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Clinical Medicine Master > Fluid Balance and Acid Base (MR) > Flashcards

Fluid Balance and Acid Base (MR) Flashcards

1
Q

Total Body Water is what % of body weight?

A

60.00%

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2
Q

ICF is what % of Total Body Water? ECF?

A

66% 33%

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3
Q

What % of ECF is Intravascular? What fluids are Intravascular?

A

25% Plasma – proteins Blood What % of TBW is Blood Volume? 8% What % of ECF is Interstitial? What is in Interstitial fluid?

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4
Q

What is basically the same between intravascular fluid (Plasma) and interstitial fluid?

A

Solutes

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5
Q

What % of ECF is Transcellular? What is in transcellular fluid?

A

25% Synovial Peritoneal CSF Intraocular

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6
Q

Hydration is a physiological balance between?

A

Interstitial and intravascular fluid

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7
Q

2 organs with big spaces in the vasculature?

A

Spleen Liver

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8
Q

2 organs where there are there are no spaces in the vasculature?

A

Brain (BBB) Prostate (BPB)

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9
Q

What are the 4 main forces of Starlings forces?

A

Interstitial Oncotic (∏i) - pulling fluid out Capillary Oncotic (∏c) - pulling fluid in Interstitial Hydrostatic (Pi) - pushing fluid in Capillary Hydrostatic (Pc) - pushing fluid out P = Hydrostatic Pressure - water thru your garden hose. C = Capillary I - Interstitial ∏ = Oncotic

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10
Q

What is the sum of all the forces?

A

Net Fluid Movement

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11
Q

When can it be a more influential component? Why is there water in the abdomen?

A

∏I , Dz State

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12
Q

A 10 yo female spayed Shitzu presents to you with grade 4/6 tricuspid systolic murmur and a belly full of fluid. You stick a needle in it and its a transudate. Why is the water in the belly?

A

Pc is ↑ due to backup of blood back into body from right side of heart

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13
Q

You have a 6yo Sharpei with chronic dxa and he’s got limb edema and mild ascites. Why is the fluid where it is?

A

↓ ∏c due to ↓ in TP - shitting it out - PLE

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14
Q

Normal dog, nothing wrong with it. Doing a study on Hetastarch which is an Oncotically (∏) active fluid. If you give him Hetastartch, what is going to happen to his interstitial fluid compartment?

A

↑ in ∏c - pull fluid from interstitium into capillaries

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15
Q

K factor in the equation is related to? What does it affect?

A

Leakiness of vasculature Fluid will move more easily in areas that are leakier like the spleen and liver

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16
Q

The role of lymphatics: You have a dog with limb edema and a very enlarged inguinal LN, why is there leg edema?

A

Pi - backup of lymphatics will cause a backup of interstitial fluid and an ↑ in Pi

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17
Q

What do lymphatics drain?

A

Interstitium

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18
Q

Effective Osmols: ECF?

A

Na+ Cl- HCO3-

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19
Q

Effective Osmols: ICF?

A

K+ PO4- ICF Proteins (too big to get out)

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20
Q

How much Na+ is there in ECF? ICF?

A

142 mEq/L 10 mEq/L

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21
Q

How similair is plasma to interstitial fluid? They are both ______?

A

Very Similar Extracellular

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22
Q

How much K+ is there in ECF? ICF?

A

4 mEq/L 140 mEq/L

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23
Q

How much Ca2+ is there is ECF? ICF? Then, where the hell is all this “oh so important” Ca2+?

A

5 mEq/L <1 mEq/L Hidden away in lil compartments inside the cell. Like Binladen.

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24
Q

Where can fluid move freely between for the most part? Where can it not?

