluid shift, just volume depletion of extracellular fluid:
- Interstitial dehydration = decreased skin turgor, dry mucus membranes
- Intravascular (plasma) dehydration = compensatory vasoconstriction, pale MM, poor pulses, tachycardia, prolonged CRT, cold extremities, elevated PCV/TP/USG, prerenal azotemia

Hypertonic (loss of solutes more than water):
Tonicity of intracellular fluid increases, shifting H2O from extracellular to intracellular, & causing extracellular dehydration

Question 52

Which is false?

1. The 2012 Surviving Sepsis Guidelines include early goal-directed therapy in the treatment of severe sepsis and septic shock, which also includes administration of broad spectrum antimicrobials within 2 hours of recognition of sepsis.
2. Aggressive volume resuscitation for noncardiogenic shock increases intravascular volume which will increase left ventricular end-diastolic volume (preload), stroke volume, and cardiac output and therefore will increase systemic oxygen delivery.
3. “Hypotensive resuscitation” can be performed in patients with uncontrollable bleeding (to a mean arterial pressure of approximately 60 mm Hg or a systolic blood pressure of approximately 90 mm Hg)
4. Current veterinary guidelines for intraop IVF state that dogs should be started at an initial rate of 5 mL/kg/h of crystalloids and cats started at 3 mL/kg/h

Answer 52

Which is false?

1. The 2012 Surviving Sepsis Guidelines include early goal-directed therapy in the treatment of severe sepsis and septic shock, which also includes administration of broad spectrum antimicrobials within 2 hours of recognition of sepsis.
   * *Should be within 1 hour.**

These are TRUE:
2. Aggressive volume resuscitation for noncardiogenic shock increases intravascular volume which will increase left ventricular end-diastolic volume (preload), stroke volume, and cardiac output and therefore will increase systemic oxygen delivery.

3. “Hypotensive resuscitation” can be performed in patients with uncontrollable bleeding (to a mean arterial pressure of approximately 60 mm Hg or a systolic blood pressure of approximately 90 mm Hg)
4. Current veterinary guidelines for intraop IVF state that dogs should be started at an initial rate of 5 mL/kg/h of crystalloids and cats started at 3 mL/kg/h

Question 53

What is the difference between “replacement” and “maintenance” crystalloid solutions?

Answer 53

What is the difference between “replacement” and “maintenance” crystalloid solutions?

Replacement fluids, are electrolyte-containing fluids with a composition similar to that of extracellular fluid. They have the same osmolarity as plasma (290 to 310 mOsm/L), and the electrolytes are small (i.e., sodium has a molecular weight of 23 daltons compared with glucose at 180 daltons).

“Maintenance” crystalloid solutions are hypotonic and contain less sodium (40 to 60 mEq/L) and more potassium (15 to 30 mEq/L) than the replacement solutions. Plasmalyte & LRS are replacement fluids.

Question 54

True or false?

Following the intravenous infusion of isotonic crystalloids, the small electrolytes and water freely pass across the vascular endothelium, and rapid equilibration between the intravascular and interstitial space ensues over 20 to 30 minutes. These fluids are “extracellular-expanding fluids,” and 25% of the volume infused redistributes to the interstitial space, whereas 75% remains in the vascular space.

Answer 54

FALSE (75%; 25%)

Corrected:
Following the intravenous infusion of isotonic crystalloids, the small electrolytes and water freely pass across the vascular endothelium, and rapid equilibration between the intravascular and interstitial space ensues over 20 to 30 minutes. These fluids are “extracellular-expanding fluids,” and 75% of the volume infused redistributes to the interstitial space, whereas 25% remains in the vascular space.

Question 55

Which one is false?

