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ONCOLOGY & CC > CCU: Fluids > Flashcards

CCU: Fluids Flashcards

1
Q

Total Body Water (TBW) is

A

60% of the body weight

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2
Q

The total body water is divided between

A

intracellular fluid (ICF) and extracellular fluid (ECF) water

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3
Q

In small animals, what percent of body weight is intracellular water (ICF)

A

40% of body weight (2/3 of TBW which is 60%)

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4
Q

In small animals, what percent of body weight is extracellular water (ECF)

A

20% of body weight (1/3 of TBW)

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5
Q

Extracellular water (ECF) is about 1/3 of the total body water. How is this further divided

A

Interstitial Water: 75%
Intravascular Water: 25%

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6
Q

2/3 of TBW is ________ while 1/3 of TBW is _______

A

2/3: intracellular fluid
1/3: extracellular fluid (75% int, 25% IV)

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7
Q

What is the barrier between ICF and ECF compartments

A

-Semi-permeable cell membrane
-Freely permeable to water based on concentration gradients
-Impermeable to electrolytes and proteins unless by tranport

Fluid moves because of osmotic forces

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8
Q

How does fluid move between ICF and ECF

A

via osmotic forces

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9
Q

How does fluid move within the ECF, specifically between the Interstitial and IV spaces

A

Endothelium
freely permeable to electrolytes based on concentration gradients- water will follow
relatively impermeable to proteins, larger molecules
*Fluid moves because of Starling forces

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10
Q

How does fluid move across semi-permeable membrane (between ICF and ECF)

A

osmotic forces

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11
Q

How does fluid move across endothelium (between Int and IV)

A

Starling’s forces

freely permeable to electrolytes based on concentration gradients

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12
Q

Loss of ECF is

A

dehydration

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13
Q

Loss of isotonic fluid is

A

loss of ECF
-osmolality does not change
-dehydration

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14
Q

Loss of hypotonic fluid is

A

loss of ICF
-may depend on how hypotonic the fluid is

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15
Q

Loss of intravascular fluid volume is

A

shock
-redistribution of fluids between ECF/ICF

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16
Q

Isotonic fluid will distribute to

A

ECF based on body fluid distribution

if you give 100mL
75mL in int while 25mL in IV

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17
Q

What are the signs of dehydration

A

-Changes in body weight
-Tacky mucous membranes
-Decreased skin elasticity
-Sunken eyes in orbit
-Signs of hypovolemia

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18
Q

What are the signs of mild dehydration

A

1) 5-7% change in body weight
2) Tacky mucous membranes
3) Slightly decreased skin elasticity
4) Normal position of the eye

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19
Q

What are the signs of moderate dehydration

A

1) 8-10% change in body weight
2) Tacky mucous membrane
3) Decreased skin elasticity
4) Eyes may be sunken

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20
Q

What are the signs of severe dehydration

A

1) 10-12% of body weight
2) Tacky mucous membranes
3) Skin stands in a fold
4) Sunken eyes
5) Hypovolemia signs

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21
Q

How fast should you correct dehydration

A

Between 4-24 hours (greater the dehydration the faster you replace it)

usually need to replace it in 8-12 hours

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22
Q

What factors influence the timeframe you correct dehydration

A

-Speed of loss
-Compensatory mechanisms
-Clinician’s experience and style
-Species
-Comobordities (heart, lung, kidneys)
-Age- young dogs very hard
-Practicality
-Monitoring abilities
-Severity of dehydration

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23
Q

You have a 28kg dog with 8% dehydration. How do you correct this fluid deficit over 12 hours

A

28 x 0.08 = 2.24 L
28 x 8 x 10= 2240mL

over 12 hours = 187 ml/hr

Can use LRS- most commonly used fluid in the US

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24
Q

What is the maintenance formula for dogs

A

132 x BW(kg)^0.75
or
70 x BW (kg)^0.75

or 40-60mL/kg/day
or 2-4mL/kg/hr (small dog higher end, big dog or cat use lower end)
or 30xBW(kg)+70ml/day

gives out mL/day

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25
Q

What is the maintenance formula for cat

A

70 x BW(kg)^0.75 =mL/day

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26
Q

Allometric scaling for maintenance

A

using BW^0.75 to determine maintenance - good because it isnt a linear scaling

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27
Q

the amount of fluid in the vascular space at equilibrium
depends on individual fluid behavior in the body

