chapter 5 Fluid therapy

Question 1

i. Intracellular –larger of the two compartments and accounts for __% of the total body water and __% of body weight.

Answer 1

i. Intracellular –larger of the two compartments and accounts for 66% of the total body water and 40% of body weight.

Question 2

i. Sodium is high in the ___fluid

ii. Potassium is high in the ___fluid

Answer 2

i. Sodium is high in the extracellular fluid

ii. Potassium is high in the intracellular fluid

Question 3

ii. Extracellular – composed of the remaining __% of total body water and __% of body weight.

Answer 3

ii. Extracellular – composed of the remaining 33% of total body water and 20% of body weight.

Question 4

1. Intravascular (plasma)- __%

2. Interstitial – __%; bathes all cells and includes lymph

Answer 4

1. Intravascular (plasma)- 25%

2. Interstitial – 75%; bathes all cells and includes lymph

Question 5

Oncotic pressure drives the movement of fluid and is determined primarily by osmotic pressure generated by proteins (____, ____, and ____ with ___ as the primary component

Answer 5

Oncotic pressure drives the movement of fluid and is determined primarily by osmotic pressure generated by proteins (globulins, fibrinogen, and albumin, with albumin as the primary component

Question 6

Hydrostatic pressure within the vascular space is related to the volume of blood that is confined within the vessel walls and is determined by intravascular ___ ____and ____ _____.

Answer 6

Hydrostatic pressure within the vascular space is related to the volume of blood that is conifed within the vessel walls and is determined by intravascular blood pressures and vascular resistance.

Question 7

a. Severe increases or decreased in sodium must be corrected slowly to prevent potentially life-threatenidng central nervous system derangements.
b. Should not be increased by more than ___mEq/hr
c. Should not be decreased by more than ____mEq/hr

Answer 7

a. Severe increases or decreased in sodium must be corrected slowly to prevent potentially life-threatenidng central nervous system derangements.
b. Should not be increased by more than 0.5mEq/hr
c. Should not be decreased by more than 1mEq/hr

Question 8

9. Severe inflammatory disease, especially postoperative animals with a systemic inflammatory response syndrome (SIRS) commonly develop a cytokine mediated increase in vascular endothelial permeability.
   a. This results in a transvascular flux of high-protein, isotonic fluid into the ______space. Clinically, non-pitting edema of the interstitial space despite intravascular volume depletion

Answer 8

9. Severe inflammatory disease, especially postoperative animals with a systemic inflammatory response syndrome (SIRS) commonly develop a cytokine mediated increase in vascular endothelial permeability.
   a. This results in a transvascular flux of high-protein, isotonic fluid into the extravascular space. Clinically, non-pitting edema of the interstitial space despite intravascular volume depletion

Question 9

3. For animals with interstitial dehydration (5-8% dehydration)
   Body wt (Kg) x % dehydration = deficit (L)
   PLUS
   Estimated ___losses
   PLUS
   ____= Fluid amount to be given over the next 6-24 hours

Answer 9

3. For animals with interstitial dehydration (5-8% dehydration)
   Body wt (Kg) x % dehydration = deficit (L)
   PLUS
   Estimated ongoing losses
   PLUS
   Maintenance = Fluid amount to be given over the next 6-24 hours

Question 10

viii. Non-cardiogenic shock therapy includes aggressive _____resuscitation. An increase in intravascular volume will increase left ventricular end-______volume (______), _____ _____, and _____ _____and therefore will increase systemic oxygen delivery

Answer 10

viii. Non-cardiogenic shock therapy includes aggressive volume resuscitation. An increase in intravascular volume will increase left ventricular end-diastolic volume (preload), stroke volume, and cardiac output and therefore will increase systemic oxygen delivery

Question 11

c. It may be favorable to perform hypotensive resucitaiton (resuscitation to a mean arterial pressure of _____mmHg or a systolic blood pressure of ____mmHg in animals with uncontrollable bleeding as aggressive fluid therapy in this setting can worsen bleeding and outcome.

