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RUSVM LAM I > Fluid Therapy 1 > Flashcards

Fluid Therapy 1 Flashcards

1
Q

What % of TBW does fluid make up?

A

60%

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2
Q

What % of TBW makes up intracellular vs. extracellular %?

A

Intracellular: 30-40%
Extracellular: 20-30%

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3
Q

What are 5 indications for fluid therapy?

A 
Decreased intake
Dehydration
Decreased circulating volume
Need for overhydration
Miscellaneous
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4
Q

What are 3 reasons for decreased intake of water?

A

Disease: anorexia, gastric reflux
Inability to ingest water: dysphagia, esophageal obstruction, neurologic dysfunciton
Lack of availability: freezing water

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5
Q

What are the 4 types of shock?

A

Hypovolemic shock
Vasculogenic shock
Maldistributive shock
Cardiogenic shock

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6
Q

In what situation would you need to overhydrate a horse?

A

Intestinal impaction- increases fluid flow to intestinal lumen and softens stool to allow for easier passage

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7
Q

What are 7 clinical signs that indicate the need for fluid therapy?

A 
Skin turgor
Mucous membranes
Urine production
Sunken eyes
Depression, muscle weakness
Heart rate
Decreased jugular distensibility
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8
Q

At what % of dehydration is skin turgor often seen?

A

8-10% dehydration you begin to notice this CS

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9
Q

Where should you check skin turgor in adult horses vs. foals?

A

Adult: neck
Foal: eyelid

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10
Q

What is the normal skin tent time?

A

<1 sec

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11
Q

At what % are dry MM noticed in equine?

A

5-7% dehydration

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12
Q

What is noticed about the urine of a dehydrated patient?

A

Decreased urine output and increased urine specific gravity

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13
Q

What species are sunken eyes most commonly observed in?

A

Ruminants-not common to see in equine

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14
Q

What is noticed about the heart rate in a dehydrated horse?

A

Tachycardia- one of the first parameters to change

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15
Q

What are 6 laboratory indicators of dehydration?

A 
PCV
TP
BUN/Crea
Albumin
Lactate
Urinalysis
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16
Q

What can mask anemia in an equine patient causing underestimation of severity of the disease?

A

Splenic contraction

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17
Q

What will you expect the TP to do as an animals %dehydration increases?

A

TP should increase

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18
Q

What can hypoproteinemia do to your estimate of % dehydration?

A

Underestimate degree of dehydration

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19
Q

What should you keep albumin above?

A

1.5 g/dL

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20
Q

What is the only possible cause of hyperalbuminemia?

A

Dehydration

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21
Q

What are 6 CS associated with hypovolemic shock?

A 
Prolonged CRT
Decreased jugular filling
Tachycardia
Decreased pulse pressure
Cold extremities
Decreased skin turgor
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22
Q

What % dehydration is the following patient?
A horse is presented to you with the following:
Skin tent (s): 2 seconds
MM: slightly tacky
CRT: normal
HR: normal
Decreased urine output

A

5%

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23
Q 
What % dehydration is the following patient? A horse is presented to you with the following:
Skin tent (s): 4 s.
MM: tacky
CRT: 2-3 s.
HR: 40-60 bpm
Decreased arterial BP
A

8%

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24
Q

What % dehydration is the following patient? A horse is presented to you with the following:
Skin tent: 5 sec. +
MM: DRY
CRT: > 4 sec.
HR: 60 BPM+
Reduced jugular fill, barely palpable pulse

A

10-12%

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25
Q

What % dehydration is the following patient? A horse is presented to you with the following:
Obvious sunken eyes and in a state of shock

A

12-15%- on the verge of death

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26
Q

What are the 7 routes of fluid administration?

A 
Oral 
IV
SubQ
Intra-peritoneal
Rectal
Intraosseous
Intra-cecal
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27
Q

What is the most common route of administration of oral fluids in a horse?

