Final Exam Flashcards
More hydrogen means a - pH
Lower ph and vice versa
Acids - protons, bases - protons
Acids donate a proton (they have more to give ), bases accept a proton and combine with free hydrogen ions
Describe homeostasis in terms of acid base
Normal pt is 7.4, respiratory and metabolic systems maintain normal pH
Is HC03 an acid or base
A weak base ready to accept protons
Is PCO2 an acid or base
Acid ready to donate hydrogens
What does co2 combine with in the biologic buffer system
Combines with water (water in donate a hydrogen)
What should you ask yourself if there is an acidemia ( ph below 7.35) or alkalemia ( ph above 7.45)
Acidemia - is there too much acid or not enough base
Alkalemia - too much base or not enough acid
Acidemia with too much acid (a high CO2) indicates
Respiratory acidosis - respiratory system controls co2
Acidemia with not enough base (low HCO3-) indicates
Metabolic acidosis
Alkalemia with too much base (high hco3 -) indicates
Metabolic alkalosis
Alkalemia with not enough acid (low co2) indicates
Respiratory alkalosis
What are 5 differentials for a metabolic acidosis (not enough base)
DKA, lactic acidosis , uremic acidosis, ethylene glycol toxicity, aspirin toxicity (think klue)
What are differentials for a metabolic alkalosis (too much base - high hco3)
GI obstruction until proven otherwise
What are differentials for a respiratory acidosis ( too much cO2)
General Anesthetics , opioids, neuro conditions (cns, cervical spinal disease, LMN ), fatigue
What are differentials for a respiratory alkalosis (too little co2)
Severe hypoxemia , mild anxiety, CNS disease, severe hyperthermia, iatrogenic
What makes up the lower urinary tract
Bladder, urethra, caudal ureters, prostate in males
Will a UTI cause an obstruction
Never - but you could have a UTI secondary to an obstruction
What are common causes of lut signs in dogs
UTI, stones, mass/cancer
What are common causes of LUT signs in a cat
Idiopathic cystitis (mucous plug) , stones, mass/cancer - cats rarely get UTIs
What will you often see in a history of LUT signs
Irritation/inflammation - pollakiuria, stranguria, dysuria, accidents, hematuria - if obstructed will locally see systemic signs and the patient will feel sick
What is the major difference in LUT signs with obstructive versus not obstructive causes
Obstructive will feel systemically ill, non obstructive will not - also obstructive will cause a large firm bladder
What are differentials of a small firm bladder with LUT signs
UTI, stones, idiopathic cystitis, tumor
What are differentials for a large firm bladder and LUT signs
Obstruction or tumor
What is the best way to diagnose a UTI
Urine culture with sterile urine from a cystocentesis - urinalysis can be misleading
What are you looking for on rads for LUT signs
Radio opaque urolithiasis / stores
What are you looking for on ultrasound of LUT signs
Radiolucent uroliths, masses, clots , free fluid, dilated ureters or kidneys
What is almost always the case in cats with LUT signs, especially if they’re male
Idiopathic cystitis - if female more likely stones
A urine culture is never
Wrong
What are the steps in treating an obstruction causing LUT signs
Stabilize / diagnostics , then unblock ,more diagnostics if needed, definitive treatment
What are the steps to treating non obstructive lut signs
Stabilize (not usually needed), diagnostics, treatment
What can often mask the signs of shock in cats
Hyperkalemia - affects and distorts heart rate
Do you place a urinary catheter or an IV catheter list in a blocked cat
IV catheter - need blood to check electrolytes like potassium in case there is hyperkalemia (you can’t stabilize a patient without addressing the hyperkalemia)
Can u give fluid therapy to a blocked patient with LUT signs to stabilize them
Yes for a short time - 5 to 10 minutes ok, will not rupture the bladder and every animal with obstruction like this has some sort of kidney injury so need to keep this from getting worse
What can you use for hyperkalemia therapy
Calcium gluconate to stabilize the electrical activity in the heart, not to change the potassiumlevel
What can you give to drive potassium into the cells
Insulin, dextrose (to prevent hypoglycemia ), bicarbonate, injectable bronchodilators
How does hyperkalemia affect cardiac function
Increases the resting membrane potential making it harder to reach, causing issues with contractility I irregular rhymes like still standstill, etc
