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Module 16 > Advanced Fluid Therapy for the Small Patient > Flashcards

Advanced Fluid Therapy for the Small Patient Flashcards

1
Q

what is the purpose in giving fluids (2)

A
  1. dehydration
  2. shock: provide maintenance requirements, treat electrolyte imbalances, maintain oncotic pressure, diuresis
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2
Q

what is dehydration

A

deficit in total body water

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3
Q

what is the normal maintenance for dogs and cats

A

50 ml/kg/day

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4
Q

why might there be low consumption of water

A
  1. anorexia
  2. starvation
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5
Q

what might pathological fluid losses be due to (5)

A
  1. vomiting/diarrhea
  2. renal disease
  3. panting (pyrexia)
  4. exudation from wounds
  5. 3rd space losses
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6
Q

what are clinical signs of dehydration (3)

A

different than shock (tachycardia, collapse, poor pulses)

  1. tacky mm
  2. delayed skin tent
  3. eyes sunken into orbit
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7
Q

what are the clinical signs of <5% dehydration

A

no clinical signs

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8
Q

what are the clinical signs of 5-6% dehydration

A

subtle loss of skin elasticity

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9
Q

what are the clinical signs of 6-10% dehydration

A

definite loss of skin elasticity

eyes possibly sunken in orbits

possibly dry mucous membranes

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10
Q

what are the clinical signs of 10-12% dehydration

A

tented skin stands in place

eyes sunken in orbit

dry mucous membranes

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11
Q

what are the clinical signs of a patient 12-15% dehydrated

A

same as with 10-12% but with additional signs of hypovolemic shock progressing to collapse and death

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12
Q

what is the issue with using PCV/TP as estimators of dehydration

A

will both rise with dehydration

BUT

we rarely know the starting values

may change with disease

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13
Q

what fluid is used in most cases for dehydration

A

isotonic crystalloid

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14
Q

when is isotonic crystalloid not indicated to treat dehydration

A

where dramatic abnormalities in sodium concentrations are present

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15
Q

what are replacement fluids

A

containing water and electrolytes with a similar composition to ECF

these will diffuse throughout the ECF

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16
Q

what are examples of replacement fluids

A

0.9% NaCl (normal saline)

ringer’s solution (added potassium)

hartmann’s solution (also called lactated ringer’s or compound sodium lactate)

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17
Q

describe the differences of replacement fluids

A

ringer’s and hartmanns have added K and Ca

hartmann’s contains lactate

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18
Q

how fast should the fluid deficit be replaced

A

over 24 hours

but also add maintenance and ongoing losses

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19
Q

4k cat with 8% dehydration, calculate the amount of fluid you would administer per hour in ml in the first 24 hours to this patient to correct for any deficits and provide maintenance requirements

A

8% x 4l = 0.08 x 4000ml = 320 ml

4kg x 50ml/kg/day = 200 ml

= 520ml total in 24 hours

= 22ml/hr

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20
Q

how do you deal with ongoing losses

A

estimation can be difficult

reassess at an appropriate interval (normally 12-24 hours) but may need to be 4 hours

check INS vs OUTS

add additional deficit to next period’s fluids

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21
Q

what are causes of potassium abnormalities (3)

A
  1. decreased intake
  2. translocation (ECF –> ICF)
  3. increase loss
22
Q

which is an emergency hyperkalemia or hypokalemia

A

hyperkalemia

leads to bradycardia

23
Q

what might the clinical signs be of hypokalemia

A

muscle weakness

PU/PD

24
Q

what are decreased intake causes of hypokalemia

A

admin of potassium free (ex. 0.9% NaCl) or deficient fluids (lactated ringer’s solution over several days)

25
Q

what are translocation causes of hypokalemia (6)

A
  1. alkalemia
  2. insulin/glucose containing fluids
  3. catecholamines
  4. hypothermia
  5. hypokalemic periodic paralysis
  6. albuterol overdosage
26
Q

what are increased losses of hypokalemia

A
  1. GI: vomiting, diarrhea
  2. urinary: chronic renal failure, distal renal tubular acidosis
  3. drugs: loop diuretics, thiazide diuretics, penicillins
27
Q

how is potassium supplemented

A

NaCl and hartmann’s may need to be spiked with potassium

28
Q

when is hypernatremia commonly seen

A

due to hypotonic fluid loss/salt intoxication

but intense thirst protects against

only commonly seen with neurological disorders and diabetes insipidus

29
Q

why must severe hypernatremia be corrected slowly

A

when giving fluids osmolarity increases and will draw water away from other organs such as the brain –> this produces idiogenic osmoles to protect itself from increases in serum sodium

if fluids without sodium are given you can drop the serum sodium faster than the brain causing the idiogenic osmoles to flood into the brain and cause cerebral edema

