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Anesthesia > Applied Fluid Therapy > Flashcards

Applied Fluid Therapy Flashcards

1
Q

What are the overall contents that make up the fluid compartments? How does this relate to a 10 kg dog and 5 kg cat?

A

OVERALL TOTAL BODY WATER = 60%

  • 40% ICF
  • 20% ECF —> 15% Interstitial, 5% plasma

10 KG DOG
- TBW = 6 L —> 4 L ICF, 1.5 L interstitial, 0.5 L plasma

5 KG CAT
- TBW = 3 L —> 3 L = ICF, 0.75 L interstitial, 0.25 L plasma

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2
Q

What are the 3 types of fluid disturbances?

A
  1. changes in volume - dehydration, blood loss
  2. changes in content - hyperkalemia, hyponatremia
  3. changes in distribution - pleural effusion, pulmonary edema

treat root causes and correct prior to anesthesia if possible

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3
Q

What are the 3 stages of dehydration?

A
  1. mild (5%) - dry MM and loss of skin turgor
  2. moderate (8%) - worsened MM and turgor with rapid, weak pulses and exophthalmos
  3. severe (> 10%) - thready pulses, hypotension, altered consciousness (obtunded, not responsive)
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4
Q

How is dehydration corrected? How is this altered if the patient is hypernatremic? What fluid is commonly used?

A

BW (kg) x % dehydration x 1000 mL = mL needed to replace deficit

0.6 kg x (1 - [Na]/145) = water deficit in L

5% dextrose in water, but can reduce Na (stop if more than 0.5 mEq/L/hr)

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5
Q

How is hypovolemia corrected? What if the patient is hypokalemic?

A

expand intravascular volume with crystalloids at shock doses and/or colloids

can use separate IV access to administer K without exceeding 0.5 mmol/kg/hr

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6
Q

How do isotonic fluids work? What are 4 examples?

A

distribute fluids into ECF due to electrolyte content and osmolality being similar to the plasma

  1. 0.9% NaCl
  2. LRS
  3. PLA 148 / PLA
  4. Norm R
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7
Q

How do hypertonic fluids work? What is the most common example?

A

raises osmolarity to shift fluid from ICF to ECF

hypertonic saline (7.5% NaCl)

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8
Q

How do maintenance fluids work? What are 2 examples?

A

hypotonic - distribute to all 3 compartments (avoids cerebral edema!)

  1. 0.45% NaCl / 2.5% dextrose
  2. PLA 56
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9
Q

What are 3 examples of shock fluids? How do they work?

A
  1. Vetastarch artificial colloid
  2. whole blood, plasma, packed RBCs
  3. hypertonic saline (7.5%)

holds fluid in vascular space

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10
Q

What are the shock doses of crystalloids in dogs and cats? What is their function? Why must they be used cautiously?

A
  • DOGS = 90 mL/kg
  • CATS = 50 mL/kg

stabilizes the cardiovascular system

small patients with a lot of room temperature fluids causes hypothermia

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11
Q

What is the point of combining colloids and crystalloids? How is this done in dogs and cats?

A

increases vascular volume and replenishes interstitial deficits

  • DOGS = colloids 5-10 mL/kg + crystalloids 40-45 mL/kg
  • CATS = colloids 1-5 mL/kg + crystalloids 25-27 mL/kg
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12
Q

What colloid is especially used in larger patients with large volume loss? When is it not used?

A

hypertonic saline - translocated fluids from interstitium to intravascular space (4-5 mL/kg dog, 2-4 mL/kg cat) to achieve the greatest cardiovascular benefit

if patient is dehydrated or hypernatremia

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13
Q

How are daily fluid maintenance rates calculated for dogs and cats? What is it?

A
  • DOGS = 132 x BW^0.75 = 2-6 mL/kg/hr
  • CATS = 80 x BW^0.75 = 2-6 mL/kg/hr

amount of fluid to maintain normal fluid balance

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14
Q

What is the most common replacement fluid used? What long-term complication is associated?

A

lactated ringers - isotonic polyionic crystalloid that replaces lost body fluids and electrolytes

can cause electrolyte imbalance - hypernatremia, hypokalemia —> monitor serum electrolytes every 24 hrs

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15
Q

What are 4 functions of anesthesia fluids?