What can you give to help restore the difference between resting and threshold potentials that was disrupted by hyperkalemia
Calcium - will buy you time but will not address the hyperkalemia
What are 2 general options to treat hyperkalenia in a blocked patient
Give drugs to drive potassium into the cells (bicarb, insulin, albuterol) or increase potassium excretion by unblocking and giving more fluids (dilute it out basically)
What’s important to remember when giving pain management/sedation to a patient with hyperkalenia
Want it to be CV sparing because the heart is already being negatively affected by potassium - options are ketamine, midazolam , alfaxalone, etc
What is common to see post obstructive divresis / post unblock in
Polyuria in excess, some degree of anotemia due to kidney damage - polyuria is a way for the kidneys to recover but you need to keep up with losses
What is the risk of antimicrobial post unblocking if there is an indwelling urinary catheter
Increased risk of resistance if indwelling urinary catheter
What empiric antibiotics are often used for UTIs
Amoxicillin - 3 to 5 days (case dependent)
Feline idiopathic cystitis if often treated with
Time and comfort - pain med, antianxiety, first time free but after then do rads to further diagnose
What stones are often seen in young toy breeds
Urate stones - shunt
Describe uroabdomen
Urine free within peritoneum causing pain peritonitis, life threatening often caused by trauma but could be a ruptured tumor , definitive treatment with surgery
How can you diagnose a uroabdomen
Compare peripheral creatinine and potassium to effusion - if abdominal potassium is 40% higher in the effision or if the abdominal creatinine in the efferent is twice the concentration as peripheral blood then uroabdomen woabdamen is indicated
What should not be used to diagnose uroabdomen
Bun - it diffuses rapidly
How do you treat uroabdomen
Drain wine with a peritoneal drainage catheter and keep bladder small with indwelling urinary catheter
Describe Kirbys rule of 20
Monitoring checklist for systemic assessment of the critically ill patient - combo of physical exam parameters and diagnostic tests
What is the benefit of Kirbys rule of 20
Minimizes the chance of missing significant abnormalities
What is meant by a point of care test
Cage side to get essential results quickly
What are 4 walls to formulate an effective monitoring plan
Anticipate potential complications, interpret physical exam and diagnostic findings, establish target endpoints (treat p not number) I implement timely changes in treatments ( life threatening first)
What is the gold standard poc test for hypoxemia (pao2 less man 80)
Arterial blood gas - pulse ox second best
Where do you take a pulse ox (saturated oz)
Non pigmented skin
Relate cyanosis and hypoxemia
Cyanosis is a late sign of hypoxemia and death may precede cyanosis it patient is anemic
What values indicate hypoventilation and how is it determined
PaCo2 over 45 (severe if over 60) - determined with co2 production divided by alveolar ventilation
How do yo measure ventilation
Arterial blood gas, venous blood gas, end tidal co2
Vomiting comes from the - regurg comes from -
Vomiting from brain, regurg from esophagus
What are signs of vomiting
Nausea, agitation, drooling, lip smacking, retching (abdomen use, hacking)
What are signs of regurgitation
Passive, often when changing positions or walking, hard swallowing , no warning and no nausea
Describe signs of large bowel diarrhea
Urgency, straining / tenesmus, mucus / frank blood
Describe small bowel diarrhea
No urgency , possible increased frequency, no straining, melena
Can ew differentiate type of diarrhea through volume or consistency
No
Can ya differentiate vomiting versus regurg based on contents
No
What on blood gas would indicate an obstruction causing diarinea or vomiting
Metabolic alkalosis
Describe hemorrhagic gastroenteritis and now do you diagnose
Collection of signs , idiopathic, elevated PCV with low or normal TS suggestive, diagnosis of exclusion ) no specific test to anti
Kidneys are - but are not -
Kidneys - filter bad stuff and hold onto water to prevent dehydration (or get rid of later to prevent fluid overload)
Describe prerenal azotemia
Problem before the kidneys - usually dehydration or hypovolemia, urine should be concentrated because kidneys are holding the water they do have
Describe post renal azotemia
Problem cores after the kidneys - lower urinary tract obstruction or rupture, base on physical exam and imaging
With how much nephron loss will you see an azotemia