Answer 11

c. It may be favorable to perform hypotensive resucitaiton (resuscitation to a mean arterial pressure of 60mmHg or a systolic blood pressure of 90mmHg) in animals with uncontrollable bleeding as aggressive fluid therapy in this setting can worsen bleeding and outcome.

Question 12

Animals with hypochloridemia, hyponatremia, or a metabolic alkalosis will often benefit from the administration of ____.

Answer 12

Animals with hypochloridemia, hyponatremia, or a metabolic alkalosis will often benefit from the administration of saline.

Question 13

iv. Extracellular expanding fluids and ___% of the volume infused redistributes to the interstitial space, while only __% remains in the vascular space.

Answer 13

iv. Extracellular expanding fluids and 75% of the volume infused redistributes to the interstitial space, while only 25% remains in the vascular space.

Question 14

1. Head trauma – _____ 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. Postoperative monitoring and maintenance of sodium levels are important

Answer 14

1. Head trauma – saline 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. Postoperative monitoring and maintenance of sodium levels are important

Question 15

1. Severe acidosis may benefit from a crystalloid that contains a buffer agent such as acetate, gluconate, or _____. Large quantities of acetate can cause vaso____and a _____in blood pressure in animals with preexisiting hypovolemia. This occurs secondary to adenosine release from muscle tissue, and adenosine is a potent ____

Answer 15

1. Severe acidosis may benefit from a crystalloid that contains a buffer agent such as acetate, gluconate, or lactate. Large quantities of acetate can cause vasodilation and a decrease in blood pressure in animals with preexisiting hypovolemia. This occurs secondary to adenosine release from muscle tissue, and adenosine is a potent vasodilator

Question 16

hypertonic solutions

ii. Causes a transient shift of water from the extravascular to the intravascular compartment. Small volumes of 4-6ml/kg can be administered over 10-20 minutes.
1. Exceeding __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

Answer 16

ii. Causes a transient shift of water from the extravascular to the intravascular compartment. Small volumes of 4-6ml/kg can be administered over 10-20 minutes.
1. Exceeding 1ml/kg/min may result in osmotic stimulation of pulmonary C-fibers, which leads to vagally mediated hypotension, bradycardia, and bronchoconstriction and should be avoided

Question 17

4. If hypertonic solutions are administered in all peripheral veins, ___and ___can result because of the hypertonicity of the fluid and subsequent damage to red blood and endothelial cells

Answer 17

4. If administered in all peripheral veins, hemolysis and phlebitis can result because of the hypertonicity of the fluid and subsequent damage to red blood and endothelial cells

Question 18

_____ can:
3. It is purple and will cause a yellow-orange discoloration to the animal’s skin, urine, serum, sclera, and mucous membranes.

Answer 18

oxyglobin

Question 19

Acute hemorrhage exceeding ___% of the blood volume often requires transfusion therapy in addition to crystalloid and colloid therapy

Answer 19

Acute hemorrhage exceeding 20% of the blood volume often requires transfusion therapy in addition to crystalloid and colloid therapy

Question 20

pRBC transfusion equation equals …

Answer 20

Volume RBC = blood volume x (PCV target – current PCV)/PCV of donor

Question 21

Stored whole blood no longer supplies functional clotting factors after ____hours

Answer 21

Stored whole blood no longer supplies functional clotting factors after 24 hours

Question 22

iv. _____ products are used most commonly in animals with profound blood loss, a coagulopathy, or severe hypoalbuminemia.

Answer 22

iv. Plasma products are used most commonly in animals with profound blood loss, a coagulopathy, or severe hypoalbuminemia.

Question 23

how many dog erythrocytic antigens are known?

Answer 23

8

Question 24

Theoretically approximately __% of first time canines at blood transfusions should be associated with an adverse immunologic reaction caused by the occurrence of naturally occurring antibodies but the clinical incidents of this is much less.

