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737 - Principles of Anesthesia > Ex 3 - Support during anesthesia (fluids, electrolytes, & recovery) > Flashcards

Ex 3 - Support during anesthesia (fluids, electrolytes, & recovery) Flashcards

1
Q

What is the Total Water Volume (TWV) in a patient?

A

60-80% of BW

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2
Q

How is the TWV in a patient divided?

A

40% = Extracellular

  • 10% = intravascular
  • 30% = interstitial

60% = Intracellular

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3
Q

Dehydration assessment involves mostly ______ water volume.

A

extracellular

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4
Q

Hypovolemia assessment involves mostly _____ water volume.

A

intravascular

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5
Q

Treatment for Dehydration

A

Crystalloids!

Restore water and electrolytes to the entire Extracellular Space (volume)

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6
Q

What are 4 examples of crystalloids used?

A
  1. Lactated Ringer Solution (LRS)
  2. Normosol
  3. Plasmalyte
  4. Physiologic Saline (0.9% NaCl)

*We use LRS most often

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7
Q

Treatment for Hypovolemia

A

Blood volume support!

  • Crystalloids
  • Colloids
  • Blood products
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8
Q

Routes for fluid administration

  1. Which do we use most often during anesthesia?
  2. What do we use when we can’t get IV access?
  3. What do we use for long-term? (slow route)
A
  1. IV
  2. IO
  3. Sq
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9
Q

How much fluid to administer - what is the plan? (3 points)

A
  1. Restore deficits
  2. Maintain normal ongoing loss
  3. Treat abnormal losses
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10
Q
  1. Restore Deficits
A

The deficit is determined before anesthesia from dehydration status, hypovolemia, and 3rd space loss assessment

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11
Q

How much LRS would be required for a 40 kg Rottweiler with 10% dehydration

A

Required LRS (L) = 10 % of BW (40kg)

10% of BW = 4L

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12
Q
  1. Maintain normal ongoing loss
A

Normal ongoing loss depends on caloric expenditure, urine & fecal production and evaporation

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13
Q

What is the average Daily Water Intake?

A

1-5 ml/kg/hr (20-120 ml/kg/day)

High metabolic needs for smaller animals (cats > dogs)

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14
Q
  1. Treat Abnormal Losses

What to consider?

A

If possible, measure it, but most times is an estimate

  • evaporate from dry anesthesia gas
  • evaporate from open cavities
  • blood loss during sx
  • 3rd space loss
  • diuresis
  • D and V (uncommon)
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15
Q

What is the guideline that is used for crystalloid administration in anesthetized patients?

A

1-10 mL/kg/hr

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16
Q

Fluid boluses

  1. What is the conservative crystalloid dose?
  2. What is the shock fluid bolus?
A
  1. 10-20 ml/kg

2. 50-100ml/kg (don’t give all at once –> better to start with conservative and add more)

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17
Q

What are colloids used for?

Which one do we use often at VTH?

A

Used to restore blood volume and maintain oncotic pressure

Hetastarch

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18
Q

What is the oncotic pressure?

A

It is the force generated by the plasma proteins to maintain water in the vascular space

Normal capillary OP = 20-22 mmHg

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19
Q

What are 5 advantages of Colloids?

A
  1. Stay in the vasculature longer (6-48 hr)
  2. Relatively economical
  3. Long shelf life
  4. Increases blood volume rapidly
  5. May prevent edema
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20
Q

What are 6 disadvantages of Colloids?

A
  1. Hemodilution
  2. Coagulopathies
  3. Limit daily dose to 20 ml/kg/day
  4. Anaphylactic reactions
  5. Fluid overload
  6. Acute renal disease
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21
Q

Name the 6 Blood Products we use

A
  1. Fresh Whole blood
  2. Stored Whole blood
  3. Stored RBC
  4. Plasma
  5. Platelet-rich plasma
  6. Oxyglobin (purified Hb)
22
Q

What does Blood Typing identify?

A

RBC Antigens

23
Q

What does Cross Matching (major and minor) detect?

A

Ig from recipient or donor

24
Q

What is fresh WB?

A

Original blood (fresh) from donor.

Contains: RBC, platelets, proteins, coagulation factors

25
Q

What is stored WB?