A

volume expansion power

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28
Q

What is the volume expansion power of hypotonic fluid

A

8.3%

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29
Q

T/F: hypotonic saline can be used for resuscitation

A

False- very had volume expansion power

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30
Q

What is the volume expansion power of isotonic crystalloid

A

25% (3/4 goes into the interstitial but it is cheap and forgiving)

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31
Q

What is the volume expansion power of colloids

A

80-120%

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32
Q

What is the volume expansion power of hypertonic saline (7.0-7.5 NaCl)

A

500-700% - pulls intracellular and interstitial fluid into the intravenous compartment

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33
Q

Why do you not want to give hypertonic saline too much

A

-Hypernatremia
-Intracellular dehydration
-Will go away in 30 minutes

good for TBI or equine practice

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34
Q

Rank the following on Volume Expansion power
Colloids, hypertonic saline, hypotonic saline, isotonic saline

A

HS > Colloids > isotonic fluid > hypotonic

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35
Q

Rank the following on Volume given for shock patients
Colloids, hypertonic saline, hypotonic saline, isotonic saline

A

Isotonic Fluid > Colloids > Hypertonic Saline

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36
Q

What is a shock dose of isotonic saline for K9-BV-EQ *

A

80-100 ml/kg

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37
Q

What is a shock dose of colloids/blood products for K9-BV-EQ *

A

20ml/kg

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38
Q

What is a shock dose of hypertonic fluid for K9-BV-EQ *

A

5ml/kg

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39
Q

What is a fluid challenge/mini-bolus for shock patients for K9-BV-EQ

A

10-20mL/kg (close to 1/4 of shock dose)

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40
Q

What is the shock dose for cats *

A

Isotonic Fluid: 40-60ml/kg
Colloids: 10ml/kg
Hypertonic fluid 3ml/kg
Blood products 10ml/kg

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41
Q

What is the isotonic fluid shock dose for cats*

A

40-60ml/kg

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42
Q

What is the colloid shock dose for cats*

A

10ml/kg

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43
Q

What is the hypertonic shock dose for cats

A

3ml/kg

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44
Q

What is the fluid challenge/mini bolus for cat patients

A

5-10ml/kg

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45
Q

How does the isotonic shock dose for dogs differ from cats

A

80-100ml/kg (dogs)
40-60ml/kg (cats)

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46
Q

How does the fluid challenge/ mini bolus dose for dogs differ from cats

A

Dogs: 10-20ml/kg
Cats: 5-10ml/kg

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47
Q

Whats a good first line of defense while you gather more information and investigate the cause of shock

A

Isotonic crystalloids

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48
Q

What is LRS shock dose for 12kg dog

A

800-1000mL

do 1/4 shock dose = 200-250 mL

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49
Q

How fast should you give the shock dose

A

aliquot the shock dose over a period of time
usually 5 to 30 minutes depending on
-severity of shock
-speed of loss
-compensatory mechanisms
-Clinicians experience and style
-Species
-Comorbidities
-Age
-Practicality
-Monitoring abilities
-Cause of shock

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50
Q

What happens if hypertonic saline is given too fast

A

bradycardia
vasodilation

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51
Q

What happens if hypertonic saline is given too slow

A

losses the VEP

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52
Q

What should you do after giving hypertonic saline

A

Follow up with another type of fluid
-Colloids or isotonic crystalloid
-But less volume of those are required (1/4 shock dose)
-Used as volume-sparing

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53
Q

T/F: hypertonic saline can be used in foals

A

False

54
Q

Hypertonic saline should be given over

A

full shock dose (3-5ml/kg) over 5 minutes
will redistribute in all compartments in 20-30min

55
Q

How are blood products delivered for shock

A

higher aliquots of volume as a shock dose (10-20ml/kg)
can be given fast (5-30minutes)
if possible, equal volume of plasma and red blood cells