Answer 24

Theoretically approximately 15% of first time canines at blood transfusions should be associated with an adverse immunologic reaction caused by the occurrence of naturally occurring antibodies but the clinical incidents of this is much less.

Question 25

d. Two commonly identified red blood cell antigens in the domestic feline are ___and ___. most domestic short hairs in the United States are type ___ but breeds such as the Scottish fold Berman, Himalayan, Somali, Persian, Cornish and Devon Rex, and British shorthair are commonly type ____.

Answer 25

d. Two commonly identified red blood cell antigens in the domestic feline are A and B. most domestic short hairs in the United States are type A but breeds such as the Scottish fold Berman, Himalayan, Somali, Persian, Cornish and Devon Rex, and British shorthair are commonly type B.

Question 26

e. Transfusion products should be warmed before administration to decrease the risk of arrhythmias changes in cardiac output, and hypothermia. A warm water bath less than ___°C is commonly used for this purpose.
f. Administration through a microfilter with 170 micro meter pores is commonly used to remove clots and larger red cell and platelet aggregates
g. possible signs of a transfusion reaction include fever, restlessness, vomiting or diarrhea, acute collapse, wheezing, dyspnea, urticaria, hemoglobinemia or hemoglobinuria, and or hypotension.
h. Additional possible adverse effects of blood transfusions include pulmonary emboli and acute respiratory distress syndrome, secondary to red cell, white cell, or platelet clumps; acidosis, and are hypocalcemia or hypomagnesemia.

Answer 26

e. Transfusion products should be warmed before administration to decrease the risk of arrhythmias changes in cardiac output, and hypothermia. A warm water bath less than 42°C is commonly used for this purpose.
f. Administration through a microfilter with 170 micro meter pores is commonly used to remove clots and larger red cell and platelet aggregates
g. possible signs of a transfusion reaction include fever, restlessness, vomiting or diarrhea, acute collapse, wheezing, dyspnea, urticaria, hemoglobinemia or hemoglobinuria, and or hypotension.
h. Additional possible adverse effects of blood transfusions include pulmonary emboli and acute respiratory distress syndrome, secondary to red cell, white cell, or platelet clumps; acidosis, and are hypocalcemia or hypomagnesemia.

Question 27

sodium:

i. sodium is the primary ______cation in the body.

Answer 27

i. sodium is the primary extracellular cation in the body.

Question 28

1. _____-hyponatremia is a phenomenon in which hyperlipidemia or hyperproteinemia can be associated with hyponatremia despite a normal plasma osmolarity due to the method of sodium measurements. This reflects a problem with measurement rather than a true decrease in serum sodium. The presence of osmotic reactive glucose or mannitol in the intravascular space results in movement of water from the extra vascular compartment into the intravascular space diluting the serum sodium concentration

Answer 28

1. Pseudo-hyponatremia is a phenomenon in which hyperlipidemia or hyperproteinemia can be associated with hyponatremia despite a normal plasma osmolarity due to the method of sodium measurements. This reflects a problem with measurement rather than a true decrease in serum sodium. The presence of osmotic reactive glucose or mannitol in the intravascular space results in movement of water from the extra vascular compartment into the intravascular space diluting the serum sodium concentration

Question 29

2. Causes of _____ hyponatremia include gastrointestinal or third space losses (e.g., drainage of chylothorax), hypoadrenocorticism, or diuretic administration

Answer 29

2. Causes of hypovolemic hyponatremia include gastrointestinal or third space losses (e.g., drainage of chylothorax), hypoadrenocorticism, or diuretic administration

Question 30

2. Examples of ______hyponatremia include heart failure, severe liver disease, nephrotic syndrome, or advanced renal failure.
   a. These patients often have ascites or clinical evidence of edema.

Answer 30

2. Examples of hypervolemic hyponatremia include heart failure, severe liver disease, nephrotic syndrome, or advanced renal failure.
   a. These patients often have ascites or clinical evidence of edema.