A
  1. correct ongoing fluid loss
  2. support cardiovascular function
  3. support maintenance of whole-body fluid
  4. counter negative effects of anesthetic agents - vasodilation, hypotension
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16
Q

What are some risks and adverse effects when too much anesthetic fluids are used?

A
  • vascular fluid overload
  • increased BW and lung water
  • coagulation defects
  • reduced GI motility and tissue oxygenation
  • increased infection rate
  • decreased PCV and TP
  • hypothermia - room temperature fluids
17
Q

What patients require altered anesthesia fluid rates?

A
  • cats
  • renal disease
  • cardiovascular disease

(typically lower rates)

18
Q

What should maintenance rates + replacement rates not exceed? What should be done if the procedure is more than 1 hour?

A

10 mL/kg/hr

reduce fluid rate by 25% hourly until daily maintenance rates are reached

19
Q

What are the overall basic maintenance anesthesia rates used in cats, dogs, and horses?

A

CATS = 3 mL/kg/hr

DOGS = 5 mL/kg/hr

HORSES = 5-15 mL/kg/hr

20
Q

What are 6 consequences of volume overload?

A
  1. cerebral edema
  2. pulmonary edema
  3. myocardial edema
  4. hepatic congestion
  5. increased venous pressure
  6. tissue edema
21
Q

What does the revised Starling equation state? How does this affect our approach to anesthetic fluids?

A

hydrostatic and oncotic pressure gradients are not only across capillary wall, but across functional and physical barrier known as the glycocalyx

  • colloids are not as effective as we once thought
  • fluid therapy is not benign and should be considered similar to administration of drugs
22
Q

What is the new approach to fluid therapy and anesthetic hypotension?

A

try a small dose of a fluid bolus

  • if there is improvement, the patient is a fluid responder
  • if there is no improvement, the patient is not a fluid responder and more fluids will NOT improve their condition
  • MAX FLUIDS = 20-30 mL/kg
23
Q

What drug is recommended to anesthesia-induced refractory hypotension? How does it work?

A

Dopamine

  • has action of alpha-1 and beta-1 receptors to improve arterial blood pressure and cardiac output
  • counteracts negative effects of inhalants on vasculature and heart
24
Q

When are colloids typically administered?

A
  • when it’s difficult to administer sufficient volumes of fluids rapidly enough for resuscitation or to achieve the greatest cardiovascular benefit with the least volume of fluids
  • large volume losses where crystalloids are not effectively improving or maintaining blood volume
  • when increased tissue perfusion and O2 delivery is needed
  • if edema develops, typically due to decreased oncotic pressure
  • need for longer duration of effect
25
Q

In what situation is hypertonic saline commonly used? When is it avoided?

A

hemorrhagic hypovolemic shock —> fast-acting, low-volume resuscitation

  • hypernatremia
  • severe dehydration
26
Q

How is hypovolemia addressed during anesthetic fluids? How can fluid therapy be used in this situation?

A
  • correct underlying disease, like CKD and heart disease
  • decrease/stop fluids
  • use diuretics

hypotonic (0.45%) NaCl for maintenance

27
Q

When is hyperkalemia suspected? How are fluids used for treatment?

A
  • urinary obstruction
  • uroabdomen
  • AKI
  • DKA
  • changes of echocardiogram

K-containing balanced electrolyte solutions - volume expansion + low K content in fluid compared to serum

28
Q

What fluids are recommended for treating hypernatremia?

A
  • replacement 0.9% saline (similar [Na] to serum)
  • once volume is met, start hypotonic solutions
29
Q

How are hypoproteinemic/hypoalbuminemic patients addressed?

A
  • nutritional support
  • plasma NOT often effective
  • synthetic colloids maintain fluid in intravascular space
30
Q

What are crystalloids?

A

fluids containing electrolytes and other solutes that can freely move between intra/extravascular fluid-containing spaces

31
Q

What are colloids? What is the difference between natural and synthetic colloids?

A

fluids containing large molecules that are restricted and stay within the intravascular space longer than crystalloids

  • NATURAL = blood, plasma, and albumin helpful to replacement of blood components —> potential for anaphylaxis!
  • SYNTHETIC = starches, polysaccharides, gelatins —> coagulation defects, exacerbate renal disease, overload (cats!)

Anesthesia (40 decks)

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