56
Q

What products do you want to give the full shock dose

A

Hypertonic saline
Blood products

57
Q

For a hypotensive patient with uncontrolled hemorrhage, you need to keep the systolic blood pressure at ________ until the hemorrhage is controlled

A

80-90mmHg

58
Q

What should you do for sepsis

A

-early aggressive fluid resuscitation
-find and control source of sepsis
-early anti-microbial use

use of artificial colloids is controversial

59
Q

What should you do for burns

A

Higher volume of crystalloids to control for evaporative losses

Use colloids or albumin products (because of protein loss)

60
Q

Use blood products for fluid resuscitation when

A

there is severe hypovolemic hemorrhage shock

61
Q

What are the criteria to use blood products in vet med

A

-More negative base excess
-High lactate *
-More severe shock (higher HR, lower temp)
-Lower PCV and TP
-Higher ANimal Trauma score- orthopedic injuries
-Semi-quantitative FAST 3 and 4

62
Q

What should you do for a patient with massive blood loss and exsanguinating regarding fluids

A

rapid administration of blood products (red blood cell and plasma)
-minimize crystalloid use

63
Q

What is the main component of osmolality

A

Sodium

64
Q

What is the normal plasma/extracellular sodium

A

140-150 mmol/L

65
Q

What is the concentration of intracellular sodium

A

10 mmol/L

66
Q

What is the plasma osmolality equation

A

mOsm/kg = 2(Na+K) + BUN (mg/dL) / 2.8 + glucose (mg/dL)/18

67
Q

T/F: ECF osmolality = ICF osmolality

A

True

68
Q

What is normal osmolality

A

280-320 mOsm/kg

69
Q

What triggers ADH

A

1) Increase Na+
2) Hypovolemia- will dilute plasma and decrease Na+

70
Q

What is the mechanism of action of ADH

A

plugs aquaporins in the distal tubule to reabsorb only water

71
Q

What triggers thirst

A

increases in Na+, dehydration, hypovolemia

72
Q

ADH being triggered due to increases in Na+ is______________ while those triggered by hypocvolemia is

A

Increases Na+: very tightly regulated
feedback loop and Na decreases

Hypovolemia: Will dilute the plasma and decrease Na but less sensitive but very efficacious

73
Q

How does Na concentration change with isotonic fluid loss

A

Na concentration does not change

74
Q

What is the only ways to change Na+

A

1) Losses of free water
2) Gain of free water
3) Losses of hypertonic fluid… extremely rare
4) Gain of hypertonic fluid

75
Q

Hypernatremia means there is ________ water

A

not enough water

76
Q

Hyponatremia means that there is ________ water

A

too much water

77
Q

What are the causes of hypernatemia

A

Losses of free water
1) CNS disorders- hypo/adyspsia,
2) No access to water
3) Diabetes inspidus
4) Fever
5) Burns
6) Panting or tachypnea

Gain of hypertonic fluid
7) Salt intoxication
8) 7.5% NaCL

78
Q

What are the three main causes of hypernatremia

A

1) CNS disorders (hypo/adyspsia)
2) No access to water
3) Salt intoxication

79
Q

What are the causes of hyponatremia

A

Gain of free water
1) Fluid therapy with hypotonic fluid-D5W
2) ADH secretion- due to hypovolemia
3) High osmolality (hyperglycemia, mannitol)
4) Renal failure
5) Addison’s Disease
6) Accidental or voluntary water ingestion

Losses of hypertonic fluid
7) very rare

80
Q

How do patients with diabetes insipidus keep their sodium normal so they dont become hypernatremic

A

keep drinking, they are PU/PD

80
Q

Hyponatremia is most likely caused by________ *

A

ADH secretion due to hypovolemia

81
Q

T/F: 1% Na variation is normal

A

False- Na+ is very tightly regulated

82
Q

How do you treat hypernatremia

A

not enough water
treat the primary cause (ie DI or CNS)

use Hypotonic fluids
D5W= Dextrose 5% in Water (100% free water)
-0.45% NaCl, Plyte 56- needs double the fluid as not 100% water