Question 31

hyponatremia and _____
1. this is an uncommon condition that can be due to psychogenic polydipsia or the syndrome of inappropriate antidiuretic hormone release, antidiuretic drugs (parentheses narcotics, nonsteroidal anti-inflammatory drugs, barbiturates, vincristine), hypothyroid induced mix edema coma, or administration of hypotonic fluids (iatrogenic).

Answer 31

Hyponatremia and nonmovolemia
1. this is an uncommon condition that can be due to psychogenic polydipsia or the syndrome of inappropriate antidiuretic hormone release, antidiuretic drugs (parentheses narcotics, nonsteroidal anti-inflammatory drugs, barbiturates, vincristine), hypothyroid induced mix edema coma, or administration of hypotonic fluids (iatrogenic).

Question 32

ii. ______ hypernatremia
1. the increased extracellular osmolarity shifts fluid from the intracellular space into the extracellular space.
2. increased sodium ingestion is uncommon but can include causes such salt ingestion, homemade Play Dough ingestion, or iatrogenic administration of sodium containing fluids (hypertonic saline, sodium bicarbonate).
3. Hyperaldosteronism and hyperadrenocroticism are disease processes that may result in ______ hypernatremia

Answer 32

ii. Hypervolemic hypernatremia
1. the increased extracellular osmolarity shifts fluid from the intracellular space into the extracellular space.
2. increased sodium ingestion is uncommon but can include causes such salt ingestion, homemade Play Dough ingestion, or iatrogenic administration of sodium containing fluids (hypertonic saline, sodium bicarbonate).
3. Hyperaldosteronism and hyperadrenocroticism are disease processes that may result in hypervolemia hypernatremia

Question 33

iii. ________ hypernatremia
1. free water loss can be divided into hypotonic water loss in pure water loss. Hypotonic water losses resulting hypovolemic hypernatremia. Both water and electrolytes are lost through vomiting, diarrhea, osmotic diuresis, or third space fluid losses.
2. Ingestion of paintballs has been reported to cause hypernatremia secondary to hypotonic fluid losses into the gastrointestinal tract from the osmotic reactive ingredients in these balls. Because electrolytes are lost from the extracellular space along with water, less osmotic poll is present for fluid to move from the intracellular space to the extracellular space, and hypovolemia results.
3. Pure water loss is less common and usually does not result in hypovolemia because as a osmolarity of the extracellular space increases, water shifts from the intracellular to the extracellular space, preventing hypovolemia. Pure water loss can occur in patients with central or nephrogenic diabetes insipidus, Burns, fever, lack of access to water, or hypodispia.
a. In animals with hypotonic or pure water losses, administration of isotonic sodium containing fluids may cause a rise in serum sodium concentration if access to or ability to consume water is limited, or of sodium water regulatory mechanisms are not functioning properly.
i. this is particularly important in critically ill patients with large fluid losses, such as those of peritonitis or renal disease, or in patients with head trauma who may have impaired thirst mechanisms.

Answer 33

iii. hypovolemic hypernatremia
1. free water loss can be divided into hypotonic water loss in pure water loss. Hypotonic water losses resulting hypovolemic hypernatremia. Both water and electrolytes are lost through vomiting, diarrhea, osmotic diuresis, or third space fluid losses.
2. Ingestion of paintballs has been reported to cause hypernatremia secondary to hypotonic fluid losses into the gastrointestinal tract from the osmotic reactive ingredients in these balls. Because electrolytes are lost from the extracellular space along with water, less osmotic poll is present for fluid to move from the intracellular space to the extracellular space, and hypovolemia results.
3. Pure water loss is less common and usually does not result in hypovolemia because as a osmolarity of the extracellular space increases, water shifts from the intracellular to the extracellular space, preventing hypovolemia. Pure water loss can occur in patients with central or nephrogenic diabetes insipidus, Burns, fever, lack of access to water, or hypodispia.
a. In animals with hypotonic or pure water losses, administration of isotonic sodium containing fluids may cause a rise in serum sodium concentration if access to or ability to consume water is limited, or of sodium water regulatory mechanisms are not functioning properly.
i. this is particularly important in critically ill patients with large fluid losses, such as those of peritonitis or renal disease, or in patients with head trauma who may have impaired thirst mechanisms.