75% nephron loss - will have isothenuria with 67% loss
What’s the difference between SDMA and CK as markers of renal function
CK affected by muscle loss , SDMA has a wider range
Describe signs of acute kidney injury
Acute onset, quite sick despite moderate azotemia, good bcs, no anemia, kidney pain and enlarged kidneys
Describe chronic kidney disease
Insidious unset, stable despite severe azotemia, anemia, muscle wasting, small and irregular kidneys
If you suspect azotemia, what tests should you do
USG and culture are top priority - urinalysis not worth it, assume some degree of pre venal azotemia
Do fluids treat kidney injury
No - with AKI you need to treat the underlying causes
Why are fluids a go to when treating AKI
Could help treat the prerenal compartment of AKI and help patient feel better / prevent further complications
Does dialysis treat kidney disease
No - fills in to the kidneys while they are sick
What happens when you refrigerate fresh whole blood
Platelets give up basically - unredigerated fresh whole blood is good for 24-48 hours (keeping platelets stable)
What happens when you centrifuge fresh whole blood
You get plasma which can be frozen for a year or packed red cells which can be frozen for 2 weeks
At what PCV do you need to transfuse
None - depends on clinical signs and suspicions of blood loss states a while for PCV to change with blood loss (quicker if uw give fluids)
Blood typing should always be done
In cats - they develop all antibodies to blood types that aren’t theirs, dogs get one transfusion before you need to crossmatch
When would you transfuse whole blood
When you reed red blood cells and plasma - coagulopathy due to rodenticide, blood loss anemia
Why are packed ABCs used more commonly
Lower risk of transfusion associated circulatory overload (taco)
What can you give if you need fresh whole blood but don’t have it
Packed RBCs and fresh frozen plasma - both of these are easier to store
How much of a blood product should you give when transfusing
Start with 10 ml/ kg then reassess
When should you not transfuse an anemic patient
If they aren’t showing signs of anemia / monitor heart rate instead (better than PCV)
What are indications for using plasma
To replace missing clotting factors (contains the most proteins), part of a massive transfusion with packed red blood cells , maybe when reduced effective circulation but no evidence
When should you almost definitely cross match before transfusing
If time and if they’ve had previous transfusions
When do you stop transfusing
When clinically the patient is better or stable, check clotting times, based on the patient not the numbers
How do you determine replacement fluids
Body weight in kg times percent dehydrated - if not eating and vomiting, safe to assume 5% dehydrated
If you have an azotemic patient and you suspect CKD what do you do
Need to know if it is an acute exacerbation or progression of CKD - collect a urine sample for culture because CKD patients more at risk for pylorephritis, consider metal obstruction or nephrotoxins, assume some degree of presenal azotemia and dehudation because the kidneys cant concentrate
How do you treat CKD
Manage clinical signs, treat secondary AKI if present, antinausea, phosphorous binders, dietary managent1 blood pressure management
Will dehydration help treat CKD
No just like AKI - will help treat or prevent dehydration and help patient feel a little better ‘
Why do CKD patients become dehydrated
They can’t concentrate wire and develop an obligatory polyuria and then polydipsia to keep up with losses I but sometimes they just can’t drink enough - so need either at home sub Q fluids or esophagostomy tube
What are pros and cons of at home subcutaneous fluids
Inexpensive and easy but does have excess salt and risk of patient intolerance and lack of client ability
What are pros and cons of an esophagostomy tube
More physiologic and no extra salt , improved patient tolerance, easy to give, can give mediations this way too, - but does cost more upfront and require a procedure to place the tube , risk of complications like a stoma infection, dislodgement of tube or esophageal strictures
What is a stoma infection
Information and swelling around an opening (like with an esophagostome tube)
What do you need to consider wha giving a CKD patient antinasusea meds to eat
Need to insider QOL - once they don’t want to eat they are close to the end - should you use an E tube to keep the patent alive if they don’t want to eat?