83
Q

How do you determine the water deficit when treating hypernatremia

A

0.6 x BW(kg) x [(Patient Na/Normal Na)-1]

Normal Na:
145 mmol/L (dog)
150 mmol/L (feline)

84
Q

How fast do you correct hypernatremia

A

if chronic changes, compensatory mechanisms in place
recommend correction of chronic changes around 0.5mEq/L/h
eg.
chances from Na+ of 170 to 150 in 40 hours
Can be faster if know acuteness of disorder

85
Q

If you have a free water deficit (hypernatremia) , why do you not want to correct it rapidly

A

the cells are shrunken and producing idiogenic osmoles to return to normal cell volume
if the clinician is aggressive they can potentially become over swollen

86
Q

How do you treat hyponatremia

A

Too much water- treat the primary cause
1) Hypovolemia (ADH secretion)- give enough fluid any kind - IV
2) Treat renal disease
3) Mineralosteroids for addisons
4) Inappropriate ADH secretion- stop fluids +/- diurectics
5) Stop giving fluids (TPN, low Na+ containing fluids)
6) Diabetes mellitus: treat hypovolemia and hyperglycemia

87
Q

When fixing the hypovolemia / hyponatremia you should match the patient’s Na concentration within

A

10 mmol/L

88
Q

How do you treat SIADH

A

Stop fluids +/- diuretics

89
Q

What is delta Na equation and what is it useful for

A

Delta Na = (fluid Na-patient Na)/ (0.6xBW)+1

shows the impact of 1L of fluid

90
Q

When correcting hyponatremia, why should you never correct more than 0.5 mmol/L/hr

A

When there is free water excess, the cells are swollen and getting rid of idiogenic osmoles if you correct too fast then the cells will shrink

-Acute cerebral swelling shrinkage leading to seizures, changes in mentation

91
Q

What happens if you fix sodium abnormalities too rapid

A

Acute: Seizures, changes in mentation, etc due to acute cerebral swelling or shrinkage

Delayed: Osmotic demyelination syndrome- consequence of steep rise of sodium concentration, delayed 3-4 days
due to a quick rise in Na concentration (typically low to normal)
myelin loss in the brain (pons > other locations)
lethargy, weakness, ataxia, hypermetria
no treatment

92
Q

What causes osmotic demyelination syndrome

A

quick rise in Na concentration (typically low to normal but can also be normal to high)
delayed 3-4 days

93
Q

What are the results of osmotic demyelination syndrome

A

myelin loss in the brain (pons > other locations)
lethargy, weakness, ataxia, hypermetria
no treatment

94
Q

How does the treatment of hypernatremia differ from hyponatremia

A

HyperNa: give free water +/- treat primary; slow and only acute risks

HypoNa: primary cause +/- extra Na ; SLOW
acute and delayed risks

95
Q

Is potassium mostly intracellular or extracellular

A

Intracellular- 140 mEq/L

Extracellular/Plasma K+ is only 5mEq/L

96
Q

T/F: potassium has a very narrow therapeutic range

A

true

97
Q

What does potassium contribute to

A

the resting membrane potential
-cell excitability
-ability to generate an action potential

98
Q

What excretes potassium

A

Renal 90%
GI 10%

99
Q

what secretes K+ in the distal nephron

A

Aldosterone

100
Q

How does the body respond to hyperkalemia

A

Increased kaliuresis- increased concentration gradient in the distal nephron

101
Q

What allows increased uptake of K+ by the muscle

A

Increase Na-K-ATPase activity

102
Q

What influences regulation of K+

A

H+ concentration
Insulin
b-adrenergic activity
diuretics

103
Q

What are the 4 main causes of hyperkalemia *

A

1) Oliguria/anuria **
2) Urinary obstruction/ruptured **
3) Addisons Disease
4) Pseudohypoaldosteronism (third spacing, trichuris infection)

104
Q

What can cause hyperkalemia

A

1) Oliguria/anuria **
2) Urinary obstruction/ruptured **
3) Addisons Disease *
4) Pseudohypoaldosteronism (third spacing, trichuris infection) *
5) Increased intake (overzealous high K+ supplementation)
6) Tissue catabolism/reperfusion injury