Question 34

The free water deficit can be made with the following formula:

Answer 34

The free water deficit can be made with the following formula: free water deficit (L) equals 0.6 X weight (KG) times (sodium presents / sodium normal -1)

Question 35

potassium is the major _____ cation in the body, and approximately 95% of total body potassium is contained in ______.

Answer 35

1. potassium is the major intracellular cation in the body, and approximately 95% of total body potassium is contained in the cells.

Question 36

1. Hypokalemia is a common finding in ____ with gastrointestinal foreign bodies.

Answer 36

1. Hypokalemia is a common finding in _____with gastrointestinal foreign bodies.

Question 37

c. Electrocardiographic changes due to hypokalemia are the result of an increase difference between resting and threshold membrane potentials and include ST segment depression, decreased amplitude __ waves, prolonged __ intervals, and various ventricular and supraventricular arrhythmias.

Answer 37

c. Electrocardiographic changes due to hypokalemia are the result of an increase difference between resting and threshold membrane potentials and include ST segment depression, decreased amplitude T waves, prolonged PT intervals, and various ventricular and supraventricular arrhythmias.

Question 38

7. pseudo-hyperkalemia occurs as a result of thrombocytosis, severely elevated white blood cell counts, and hemolysis in breeds with increased potassium concentrations in their red blood cells (e.g., ketones, which dog breed _____).

Answer 38

7. pseudo-hyperkalemia occurs as a result of thrombocytosis, severely elevated white blood cell counts, and hemolysis in breeds with increased potassium concentrations in their red blood cells (e.g., ketones, English Springer spaniels).

Question 39

HYPERKALEMIA
b. 5.7 – 6.0 mEq/L results in spiked __waves and shortening of the ___interval
c. 7.0 – 8.5 M EQ/L prolongation of the
__ interval, and widening of the ___ complex.
d. Greater than 8.5 mEq/L __ waves disappear, our wave amplitude decreases, and S wave prominence increases resulting in a sinoatrial wave.
e. 10.0 – 12.0 mEq/L ____and ventricular fibrillation can occur.

Answer 39

b. 5.7 – 6.0 mEq/L results in spiked T waves and shortening of the QT interval
c. 7.0 – 8.5 M EQ/L prolongation of the PR interval, and widening of the QRS complex.
d. Greater than 8.5 mEq/L P waves disappear, our wave amplitude decreases, and S wave prominence increases resulting in a sinoatrial wave.
e. 10.0 – 12.0 mEq/L asystole and ventricular fibrillation can occur.

Question 40

calcium gluconate (10%) can be given intravenously (for hyperkalemia) at a dose of 0.5 – 1ML/KG over 10 to 20 minutes. Calcium gluconate does not alter the serum potassium concentration but alters the electrical environment of the cardiac _____, raising the threshold member potential to restore cell excitability. Effects last approximately one hour. Life-threatening bradycardia can develop if calcium is administered too rapidly, so an ECG should be used to monitor the patient, and the infusion stopped if bradycardia develops.

Answer 40

calcium gluconate (10%) can be given intravenously at a dose of 0.5 – 1ML/KG over 10 to 20 minutes. Calcium gluconate does not alter the serum potassium concentration but alters the electrical environment of the cardiac myocytes, raising the threshold member potential to restore cell excitability. Effects last approximately one hour. Life-threatening bradycardia can develop if calcium is administered too rapidly, so an ECG should be used to monitor the patient, and the infusion stopped if bradycardia develops.

Question 41

i. ______is a divalent cation that plays important roles in neural excitability, muscle contraction, and blood coagulation.

Answer 41

i. calcium is a divalent cation that plays important roles in neural excitability, muscle contraction, and blood coagulation.