1. Surgical patients with head trauma should be resuscitated with 0.9% NaCl (highest Na+ concentration which is least likely to cause water movement into the brain)
2. Patients with severe hypo/hypernatremia need crystalloid fluids with a higher/lower Na+ concentration in order to normalization their sodium concentration.
3. Patients with a hypochloremic metabolic alkalosis may benefit from 0.9% NaCl because this is the highest chloride-containing fluid. It will help to normalize blood pH by dilution and by increased chloride level, with a subsequent decrease in bicarbonate concentration.
4. Patients that have a severe metabolic acidosis (not due to lactic acidosis) may benefit from a crystalloid that contains a buffer agent such as acetate, gluconate, or lactate (i.e., NOT 0.9% NaCl because this fluid tends to be acidifying).

Answer 55

Which one is false?

2. Patients with severe hypo/hypernatremia need crystalloid fluids with a higher/lower Na+ concentration in order to normalization their sodium concentration.
   FALSE - need crystalloid fluids that most closely match their concentration to avoid rapid increase/decrease in sodium concentration (no more than increase of 0.5 mEq/L/h or decrease of 1 mEq/L/h).

These are TRUE:
1. Surgical patients with head trauma should be resuscitated with 0.9% NaCl (highest Na+ concentration which is least likely to cause water movement into the brain)

3. Patients with a hypochloremic metabolic alkalosis may benefit from 0.9% NaCl because this is the highest chloride-containing fluid. It will help to normalize blood pH by dilution and by increased chloride level, with a subsequent decrease in bicarbonate concentration.
4. Patients that have a severe metabolic acidosis (not due to lactic acidosis) may benefit from a crystalloid that contains a buffer agent such as acetate, gluconate, or lactate (i.e., NOT 0.9% NaCl because this fluid tends to be acidifying).

Question 56

Name some hypotonic crystalloids:

Answer 56

Name some hypotonic crystalloids:

Maintenance fluids are hypotonic crystalloids that are low in sodium, chloride, and osmolarity but may be high in potassium compared with normal plasma concentrations. Maintenance solutions include 0.45% sodium chloride, 2.5% dextrose with 0.45% saline, Plasma-Lyte M with 5% dextrose, Normosol-M, and Plasma-Lyte 56. Free water solutions include 5% dextrose (D5W).

Question 57

What are some side effects of hypertonic saline?

Answer 57

What are some side effects of hypertonic saline?

1. Increased Na+ & Cl-, decreased K+ & bicarb
2. Hemolysis & phlebitis if given in small peripheral veins
3. Arrhythmias if given via jug catheter in the R atrium, also cardiac depression
4. Limited efficacy if given to dehydrated animals

Question 58

What are some side effects of synthetic colloids?

Answer 58

What are some side effects of synthetic colloids?

1. Disruption of normal coagulation (decrease in factor VIII & von Willebrand, impairment of platelet function, interference with stability of fibrin clots making it more susceptible to fibrinolysis)
2. Renal impairment (in people)
3. Allergic reactions (in people)

Question 59

Fill in the blanks:
Most animals can tolerate an acute loss of ______% of blood volume without requiring natural blood product transfusions (although intravascular volume resuscitation is vital). Acute hemorrhage exceeding ____% of the blood volume often requires transfusion therapy in addition to crystalloid and colloid therapy (as discussed earlier). In animals with acute blood loss requiring transfusion therapy, fresh whole blood or packed red blood cells and fresh frozen plasma should be used to stabilize clinical signs of shock, maintain hematocrit above ____%, and keep clotting times within the normal range.

Answer 59

Fill in the blanks:
Most animals can tolerate an acute loss of 10% to 15% of blood volume without requiring natural blood product transfusions (although intravascular volume resuscitation is vital). Acute hemorrhage exceeding 20% of the blood volume often requires transfusion therapy in addition to crystalloid and colloid therapy (as discussed earlier). In animals with acute blood loss requiring transfusion therapy, fresh whole blood or packed red blood cells and fresh frozen plasma should be used to stabilize clinical signs of shock, maintain hematocrit above 24%, and keep clotting times within the normal range.

Question 60

How long are platelets present in stored whole blood after collection? And how long are clotting factors functional for?

