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Eq ACVS Phase 1 > Ch.3 Fluids, Electrolytes and Acid-Base Therapy > Flashcards

Ch.3 Fluids, Electrolytes and Acid-Base Therapy Flashcards

1
Q

The volume of total body water (TBW) represents what % of body weight in adults?

A

60%

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2
Q

The volume of total body water (TBW) represents what % of body weight in neonates?

A

Up to 70%

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3
Q

ECF Extracellular fluid represents what % of total body water (TBW) in adults?

A

33% of TBW (20% of body weight)

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4
Q

ECF Extracellular fluid represents what
% of total body water (TBW) in neonates?

A

40% of TBW decreases to 30% by week 24

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5
Q

ICF Intracellular fluid represents what % of total body water (TBW) in adults?

A

66% of TBW (40% of body weight)

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6
Q

What is the ECF composed of?

A

75% interstitial fluid
25% plasma
<1% lymph, transcellular fluids - synovial, pleural, abdominal, cerebrospinal

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7
Q

What is the normal volume of gastrointestinal secretion in horses per 24hr

A

100L/24Hr in a 500kg

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8
Q

Blood volume represents what % of body weight

A

8% in sedentary horses up to 14% in fit horses

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9
Q

Blood volume represents what % of body weight in neonates

A

15% decreases to 8% by 12 weeks

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10
Q

What are the significant components of interstitial fluid

A

Sodium
Bicarbonate
Chloride

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11
Q

Interstitial fluid makes up what % of the ECF?

A

75%

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12
Q

What are the main cations and anions in plasma?

A

Cation - Sodium
Anions - Bicarbonate and Chloride

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13
Q

Plasma has more protein than interstitial fluid and these act as anions, how is this compensation for in the interstitial fluid

A

Increased chloride

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14
Q

What are the important cations and anions of ICF?

A

Cations - Potassium, Magnesium
Anions - Phosphates and proteins

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15
Q

Define Osmolality

A

The concentration of osmotically active particles in solution per kg of solvent (mOsm/kg)

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16
Q

Define osmolarity

A

The number of particles of solute per litre of solvent (mOsm/L)

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17
Q

What is normal plasma Osmolality for adult horses

A

275-313 mOsm/kg

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18
Q

What is starlings equation and what does it describe

A

Net filtration = Kf<(Pcap - Pint) - delta(Pie p - Pie int)>

extracellular fluid movements between blood and tissues are determined by differences in hydrostatic pressure and colloid osmotic pressure between plasma inside microvessels and interstitial fluid outside them

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19
Q

What does COP (Colloid osmotic pressure) represent

A

The osmotic pressure generated by proteins mainly albumin

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20
Q

What are normal COP readings for adult horses and foals

A

19.2 - 31.3mmHg Adult
15 - 22.6mmHg Foal

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21
Q

Describe the endothelial glycolax layer

A

1 - Space between the plasma volume and endothelial cells lining the capillaries
2 - Contains no proteins
3 - Prevents movement of fluid from interstitial compartment to the capillaries

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22
Q

Forces that retain fluid in vascular space

A

1- Plasma oncotic pressure
2 - Tissue hydrostatic pressure

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23
Q

Forces that favour filtration

A

1 - Capillary hydrostatic pressure
2 - Tissue oncotic pressure

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24
Q

How is fluid transferred back into the capillaries from the interstitial space?

A

Fluid cannot be absorbed back into the capillaries from the interstitial space, instead it returns to circulation via the lymph

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25
Q

What is the ECF osmolarity formula?

A

Used to estimate serum osmolarity

2<(Na+(mmol/L)> + glucose(mmol/L)/18 + urea(mmol/L)/2.8

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26
Q

Exchanges between the extra and intracellular compartments are fast or slow? How long do they take to reach equilibrium

A

Slow
Up to 24 hours

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27
Q

Normal Cation values in an adult horse

A

1) Sodium 132 - 146 mmol/L
2) Potassium 2.4 - 4.7 mmol/L

3) Calcium 2.8 - 3.4 mmol/L
a- Ionized Ca 1.0 - 1.3 mmol/L

4) Magnesium 0.9 - 1.15 mmol/L
a- Ionized Magnesium 0.4 - 0.55 mmol/L

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28
Q

Normal Anion values in an adult horse

A

1) Chloride 99 - 109 mmol/L

2) Lactate 1.11 - 1.78 mmol/L

3) Total CO2 24 - 32 mmol/L

4) Plasma protein 58-87 g/L
a) Albumin 29 - 38 g/L

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29
Q

Normal venous blood gas values in adult horses

A

1) pH 7.32 - 7.44

2) pCO2 38 - 46 mmHg

3) pO2 37 - 56 mmHg
a- arterial 80 - 100 mmHg
4) HCO3- 20 -28 mmol/L

5) Base excess -2 to +2 mmol/L

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30
Q

Stewart’s definition of acids and bases

A

Acids increase H+ in fluid
Bases decrease H+ ih fluid

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31
Q

Describe the traditional approach to determine the acid-base and electrolyte status of a patient