Question 42

ii. ___% of calcium is banned as hydroxyapatite and bone. The remaining ___% is divided between extracellular and intracellular fluid compartments and is present in three biological forms: ionized, protein bound, and chelated.
iii. _____calcium is the physiologically active form. Acidosis shifts protein bound calcium to the ionized form.

Answer 42

ii. 99% of calcium is banned as hydroxyapatite and bone. The remaining 1% is divided between extracellular and intracellular fluid compartments and is present in three biological forms: ionized, protein bound, and chelated.
iii. Ionized calcium is the physiologically active form. Acidosis shifts protein bound calcium to the ionized form.

Question 43

v. Three hormones help regulate calcium levels in the body: parathyroid hormone, vitamin D (cholecalciferol), and calcitonin. These hormones act at the kidney, intestine, and bone to regulate calcium balance.
1. ___hormone results in increased mobilization of calcium from bone, increase resorption of calcium in the renal tubules, and activation of vitamin D.
2. _______ in the kidneys acts on the intestine to increase calcium absorption.
3. _____works to inhibit bone resorption and release of calcium in response to elevated plasma calcium levels.

Answer 43

v. Three hormones help regulate calcium levels in the body: parathyroid hormone, vitamin D (cholecalciferol), and calcitonin. These hormones act at the kidney, intestine, and bone to regulate calcium balance.
1. Parathyroid hormone results in increased mobilization of calcium from bone, increase resorption of calcium in the renal tubules, and activation of vitamin D.
2. Vitamin D in the kidneys acts on the intestine to increase calcium absorption.
3. Calcitonin works to inhibit bone resorption and release of calcium in response to elevated plasma calcium levels.

Question 44

3. ________ hypoparathyroidism occurs following surgical removal of, or trauma to, the parathyroid glands, most commonly recognized after thyroidectomy (with inadvertent trauma or removal of parathyroid glands), para thyroidectomy, or cervical trauma.

Answer 44

3. Secondary hypoparathyroidism occurs following surgical removal of, or trauma to, the parathyroid glands, most commonly recognized after thyroidectomy (with inadvertent trauma or removal of parathyroid glands), para thyroidectomy, or cervical trauma.

Question 45

causes of ______ include:
urinary tract obstruction, renal failure, sodium phosphate enemas in cats or small odgs, eclampsia, bicarbonate therapy, blood transfusions, pancreatitis, ethylene glycol intoxication, soft tissue trauma in foals and humans, SIRS, and hypoalbuminemia

Answer 45

hypocalcemia

Question 46

The most common neoplastic process associated with ______include lymphoma, and anal gland adenocarcinoma, multiple myeloma, and metastatic/primary bone neoplasms.

Answer 46

The most common neoplastic process associated with hypercalcemia include lymphoma, and anal gland adenocarcinoma, multiple myeloma, and metastatic/primary bone neoplasms.

Question 47

iii. Hypermagnesemia
1. because the kidney has the ability to handle and excrete large excesses of magnesium, hypermagnesemia does not typically occur without some impairment of ____function.

Answer 47

iii. Hypermagnesemia
1. because the kidney has the ability to handle and excrete large excesses of magnesium, hypermagnesemia does not typically occur without some impairment of renal function.

Question 48

1. phosphorus is the major _______anion.

Answer 48

1. phosphorus is the major intracellular anion.

Question 49

chloride is the primary ______anion

Answer 49

chloride is the primary extracellular anion

Question 50

hypochloremia

a. excessive losses of chloride: gastrointestinal or renal causes. Upper intestinal obstructive disease that results in vomiting of stomach contents, as well as gastrointestinal diseases associated with hyponatremia and hyperkalemia such as trichuriasis, salmonellosis, or duodenal ulcer perforation, can result in hypochloremia. Diuretic therapy with thiazides for loop diuretics can cause excessive renal losses of chloride, as can chronic respiratory acidosis or hyperadrenocorticism
b. excessive gain of sodium relative to chloride can occur after sodium bicarbonate administration because sodium is added to the extrasolar space without additional chloride; therefore the corrected chloride concentration will be low. Pseudohypochloremia can occur as the result of lipemic Serum when levels are measured using techniques that are not ion sensitive