A

Interstitium & Plasma ECF & ICF

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25
Tonicity is regulated by? Where/how is it restricted?
Effective Osmols (EOs) ICF by membrane
26
Isotonic?
same concentration of EOs inside and out of cell
27
Hypotonic?
Less EOs outside/More Eos inside of cell and fluid enters cell
28
Hypertonic?
Less Eos inside/More EOs outside of cell and fluid exits cell
29
What is the Osmosis Cheer?
Water follows solute hey!
30
What is dehydration? Who bears the brunt of the fluid loss?
Loss of bodywater due to hypertonic ECF ICF
31
What is the hallmark of dehydration? Why?
Hypernatremia It is the 1º ECF so if it is ↑, you know dehydration! What does body care about more, water in cells or water in vasculature? When ECF becomes hypertonic and water exits cells. Volume in vasculature to stay alive, even to detriment of cells
32
What behaviors/situations lead to thirst?
Fever Panting lack of water
33
What are the two types of thirst?
Hypovolemic Osmotic
34
Ostmotic Thirst: what signals to brain that you need to drink?
Na+
35
What is the pathway of signaling that leads to water conservation?
Osmosensory neurons to preoptic area = ↑ Vasopressin release to ↑ water conservation and to hypothalmus to ↑ thirst and make you drink
36
Hypovolemic Thirst: what is the difference and where are the signals involved in correction?
Volume is the concern Cardiac Baroreceptors signal to brainstem Kidney Baroreceptors to trigger Angiotensin II signal to subfornical Then, both brainstem and sf organ signal Preoptic Area
37
Explain the common portion of the thirst and water conservation mechanism?
Water Conservation: Preoptic Area to Supraoptic nucleas & paraventricular nucleas to release Vasopressin and inact water conservation
38
What is hypovolemia?
Water & Electrolyte Loss
39
What is the change in water balance with Isotonic water loss?
None
40
Which compartment is primarially affected with hypovolemia? Causes?
Intravascular Hemorrhage GI loss Burns Tissue Injury
41
With hypovolemia, what is the cascase of events?
↓ Blood Volume - ↓ Venus Return - ↓ Stroke Volume - ↓ Cardiac Output ↓ Tissue Perfusion
42
What can you test to see if you have a ↓ in tissue perfusion?
Lactate
43
What do baroreceptors respond to?
Blood Pressure and Volume
44
What 2 mechanisms do Baroreceptors turn on to correct pressure and volume?
Neuro Mechanisms Endocrine Mechanisms
45
What are the neuro mechanisms turned on by baroreceptors?
Baroreceptors Chemo receptors Cardiovascular centers Sympathetic Activation to release Epi and NE leading to ↑ Cardiac CO
46
What is the result of the neural mechanism?
↑ CO Peripheral Vasoconstriction ↓ BP ↓ Venous Reserve
47
What are the Endocrine mechanisms turned on by baroreceptors? What is the combined effect?
ADH Angiotensis II Aldosterone EPO ↑ Blood Volume
48
What does Angiotensin II do?
↑ Sympathetic System Tubular reabsorption of Na+, Cl-, & Water follows (& K+ excretion) Powerful Vasoconstrictor - ↑ BP ADH Secretion from Posterior Pituitary - Collecting duct H2O absorption
49
Progressive Hypovolemia: why is it progressive?
bc cells keep metabolizing til they die
50
What is Dysoxia? Does this occur when animal is breathing normally?
Lack of O2 or ability to utilize O2 at the cellular level Sure can!
51
What happens when you have Dysoxia? What type occur due to inadequate O2? What type inhibit mitochondrial function (oxidative phosphorylation)?
SHOCK Hypovolemic & Cardiogenic Endotoxic & Septic
52
When cell doesnt have O2 to make energy what happens? Producting?
Anaerobic Metabolism Lactate
53
CX of Hypovolemia?
Tachycardia ↓ Pulse Pressure ↑ CRT, ↓ Jugular Fill Tachypnea Cold Extremities ↓ Urine Output Obtunded/Ataxic
54
CX of Dehydration - %5?
Tachy MM Prolonged Skin tent - not sensitive Sunken Eyes ↑ USG Snarky Muscle Cramping
55
Why does Hypovolemia cause tachycardia?
Body tries to correct volume SV * HR = CO SV ↓ so to maintain CO, HR ↑
56
What happen together?
Severe Dehydration & Hypovolemia!
57
When does volume status need to be corrected? When does hydration status need to be corrected?
NOW – EMERGENCY Over 12 - 24 hrs
58
TQ!!! Dx Testing: What is the easiest and best way to evaluate hydration status over time in the hospital?
Body Weight Monitoring!!!
59
How much does a L of water weigh?
1kg
60
What other test are used to determine water balance situation?
PCV/TS USG Creatinine/BUN Lactate CVP - Central Venus Pressure (meh) Venous O2 Saturation
61
What does Lactate measure? RR?
Anaerobic Metabolism Marker < 1.0 mmol/L
62
How is a CVP performed?
Catheter(at level of Rt Atrium) and monometer outside Right Jugular Vein
63
What % is mild dehydration? CX?
5 - 7% Skin Tent Mildly tachy mm
64
What % is moderate dehydration? CX?
8 - 10% Depressed Tacky MM CRT > 2 sec Correlated Hypovolemia