105
Q

How do you diagnose hyperkalemia

A

-Serum K+
-ECG: bradycardia, spiking of t waves, widened qrs, decrease/loss of p waves, increase p-R interval, sin wave
-physical examination findings: bradycardia and hypothermia in urethral obstruction in cats

106
Q

in hyperkalemia, what would the ECG look like

A

-bradycardia
-spiking of t waves
-widened qrs
-decrease/loss of p waves
-increase p-R interval
-sin wave

107
Q

In urethral obstruction in cats, what is a physical exam finding

A

hypothermia and bradycardia

108
Q

What amount of potassium is very concerning and you should freak out

A

> 6-7.5mmol/L and clinical signs!

also primary disease: anuric renal failure vs urethral obstruction

109
Q

How do you counteract the cardiovascular effect of hyperkalemia

A

calcium administration - usually gluconate 10%

110
Q

How do you treat hyperkalemia

A

-IV fluids if able to urinate
-Insulin (+dextrose)
-Dextrose
-HCO3-
-Dialysis

Calcium gluconate to counteract cardiovascular effect

111
Q

What causes hypokalemia

A

1) Increased renal losses- diuretics and renal insufficiency
2) Translocation of K+
3) Increased GI loss - vomiting and diarrhea
4) Decrease intake (rare)

112
Q

What might cause hypokalemia due to increased renal losses

A

1) Diuretics *
2) Renal insufficency *
3) Hyperaldosteronism
4) Fluid therapy
5) Metabolic acidosis
6) Hypomagnesemia

113
Q

What might cause hypokalemia through translocation of K+

A

1) Insulin/dextrose therapy
2) b-adrenergic toxicity (albuterol)
3) Hypothermia
4) Metabolic alkalosis

114
Q

What might cause hypokalemia through increased GI loss

A

vomiting and diarrhea

115
Q

How do you diagnose hypokalemia

A

1) Serum K+
2) Physical exam: neck ventroflexion

116
Q

What is a physical exam finding of hypokalemia

A

neck ventroflexion

117
Q

You should treat hypokalemia when it is

A

less than 2.5-3.0

118
Q

How much KCl should you give to treat hypokalemia

A

supplement using table
*Do not exceed 0.5mEq/kg/hr
make sure to monitor, especially at high K+ supp rate

119
Q

What commonly cause hypercalcemia

A

Vitamin D toxicity (e.g cholecalciferol-based rat bait)
Neoplasia

120
Q

When Ca x P gets ___________ there is a risk for organ mineralization

A

> 60-70

121
Q

How do you treat hypercalcemia

A

IV fluids with 0.9% NaCl, furosemide, steroids

122
Q

What is a common cuase of hypocalcemia

A

eclampsia

123
Q

How do you treat hypocalcemia

A

Ca gluconate 10% at 0.5-1 mL.kg over 15-20 min

124
Q

What commonly causes hypomagnesemia

A

grass tetany in large animals
critically ill patients: SIRS, etc in SA

125
Q

How do you treat hypomagnesemia

A

treat with IV supplementation (magnesium sulfate or chloride) or use Plasmalyte 148/ Normosol R

126
Q

What is the equation for sodium deficit

A

0.6 x BW (kg) x (Normal Na-Patient Na)

127
Q

Shock should be staged based on severity using

A

1) Lactate measurement
2) Blood pressure
3) Decreased urine output

128
Q

What shock syndromes are not fluid responsive

A

Anemic
Hypoxemic
Metabolic Shock

129
Q

what shock syndrome is the most responsive to fluid resuscitation

A

hypovolemic

130
Q

Why is distributive shock only partially fluid responsive

A

vasopressors also needed to counteract inappropriate vasodilation

131
Q

Obstructive shock may also be fluid responsive but what else do you need to do

A

definitive treatment of underlying cause (ie. drain pericardial fluid or correct the gastric-dilation volvulus)

ONCOLOGY & CC (6 decks)

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