Answer 50

a. excessive losses of chloride: gastrointestinal or renal causes. Upper intestinal obstructive disease that results in vomiting of stomach contents, as well as gastrointestinal diseases associated with hyponatremia and hyperkalemia such as trichuriasis, salmonellosis, or duodenal ulcer perforation, can result in hypochloremia. Diuretic therapy with thiazides for loop diuretics can cause excessive renal losses of chloride, as can chronic respiratory acidosis or hyperadrenocorticism
b. excessive gain of sodium relative to chloride can occur after sodium bicarbonate administration because sodium is added to the extrasolar space without additional chloride; therefore the corrected chloride concentration will be low. Pseudohypochloremia can occur as the result of lipemic Serum when levels are measured using techniques that are not ion sensitive

Question 51

2. _____cells are unique in that they are permeable to glucose and can use glucose without the aid of insulin. Other cells in the body require insulin to move sufficient quantities of glucose into the cell, and therefore those cells primarily utilize fatty acids for energy during times of decreased insulin secretion (fasting). If blood glucose levels fall too low (less than 30 – 50 mg/dL and parentheses, clinical signs of hypoglycemia (mental depression, syncope, ataxia, blindness, seizures, or coma) may result.

Answer 51

2. Brain cells are unique in that they are permeable to glucose and can use glucose without the aid of insulin. Other cells in the body require insulin to move sufficient quantities of glucose into the cell, and therefore those cells primarily utilize fatty acids for energy during times of decreased insulin secretion (fasting). If blood glucose levels fall too low (less than 30 – 50 mg/dL and parentheses, clinical signs of hypoglycemia (mental depression, syncope, ataxia, blindness, seizures, or coma) may result.

Question 52

1. _____is thought to induce hypoglycemia via combination of factors. Increase circulating levels of cytokines (e.g., tumor necrosis factor alpha, interleukin – 6) cause increase utilization of glucose by the tissues. Further, decreased hepatic responsiveness to counterregulatory hormones (catecholamines, glucagon, glucocorticoids, and growth hormone) in _____ patients results in decreased hepatic production of glucose.

Answer 52

1. Sepsis is thought to induce hypoglycemia via combination of factors. Increase circulating levels of cytokines (e.g., tumor necrosis factor alpha, interleukin – 6) cause increase utilization of glucose by the tissues. Further, decreased hepatic responsiveness to counterregulatory hormones (catecholamines, glucagon, glucocorticoids, and growth hormone) in septic patients results in decreased hepatic production of glucose.

Question 53

iv. carbon dioxide acts as an acid because it can combine with ____to form carbonic acid.

Answer 53

iv. carbon dioxide acts as an acid because it can combine with water to form carbonic acid.

Question 54

Henderson Hassellbalch equation = …

Answer 54

CO2 + H2O ↔ H 2 CO 3↔ H + HCO 3

Question 55

anion gap =

Answer 55

Anion gap = (Na + K) - (CL + HCO 3)

Question 56

a. respiratory _____
i. occurs when hypoventilation causes hypercapnia, or an increase in blood PaCO2. The compensatory response to this condition is increased renal excretion of hydrogen ions, which results in increased extracellular bicarbonate.

Answer 56

a. respiratory acidosis
i. occurs when hypoventilation causes hypercapnia, or an increase in blood PaCO2. The compensatory response to this condition is increased renal excretion of hydrogen ions, which results in increased extracellular bicarbonate.

Question 57

b. Respiratory _______. occurs when hyperventilation results in hypocapnia or low arterial CO2 levels.
ii. A low CO2 with an elevated pH is a primary respiratory alkalosis.
iii. Clinical signs of restaurant alkalosis are uncommon tachypnea may be the only clinical sign apparent in animals. Increased ventilation can be the result of hypoxemia, primary pulmonary disease, direct activation of central respiratory centers, overzealous manual ventilation, and pain, anxiety, or fear.
iv. Treatment is focused on addressing the underlying cause.