65
What % dehydration is Severe? CX?
>10% Cool extremeties Poor Perfusion
66
TQ!!! How much does 1L of fluid weigh?
1 kg
67
What info do you need to calculate fluids?
Deficits Ongoing Losses Maintenance
68
What is the maintenance does for Dogs & Cats? Horses?
40 - 60 ml/kg/day Dogs Higher end/Cats lower end 50 ml/kg/day
69
How do you calculate deficit?
kg * % dehydrated remember 1kg = 1 L
70
How do you figure out losses ongoing?
Estimate or measure and add it in in mL or L
71
What should you estimate for mild horse dxa?
1L / hr
72
What happens if you are hypovolemia?
Shock Dose!
73
Can you kill something with fluids?
YES
74
What is blood volume of body weight?
8-9%
75
What is the Shock Dose for fluids? Except for?
80 - 90 ml/kg CATS!
76
What is a BOLUS?
Any amount that goes in all at once
77
What is delivery of Shock Dose?
1/4 Total Dose as Bolus √ √ √ - if hypovolemic - Administer another 1/4 Bolus √ √ √ - if still hypovolemic - repeat until CX improve.
78
What do you do once no longer hypovolemic?
Move to Maintenance dose
79
What are the 2 major types of fluids?
Crystalloids Colloids
80
What are Crystalloids? List?
Basic E-lyte Solutions, Buffers LRS Saline Plasmalyte Hypertonic Saline
81
What are colloids? List?
Large osmotically active particles (remain intravascular) Pull fluid into vasculature! Artificial - Hetastarch, Oxyglobin Natural - Blood/Plasma Products
82
If you give a colloid, what will you then need to fix? How?
Interstitial balance Crystalloid
83
What is the tonicity of most crystalloids?
Isotonic - flow like plasma
84
How quickly does crystalloid move from plasma to interstitium?
30 min
85
What are Colloids generally used for?
Hypovolemia Hypoproteinemic
86
CAVE of hetastarch?
+/- bleeding times on high doses
87
What is Oxyglobin?
Polymerized Bovine Hgb Product
88
What are Blood Products? CAVE?
Whole Blood, FFP, pRBCs, Platelet Concentrate Transfusion Rxns
89
TQ!!! Combination Therapy Rule of Thumb?
For every 1L of Hypertonic Saline replace with 10 L of Crystalloid
90
What % NaCl is Hypertonic Saline?
7.00%
91
What is Hypertonic Saline used for? What does it do? How much?
Resuscitation! - NOT MAINTENANCE Pulls water into vasculature! 2 - 3 X fluid expansion of what was infused
92
Hypertonic solution will have what effect on ICF/ECF? Causing?
ICF redistributes to ECF (Robbing Peter to pay Paul) Dehydration - Give a crystalloid (isotonic)!
93
What % NaCl are normal saline fluids?
0.90%
94
What does 1/2 strength saline consist of?
0.45 saline + dextrose
95
Can you fix hypovolemia with oral fluids? Why?
NO Blood flow to gut is ↓ with hypovolemia (Sympathetic) Only mild dehydration Oral/Enteral ROA? (2) Contraindications? (3) Free choice Nasogastric Tube – Horse Refluxing GI obstruction Hypovolemia
96
Subcutaneous ROA: who? Which fluids? Dose Contraindications?
SA Isotonic Only! 10 ml/kg/site hypovolemia
97
IV ROA: Who? When is it MOST appropriate? Where?
Everyone! Mod - Severe dehy/hypovolemia recuscitation Jugular, Cephalic, SaphenousWhat is Intraosseus good for?
98
What is Poiseuille's Law?
Q = Pie r4 P/ 8 η L
99
What is laminar foow along the tube proportional to?
4th power of tube radius
100
What size should you use pertaining to the job?
Smallest necessary
101
What size catheter should be used for resuscitation?
Biggest Possible
102
Typer of Cathethers? Which is for shorter-term?
Over the Needle - shorter term Over the Wire
103
Response to Fluid Therapy: Hypovolemia? HR? PP/Jug Fill? RR?
↓ HR ↑ PP/ ↑ Jug Fill ↓ RR
104
What % is mild dehydration? CX?
5 - 7% Skin Tent Mildly tachy mm
105
What % is moderate dehydration? CX?
8 - 10% Depressed Tacky MM CRT > 2 sec Correlated Hypovolemia
106
What % dehydration is Severe? CX?
>10% Cool extremities Poor Perfusion CRT > 3-4 %
107
What is the pH of the stomach?
1
108
What determines [H+]?
pCO2 & [HCO3- ]
109
What does pH =?
Negative log of [H+]
110
What is the main reason to do an arterial blood gas?
to evaluate respiratory system and O2 exchange
111
Which artery do you do an arterial blood gas in in SA?
Femoral Dorsal pedal
112
What is the arterial blood gas parameter for hypoxemia?
PaO2 < 80 mmHg
113
What is PCO2?
Partial Pressure of O2
114
What is TCO2?
An estimate of HCO3-
115
What are the two ways to become acidemic?
↑ PCO2 ↓ HCO3-
116
What are the 2 ways to become alkalotic?
↑ HCO3- ↓ PCO2
117
How do you know if there is compensation?
Identify primary disorder, if the other is out of RR in the same direction you have compensation.
118
Causes of Respiratory Alkalosis?
Hypoxemia due to Pulm/Card Dz CNS dz/hemorrhage Salicylate intoxication Sepsis Iatrogenic tachypnea
119
What is Anion Gap?
[Na+ + K+] + [Cl- + HCO3-]
120
What is normal Anion Gap?
16+/-4

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