A

Original blood from donor, but preserved in the fridge

Contains: RBC, proteins, coagulation factors, etc
no platelets!

26
Q

What is stored RBC?

A

Concentrate of RBC and contains mainly RBC (PCV = 70-80%)

27
Q

What is plasma?

A

It is the plasma remnant after spinning the blood for RBC.

Contains: proteins, coagulation factors, etc
no RBCs

28
Q

What is platelet-rich plasma?

A

Concentrate of platelets in plasma

not commonly used in vet med

29
Q

What is Oxyglobin?

A

O2 carrying fluid from Bovine Hb.

not available at the moment

30
Q

Where is sodium found and what is it a major component of?

A

ECF

Osmolality

  • Na and H20 imbalances generally occur simultaneously
  • Na levels often used to estimate fluid balance
  • Regulated by kidney via aldosterone
31
Q

Where is K+ found? What is it important for?

A

ICF

Fxn in excitable membranes (heart, nervous system)

  • serum levels are poor reflection of total body stores
  • exchanges with H+ in acidosis
  • regulated by renal fxn and H+
32
Q

What can high K+ result in?

A

Cardiac arrhythmias or cardiac death

33
Q

Where is Chloride important?

A

important anion in ECF

  • inverse relationship with HCO3
  • important for pH balance
  • Tends to follow Na, and improves with treatment of Na abnormalities
34
Q

How is Ca++ measured? Why it is important?

A

Measured as total or ionized Ca++ (ionized is more clinically relevant)

Important for myocardial, vascular, and neuromuscular fxn

35
Q

Why is Magnesium important?

A
  • Ca++ regulation
  • vital to CV and neuromuscular fxn
  • anti-thrombotic
  • anti-convulsant
  • treats some refractory dysrhythmias
  • may be used to treat pain
  • not commonly measured
36
Q

What is Phosphate essential for? Why is it important?

A

Essential for energy production (ATP)!

Component of 2nd messengers, enzymes, and important for RBC integrity

High levels precipitate with Ca++ and cause calcifications

37
Q

How do we measure AG?

A

AG = (Na + K) - (Cl + HCO3)

38
Q

Normal AG in dogs/cats?

39
Q

Normal AG in horse?

40
Q

Normal AG in FA?

41
Q

Whats a good diagnostic tool for ethylene glycol toxicity?

A

Measure AG!

Ethylene glycol is a “UA” –> AG will be very high in toxicity cases

42
Q

Hypoventilation (high CO2) causes _____ (high H+ and low pH)

A

Respiratory Acidosis

43
Q

Hyperventilation (low CO2) causes _______ (low H+ and high pH)

A

Respiratory Alkalosis

44
Q

High bicarbonate causes ______

A

Metabolic alkalosis

45
Q

Low bicarbonate causes _____

A

Metabolic acidosis

46
Q

Tx for respiratory acidosis or alkalosis?

A

Correct Ventilation

47
Q

Tx for metabolic acidosis or alkalosis?

A

Correct underlying disease

If emergency:

  • bicarbonate for acidosis
  • physiologic saline for alkalosis
48
Q

Name 8 causes of hypoglycemia

A
  1. over dose of insulin
  2. insulinoma
  3. sepsis
  4. anorexia (rare)
  5. liver disease
  6. Addison’s
  7. neoplasia
  8. idiopathic (e.g. neonatal)
49
Q

Name 9 causes of hyperglycemia

A
  1. Stress - sepsis - pain
  2. diabetes
  3. Cushing’s
  4. Drugs (a2 agonist, guaifenesin, steroids)
  5. neoplasia
  6. Iatrogenic (dextrose administration)
  7. postprandial
  8. Acromegaly (cats)
  9. parenteral nutrition
50
Q

Treatment for Severe Hyperglycemia

A

Regular insulin: 0.1-0.25 U/kg

(DKA) regular insulin CRI: 0.05-1 U/kg/hr

51
Q

Treatment for Severe Hypoglycemia

Whats the guideline dose?

A

Dextrose administration

R gluc (mg) = BW x 0.3 (D gluc - P gluc)

R = required 
D = desired 
P = patient level

737 - Principles of Anesthesia (10 decks)

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