Answer 57

b. Respiratory alkalosis
i. occurs when hyperventilation results in hypocapnia or low arterial CO2 levels.
ii. A low CO2 with an elevated pH is a primary respiratory alkalosis.
iii. Clinical signs of restaurant alkalosis are uncommon tachypnea may be the only clinical sign apparent in animals. Increased ventilation can be the result of hypoxemia, primary pulmonary disease, direct activation of central respiratory centers, overzealous manual ventilation, and pain, anxiety, or fear.
iv. Treatment is focused on addressing the underlying cause.

Question 58

a. Metabolic __________
i. defined as low bicarbonate with a low pH.
ii. Compensation for a metabolic acidosis is accomplished via hyperventilation to decrease CO2.
iii. Causes of a hypercholesterolemic metabolic acidosis include diarrhea (loss of bicarbonate into the gastrointestinal tract), renal tubular acidosis (decreased bicarbonate resorption or decreased hydrogen ion excretion in the kidney), and administration of carbonic anhydrase inhibitors are alkali free, chloride containing intravenous fluids (saline).
iv. Sodium bicarbonate is the most common alkali therapy used in small animals, but treatment should not be taken lightly for several reasons. It is extremely hyperosmolarity cause significant fluid shifts into the intravascular and interstitial fluid compartments. Electrolyte abnormalities such as hypokalemia hypocalcemia and hypernatremia can result following administration.
NaHco3 (mEq) = 0.3 x body weight (Kg) x base deficit (mEq/L)

Answer 58

a. Metabolic acidosis
i. defined as low bicarbonate with a low pH.
ii. Compensation for a metabolic acidosis is accomplished via hyperventilation to decrease CO2.
iii. Causes of a hypercholesterolemic metabolic acidosis include diarrhea (loss of bicarbonate into the gastrointestinal tract), renal tubular acidosis (decreased bicarbonate resorption or decreased hydrogen ion excretion in the kidney), and administration of carbonic anhydrase inhibitors are alkali free, chloride containing intravenous fluids (saline).
iv. Sodium bicarbonate is the most common alkali therapy used in small animals, but treatment should not be taken lightly for several reasons. It is extremely hyperosmolarity cause significant fluid shifts into the intravascular and interstitial fluid compartments. Electrolyte abnormalities such as hypokalemia hypocalcemia and hypernatremia can result following administration.
NaHco3 (mEq) = 0.3 x body weight (Kg) x base deficit (mEq/L)

Question 59

a. metabolic _______
i. defined as an elevated bicarbonate and an increased pH
ii. can result from loss of chloride or gain of exogenous alkali
iii. respiratory compensation for metabolic alkalosis involves hypoventilation to raise carbon dioxide in response to elevated bicarbonate.
iv. Possible causes of chloride loss and resulting metabolic alkalosis include vomiting, suctioning of gastric contents, and administration of diuretics that in use chloride excretion (e.g., furosemide)
v. treatment: correcting the underlying disorder providing chloride through administration of 0.45% or 0.9% saline plus or minus KCl can aid in correcting the alkalosis until definitive correction of the underlying disorder can be attained

Answer 59

a. metabolic alkalosis
i. defined as an elevated bicarbonate and an increased pH
ii. can result from loss of chloride or gain of exogenous alkali
iii. respiratory compensation for metabolic alkalosis involves hypoventilation to raise carbon dioxide in response to elevated bicarbonate.
iv. Possible causes of chloride loss and resulting metabolic alkalosis include vomiting, suctioning of gastric contents, and administration of diuretics that in use chloride excretion (e.g., furosemide)
v. treatment: correcting the underlying disorder providing chloride through administration of 0.45% or 0.9% saline plus or minus KCl can aid in correcting the alkalosis until definitive correction of the underlying disorder can be attained