Answer 60

How long are platelets present in whole blood after collection?
Best given within 8hrs, platelets gone after 24hrs.

And how long are clotting factors functional for? 24hrs

Question 61

What are some adverse effects of a blood transfusion and reactions seen?

Answer 61

What are some adverse effects of a blood transfusion and reactions seen?

1. Fever, restlessness, vomiting or diarrhea, acute collapse, wheezing, dyspnea, urticaria, hemoglobinemia or hemoglobinuria, and/or hypotension
2. Pulmonary emboli, acidosis, and/or hypocalcemia or hypomagnesemia
3. Transfusion-associated circulatory overload (TACO), secondary to fluid overload secondary to significant oncotic pull from blood products
4. Nonhemolytic febrile reaction, increase of body temperature of at least 1°C within 30 to 60 minutes of transfusion and lasting up to 20 hours (with no other apparent cause for the elevation)
5. Transfusion-related acute lung injury (TRALI) (most common cause of human mortality), onset of respiratory distress within 24 hours of a transfusion with no other significant indicating factor (e.g., cardiac disease, pneumonia) and is most commonly associated with plasma transfusions

Question 62

What is the primary extracellular cation in the body?

Answer 62

What is the primary extracellular cation in the body?

Na+

Question 63

What are the causes of hyponatremia?

Answer 63

What are the causes of hyponatremia?

1. Low plasma osmolality
   - Hypervolemia (CHF, nephrotic syndrome, severe liver dz, advanced kidney failure)
   - Normovolemia (psychogenic polydipsia, syndrome of inappropriate ADH release, antidiuretic drugs like narcotics/vincristine/NSAIDS, myxedema, hypotonic fluid infusion)
   - Hypovolemia (GI loss like v/d, 3rd space loss like pancreatitis/peritonitis/uroabd/cavitary effusion, cutaneous loss like burns, renal loss like addison’s/diuretic admin)
2. Normal plasma osmolality (“pseudohyponatremia”)
   - hyperproteinemia
   - hyperlipidemia
3. High plasma osmolality
   - hyperglycemia
   - mannitol infusion

Question 64

What happens to the brain with acute hyponatremia and what are some clinical signs?

Answer 64

What happens to the brain with acute hyponatremia and what are some clinical signs?

Signs of acute hyponatremia include central nervous system depression, ataxia, coma, or seizures secondary to cerebral edema as fluid from the extracellular space moves intracellularly. Clinical signs of chronic hyponatremia are similar but are rarely seen in small-animal medicine. Signs of cerebral edema most commonly develop at concentrations less than 120 mEq/L, or with rates of decrease greater than 0.5 mEq/L/h.

Question 65

What are the causes of hypernatremia?

Answer 65

What are the causes of hypernatremia?

1. Hypovolemic
   - GI loss (v/d, obstruction)
   - 3rd space loss (pancreatitis, peritonitis)
   - Cutaneous loss (burns)
   - Renal loss (failure, osmotic diuresis with diabetes mellitus/mannitol infusion, diuretics, postobstructive diuresis)
2. Normovolemic
   - Diabetes insipidus (nephrogenic/central)
   - inadequate water intake (hypodipsia, restricted, unable)
   - increased insensible losses (hot environment, fever, exercise, seizures)
3. Hypervolemia
   - Excessive salt intake
   - Hypertonic IVF (hypertonic saline, sodium bicarb, sodium phosphate enemas, parenteral nutrition)
   - Cushings
   - Hyperaldosteronism

Question 66

In chronic hypernatremia, what rate of lowering the serum sodium concentration should not be exceeded?

Answer 66

In chronic hypernatremia, what rate of lowering the serum sodium concentration should not be exceeded?

0.5 mEq/L/h

Question 67

What is the major intracellular cation in the body, approximately 95% of which is contained in the cells?

Answer 67

What is the major intracellular cation in the body, approximately 95% of which is contained in the cells?

K+