A

Henderson-Hasselbach
1) Centered on pH, bicarb, hydrogen ions

2) HCO3- and H+ are independent

3) pH is maintained within narrow margins in health

4) Buffering of acids and bases

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32
Q

Describe the quantitative strong ion approach to determine the acid-base and electrolyte status of a patient

A

1) Centred on strong ions, weak acids and bases

2) HCO3- and H+ are dependent on strong ions and weak acids and bases

3) Concentration of strong ions are maintained within narrow margins in health

4) Change in the dissociative state of weak acids to satisfy rule of electroneutrality, conservation of mass and dissociation equilibrium

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33
Q

How many mmol/L of H+ is present in the body?

A

0.0004 mmol/L

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34
Q

What is the primary buffer system of the extracellular fluid

A

Bicarbonate

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35
Q

What are the primary buffers of the intracellular fluid

A

Protein and inorganic and organic phosphates

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36
Q

In body fluids pH is a function of what ratio

A

HCO3- : pCO2
20 : 1

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37
Q

What do metabolic (acid-base) disorders refer to

A

Net excess or deficit of nonvolatile or fixed acid
(lactate, acetate, pyruvate, citrate)

38
Q

What do respiratory (acid-base) disturbances refer to

A

Net deficit or excess of volatile acid (dissolved CO2)

39
Q

What is metabolic acidosis and what is a common cause of it in horses

A

Decrease in HCO3- due to loss or buffering nonvolatile acids (lactate, pyruvate, citrate, acetate)

Accumulation of lactate due to poor perfusion and HCO3- losses in the GI tract from diarrhoea

40
Q

What is metabolic alkalosis and what is a common cause in horses

A

Increased conc of HCO3-

Loss of chloride through sweating or reflux

41
Q

Tachypnea may cause respiratory acidosis or alkalosis?

A

Alkalosis

42
Q

How does the body compensate for respiratory disorders

A

Initial titration by nonbicarb buffers
Chronic response mediated by the kidney - net acid secretion and bicarbonate resorption - 2-5 days to be complete

43
Q

What are the strong ions?

A

Exist completely dissociated in solution
Cations: Na+, K+, Mg++, Ca++
Anions: Cl-, Lactate

Cl-, K+ and Na+ are present in high concentrations

44
Q

How is SID strong ion difference calculated

A

(Na+ + K+) - (Cl- + lactate) = 38 - 42

45
Q

What causes an increased SID

A

Metabolic alkalosis

46
Q

What causes a decreased SID

A

Metabolic acidosis

47
Q

What does Atot represent

A

Total mass of nonvolatile weak acids mainly comprised of proteins and in ruminants phosphate

48
Q

Are total proteins weak acids or weak bases

A

Weak acids

49
Q

How is blood collected for blood gas analysis?

A

Anaerobically
Anticoagulant - lithium heparin
Introduction of room air will falsely increase the pO2

50
Q

How does temp affect the pO2 and pCo2

A

Increased temp gas is less soluble - increases pO2 and pCO2
decreased temp gas is more soluble - decreases in pO2 and pCO2

51
Q

What are the measured values and calculated values provided by the gas analysers

A

Measured - pO2, pCO2, pH
Calculated - Total CO2, HCO3- and Base Excess

52
Q

What does the AG anion gap measure?

A

AG = (Na+ + K+) - (Cl- + HCO3-)
The difference between the sum of the commonly measured cations and anions

53
Q

The negatively charged plasma proteins are responsible for what % of the normal AG

A

90%

54
Q

What is a normal AG

A

10.4 +/- 1.2mmol/L

55
Q

SIG (strong ion gap) measures what?