Why are phosphorus binders often used to treat symptoms of CKD
Phosphorous depends on GFR and tends to follow bun and CK (so phosphorous is high in azotemic patients) - high phosphorous an mike the patient nauseous and uncomfy and on worsen calcium and then kidney function - 50 give phosphoras binders to prevent these side effects
Are prescription diets recommended to treat kidney disease
CKD yes - can slow progression and extend life expectancy, not really with AKI
Why should you monitor blood pressure in CKD patients
Hypertension common in CKD patients and hypertension worsens kidney function - treat if persistent and severe hypertension
How do you often treat hyper tension in CKD patients
Enalapril and amlodipine
A cat ingested large amounts of Lillies - do you give then hydrogen peroxide to induce vomiting
No never - hydrogen peroxide in cats can cause gastritis with terrible uceration or fatal henormagic gastritis
Is hydrogen peroxide still the recommendation to induce vomiting in dogs
No causes significant irritation of the esophagus and stomach causing partial ulceration
What is recommended in dogs now to induce vomiting - which works better
Apomorphine (compounded to be an IV injection) or clevor eye drops, hydromorphone - apomorphine less likely to need a second dose
What is recommended to induce vomiting in cats
Alpha 2s like dexmedetomidine and xylazine, hydromorphone extra label
What is the number I thing you need to do when a patient ingests toxins
Get it out of the body quickly - need to made sure p can protect their airways and has an appropriate mention before inducing vomiting
Most toxins warrent - unless otherwise noted
Warrent emesis - especially if concern for foreign body obstruction, note mention and make sure p is stable first
When do you not induce erresis
Corrosive or caustic agents , over 6 hours post ingestion, predisposed to aspiration , poor mention or neuralgic status
Which adsorbent works well for decatomination
Activated charcoal /toxiban - single dose used for most intoxicants , risk of hypernatremia after multiple doses
Why is sorbitol often given with activated charcoal
Rapid transit through the gut
What can ya do to decontaminate comatose patients or patient where emesis did not work
Gastric lavage
What do you give in an enema for decontamination
Warm tap water, lactulose , dawn or ivory dish soap
How do you treat toxic ingestions
Decontaminate S treat clinical signs, decontaminate if possible, intra lipid therapy, minimize absorption with enemas
Most toxins cause - unless otherwise noted
Git signs even if git is not the target damage organ
What organs are targeted by chocolate toxicity (methylxanthines - caffeine, theobromine/theophylline)
Git specifically , vomiting is often seen - heart and brain affected too
What are clinical signs of chocolate toxicity and when do they occur
Vomiting, tachycardia, tesessness, hyper excitation, agitation - signs occur 1-4 hours post ingestion
What is the treatment for methlyxanthine toxicity (chocolate)
Activated charcoal with sorbitol, ECG , fluids - often just reed one dose and then they’re fine / really good prognosis if decontamination happened quick enough
Describe clinical signs of NSAID toxicity
GI - abdominal pain, hematamesis, melena
renal - pu/pd, decreased urine;
hepatic damage- is idiosyncratic and not dose dependent!
Nerve - seizures, obtunded
Heart - hypovolenick shock
What signs can result with COX 1 inhibition from NSAID toxicity
Gastric ulcers, GI bleeding
What signs can occur with cox 2 inhibition from NSAID toxicity
Hypertension, water and sodium retention, AKI
Are you likely to see gastric ulcers from NSAID toxicity
Maybe but more likely to see with chronic NSAID use
How do you treat NSAID toxicity
Ulcer prevention, renal support (fluids and monitor urine + weight), treat hypovolemic shock- intravenous lipids, dialysis if needed
Does sucralfate treat gastric ulcers
Binds defects but does not protect the mucosal lining - so keeps present defects from worsening but doesn’t paint formation of new ones
What is the prognosis for nsaid toxicity
Worse if decreased to no urine output, renal failure ór ulceration requiring surgery - neurodeficits will usually get better
What are clinical signs of xylitol toxicity
Weakness, depression, ataxia, tremors, seizures hepatic /hematologic like icterus, melena, petechia ,remarriage, hypoglycemia due to increased insulin release from pancreas, hepatic failure if ingested large amants
How do you treat xylitol toxicity
Dextrose for emergent seizure patients and for hypoglycemia, nacelyleistine for hepatic necrosis, monitor pt and att
What are clinical signs of wild mushroom toxicity
Unexplained acute signs - hypersalivation, ataxia, v/d. Dull mention, tremors, agitation, vocalization
Most wild mushroom toxicity can be treated by decontamination except
Amanita and galerinia - both are hepatotoxic and need hepatic support
Sago palm toxicity is similar to _ and cause -
Xylitol toxicity - causes hypersalivation, pu/ pp, melena, jaundice, seizures, ataxia, dull mentation
Who an d what is most affected by sago palm toxicity
Dogs most affected - all parts of plant toxic and target git, liver and CNS
What is the primary target organ of marijauna /THC / CBD? What clinical signs are seen?