30
Q

what should the rate of change of serum sodium be in hypernatremia

A

0.5 mmol/l

31
Q

why must chronic severe hyponatremia be corrected slowly

A

risk of myelinosis

the rapid rise in sodium concentration is accompanied by the movement of small molecules and pulls water from brain cells

32
Q

at what level is hypoalbuminemia critically low

A

<15 g/l

33
Q

how do you treat the hypoalbuminemic patient

A

increasing production

and reducing loss

colloid osmotic pressure (COP) may be supported by using synthetic colloids

34
Q

at what rate should synthetic colloids be used to treat hypoalbuminemia

A

20ml/kg/day

35
Q

what are the side effects of colloids (3)

A
  1. coagulopathy
  2. renal damage
  3. anaphylaxis
36
Q

describe the differences between haemacel and pentastarch/tetrastarch 6%

A
37
Q

what is the issue with administering albumin

A

can be assocaited with severe anaphylaxis shock esp in relatively healthy dogs

$$$$

not nearly enought albumin in fresh frozen plasma to get concentrations up

38
Q

what electrolyte imbalances can chronic diarrhea or severe acute losses lead to

A

can lead to hypokalemia and metabolic acidosis

39
Q

what electrolyte imbalances does pre pyloric vomiting cause

A

loss of K+, Na+ and Cl- resulting in hypochloremic metabolic alkalosis

40
Q

why is metabolic alkalosis self perpetuating

A

increased renal reabsorption of bicarbonate in the presnece of volume, chloride and potassium depletion

ECF volume is preserve preferentially to pH

kidneys prioritize volume over acid/base balance

41
Q

what is paradoxical aciduria

A

acidic urine pH despite extracellular alkalemia

42
Q

what fluid would be indicated in a metabolic alkalosis due to vomiting

A

use an acidifying fluid with high chloride concentration

(not hartmann’s Cl isn’t high enough)

normal saline with some potassium mixed in

43
Q

what fluid would you use in a dehydrated patient with pancreatitis

A

evaluate degree of shock

commonly used hartmanns

44
Q

why is fluid therapy an important treatment for pancreatitis

A

fluid therapy is important to maintain pancreatic microcirculation

45
Q

why would fresh frozen plasma be used in pancreatitis

A

replenishes antiproteases primarily a-macroglobulins

46
Q

how do bowel obstructions cause fluid imbalances

A

marked loss of fluid and electrolytes into the intestine

increased secretion of sodium, potassium and albumin into the lumen

metabolic acidosis is a consequence of bicarb loss

perforation/breakdown of GI barrier may lead to septic shock

47
Q

what liver diseases can cause fluid imbalances (8)

A
  1. impaired ability to metabolize lactate (hartmann’s) in severe hepatic dysfunction
  2. hypoalbuminemia
  3. coagulopathy
  4. hypokalemia (due to enteric losses, hyperaldosteronism)
  5. variable acid/base changes
  6. hypoglycemia
  7. hepatic encephalopathy (worsened by hypokalemia and alkalosis)
  8. ascites
48
Q

what if there are patients that only require maintanence fluids (ex. comatose patients, patients with feeding tubes)

A

compared to the composition of hartmann’s or NaCl these patients need less Na and more K to compensate for normal losses

maintenance fluids generally contain less sodium and more potassium

glucose is usually added to make them isotonic and prevent hemolysis

49
Q

what should %5 dextrose not be used for

A
  1. calorific support
  2. treatment of shock: very rapidly metabolized leaving a hypotonic fluid which is not retained in the vascular space
  3. treatment of most dehydrated patients: most of these patients have electrolyte losses as well
50
Q

what are complications with fluid therapy (4)

A
  1. iatrogenic electrolyte disturbances
  2. overzealous use of fluids can lead to volume overload
  3. catheter issues
  4. complications with products (coagulopathy with colloids)
51
Q

what can volume overload cause (7)

A
  1. chemosis
  2. serous nasal discharge
  3. increased resp rate, effort and noise
  4. restlessness
  5. peripheral edema
  6. polyuria
  7. pulmonary and interstitial edema

Module 16 (26 decks)

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