A

Unmeasured anions

56
Q

How to avoid in vitro lactate production by erythrocytes in a sample

A

Analyze immediately
Use a fluoride containing tube
Store on ice
Separate plasma

57
Q

What is the difference between replacement fluids and maintenance fluids

A

Maintenance - lower Na+ and Cl-
- higher Ca++, K+ and Mg++

58
Q

What is the maintenance fluid requirement for a horse

A

60 ml/kg/day (2.5ml/kg/hr)

59
Q

Variables used to determine degree of dehydration

A

1) HR Ranges 40 - >100
2) CRT 2 - >4
3) PCV/TP 40/70 - >50/>80
4) Creatinine 132 - >350

60
Q

When lack of water intake is prolonged what steps should be taken in replenishing

A

Slowly to allow time for slow fluid shifts to occur

61
Q

When is the use of IV Saline indicated

A

If acute hyponatremia is present
Na+ <125 mmol/L for 24 hours or less
or
If there is severe hypochloremia relative to hyponatremia

62
Q

Why should IV saline not be used in cases of metabolic acidosis

A

It has a pH of 5

63
Q

Longterm fluid maintenance with BES will result in?

A

Hyperchloremia
Hypernatremia
Hypocalcema
Hypokalemia
Hypomagnesemai

64
Q

Low concentrations of serum ionized Ca and Mg are more prevalent in what colic cases

A

Surgical GI disease
Esp SI or large and small colon non strangulating infarction or strangulation
and in post op ileus
Enterocolitis

65
Q

How much 23% Calcium gluconate is usually sufficiency to maintain normocalcemia

A

50-100ml per 5L bag

66
Q

Hypocalcemia which is refractory to calcium therapy may indicate what

A

Hypomagnesemia

67
Q

What is the maintenance req of Mg2+

A

13mg/kg/day

68
Q

When Mg2+ is provided by MgO, MgCO3 or MgSO4 what are their respective doses?

A

MgO - 31 mg/kg/day
MgCO3 - 64 mg/kg/day
MgSO4 - 93 mg/kg/day

69
Q

At what rate should K+ be administered

A

No faster than 0.5 mmol/kg/hr

70
Q

Rules of thumb fro choosing NaHCO3 supplementation in acute severe metabolic disorders

A
  1. Horse should have normal respiratory function
  2. Hyponatremia in relation to Cl- conc should be present
  3. Blood pH should be less than 7.2
  4. Half of the calculated amount should be administered rapidly, the remainder over 12-14 hrs
  5. IV Na bicarb should not be given with Ca+ containing sols
71
Q

What concentrations in NaHCO3- injectable available in

A

5% - contains 0.59 mmol/ml of HCO3- and 0.59 mmol/ml of Na+

8.4% - contains 1 mmol/ml of each

72
Q

How many mmol of HCO3- in 1gram of baking soda?

A

12

73
Q

As a source of energy dextrose can be administered at what dose

A

1-4 mg/kg/min

74
Q

Hypertonic saline is what conc

A

7.2% NaCl

75
Q

How does the tonicity of Hypertomic crystalloids compare to plasma

A

Hypertonic saline has 9 times the tonicity of plasma and ECF (Na+ 1232 mOsm/L, Cl- 1232 mOsm/L)

76
Q

How many litres does hypertonic saline expand blood vol by

A

2L

77
Q

What is the duration of effect of hypertonic saline

A

45mins

78
Q

What is the recommended dosage of hypertonic saline

A

4ml/kg or 2L/500kg

79
Q

When is Collodi use indicated

A

TP <40g/L (4g/dl)
Albumin <20g/L (2g/dl)
Oncotic pressure <12 mmHg
Clinical signs of hypo proteinemia

80
Q

Calculating plasma dose

A

Plasma to be delivered (L) =
(TPdes - TPpt) x 0.05BWkg / TP don

81
Q

What molecular weight colloids are advised

A

Low molecular weight and molar substitution 130kDa/0.4

82
Q

Dose of HES

A

10ml/kg/day

83
Q

What dose of HES has been associated with coagulopathies

A

20ml/kg/day

84
Q

What effect do HES have on protein

A

Dilutes it due to its oncotic effects decreasing the measured TP

85
Q

Dose of crystalloids for dehydration or shock

A

20ml/kg bolus over 30-60mins followed by another 10-20ml/kg if required

86
Q

Maintenance crystalloid fluid rate following bolus in dehydrated horse who is stabilising

A

2-4ml/kg/hr

87
Q

How would you prepared an isotonic electrolyte solution for oral fluids

A

Per 1L of tap water add
5.27g of NaCl
0.37g of KCl
3.78f of NaHCO3-

135 mmol/L Na+
95 mmol/L Cl-
5 mmol/L K+
45 mmol/L HCO3-
Osmolarity - 255mOsm/L

88
Q

What is the least thrombogenic catheter material

A

Silastic

89
Q

What is the most thrombogenic catheter material

A

Polypropylene, polyethylene

90
Q

How often should teflon and polyurethane catheters be replaced

A

Teflon - 3 days
Polyurethane - 2 weeks

Eq ACVS Phase 1 (72 decks)

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