Nervous system /brain - causes lethargy, hyperesthesia, ataxia, agitation, seizures, comatose - can also cause bradycardia and hypothermia
When do signs of marijauna toxicity occur
20-30 minutes after exposure and can last 2-3 days
Do animals have to ingest the marijauna for it to be toxic
No - Can just be from inhalation
How do you treat marijauna toxicity
Benign neglect usually, emesis with AC + sorbitol for large ingestion amounts
What shard you rapidly use for marijauna toxicity
Rapid use of intralipids when clinical - improves in 30 mins to 1 hour
What are signs of seroton uptake inhibitors toxicity and when do they occur
Tachycardia, neuro signs ( ataxia, disorientation, absent menace, tremors) 1 occurs 1-2 hours after ingestion
How do you treat ssri toxicity
Acepromazine, methocarbomal for tremors; cryptoheptdine as serotonin antagonist - supportive therapy leads to a good prognosis
What clinical signs do you see from rodenticide toxicity and when do you see them
Green discolored feces, neuro signs , nystagmus - an see signs as early as 24 hard but can progress to 2 weeks
What is the most common rodenticide toxicity
Bromethalin
How to you treat rodenticides
No antidote - AC, intralipids, seizure control, mannitol - severe neurologic signs bad prognostic indicator but if my only develop mild signs they have a better prognosis
What clinical signs do you usually see with pyrethoids
Most commonly see in cats (flea and tick ) - neurotoxic, clinical signs in 1-2 hours
How do you diagnose pyrethroid toxicity
Lbs consistent with muscle trauma - kidney injury, dehydration, hyperthermia
How do you treat pyrethroid toxicity - common in cats
Bath if applied topically, seizure management, intralipids therapy to protect nervous system
What are signs of vitamin. D toxicosis
Nephrotoxic - pu/pd, uremic ulcers, GI signs, near signs, hyperkalenia leading to kidney failure
How is vitamin D toxic
Cholecalciferol converted to calcitriol in is dreys which decreases calcium and p excretion and increases gut aborpken
How do you treat vitamin D toxicosis
Promote decreased renal absorption and increased excretion to remove excess calcium- phosphate binders to decrease git absorption of calcium and phosphorous
What are clinical signs of grape/raisin toxicity and what is their MOA
Renal / nephrotoxic - pu/pd / standard git effects - idiosyncratic toxicity
How do you treat grape toxicity
Control symptoms of AKI and azotemia (like with vitamin D toxicosis) - monitor for hypertension which makes kidney injury worse
Describe signs of ethylene glycol toxicity and when they occur
Nephrotoxic - urine dribbling, near (1-6 hours), drunk phase that resembles marijauna1 ataxia, blindness - occur within 12-24 hard
How do you treat ethylene glycol / antifreeze toxicity
Dialysis, ethanol - treatment has to be sought in 6 hard or prognosis is poor
What is the MOA of Lilly toxicity
All parts of the Lilly is toxic - affects the glomensus and fuses obstruction of the tubules
What are clinical signs of Lilly toxicity - when do you see signs
Nephrotoxic - pu/pd, drooling, seizures, see signs in 24 hours
With what nephotoxic substance do you often see hypercalcemia
Vitamin D toxicosis
Describe signs anticoagulant rodenticide toxicity
Multi compartment bleeding, green feces, dyspnea - signs of bleeding may not be seen for up to a week after exposure
When should you recheck coagulopathy times after treating an anticoagulant rodenticide poisoning with vitamin K
48 - 72 hours after stopping the vitamin K
What is important to remember about acetaminophen toxicity
Some contain codeine so might need to treat for 2 toxicities
What are clinical signs of acetominpher toxicity
Cyanosis due to methb 1 dull mention, signs of liver failure in 2 days
What is the prognosis for acetaminophen toxicity
Poor due to toxic metabolites - often in liver failure before you see cyanosis
What are toxin differentials for a coagulopathy
Vitamin K rodenticide , hepatotoxic substances, NSAIDs
What are toxin differentials for azotemia
Lillies in cats, ethylene glycol, raisins I grapes, NSAIDs
What are toxin differentials for increased liver enzymes
Sago palm , xylitol, acetaminophen , amatoxic mushrooms, NSAIDs
List primary hematologic toxins
Anticoagulant rodenticides , acetaminophen
List primary nephrotoxic substances
Vitamin D toxicosis, grapes I raisins, ethylene glycol/antifreeze , Lillies in cats
List primary neurotoxic substances
Marijauna ,ssris , neurotic rodenticides (bromethalin), pytethroids
List multi organ target toxins
Methylxanthines (chocolate) / NSAIDs / xylitol, wild mushrooms, sago palm