A

Nasogastric tube for fluid administration

28
Q

How many L can be administered at once via oral route?

A

6-8L should be targeted at once (can get up to 12-16 L)

29
Q

What is the fluid transit time from the stomach?

A

<30 min

30
Q

What complication commonly benefits from oral administration the most?

A

LI impactions

31
Q

What is the major contraindication of oral fluid administration?

A

Presence of gastric distention, reflux and ileus

32
Q

What is the second most common route of fluid administration?

A

IV route

33
Q

What are the four sites of IV placement?

A

Jugular vein
Lateral thoracic vein
Cephalic vein
Saphenous vein

34
Q

What direction should the catheter be placed?

A

TOWARDS THE HEART

35
Q

What side of the horse are intra-peritoneal fluids administered?

A

Dorsal aspect of left flank

36
Q

What is a major advantage of intra-peritoneal fluids?

A

Potentially large volumes at a rapid rate

37
Q

How should you position a horse receiving rectal fluids?

A

Horse should stand on an incline with head/forelimbs lower than hind end-avoids evacuation reflex of terminal small colon and rectum

38
Q

What is the major concern of intra-osseous fluid administration?

A

Rate at which the fluids can be administered

39
Q

What is the rate of intra-oseous fluid administration limited by?

A

Size of needle-maximum administration is 2L/hr

40
Q

What is the rate limiting step of fluid administration?

A

narrowest diameter in system- 10 G is the rate limiting catheter size

41
Q

What is the length and flow of a 14 G catheter?

A

Length: 5.25 in.
Flow: 13.1 L/hr

42
Q

What is the flow of a 12 G catheter?

A

26.9 L/hr

43
Q

What is the flow of a 10 G catheter?

A

36.5 L/hr

44
Q

What is the typical STAT IV set?

A

8; above horse with 28L/hr gravity flow capacity

45
Q

What is the typical rate of a macrodrip set in equine?

A

10-15 drops/mL

46
Q

What type of material makes up long term catheters?

A

Polyurethane or silicone

47
Q

What type of material makes up short term catheters?

A

Teflon and polyethylene

48
Q

What is the maximum time period that short-term catheters can be kept in?

A

72 hrs.

49
Q

The rate of thrombosis depends on what 6 factors?

A

systemic state of animal
stiffness of catheter- stiffer=more thrombogenic
Size of catheter- larger=more thrombogenic
length of catheter- longer=more thrombogenic
material of catheter- most thrombogenic (polypropylene) least thrombogenic (polyurethane/mila)
Vessel trauma

50
Q

What is the typical acid-base disturbance in horses?

A

Metabolic acidosis

Typically have loss of K and Ca

51
Q

What 3 factors determines the choice of fluid used?

A

Fluid type
fluid tonicity
fluid effect on acid/base status

52
Q

What are the most common type of fluids used in equine medicine?

A

Crystalloids

53
Q

What are examples of crystalloid solutions?

A 
LRS
Saline
Normosol (M/R)
Plasmalyte
Dextrose solutions
Bicarbonate solution
54
Q 
What % sodium is in the following solutions:
Normal saline
Half-strength saline
Twice stregnth saline
Hypertonic saline
A
  1. 9%
  2. 45%
  3. 8%
  4. 2%
55
Q

When are colloid solutions used?

A

Increase oncotic force within IV space to retain fluid within that space

56
Q

What specific case are colloids commonly used?

A

Hypoproteinemia

Dextran, hetastarch, plasma, serum are used

57
Q

What is the most common fluid used in equine medicine?

A

LRS

58
Q

What is the most common reason for hypertonic saline use?

A

Emergency resuscitation in hypovolemia

59
Q

What site should hypertonic saline be administered?

A

Jugular catheter

60
Q

What is the MOA of hypertonic saline?

A

fluid shift from intracellular space into ECF space associated w/ increased tonicity

61
Q

What is the direct effect of hypertonic saline?

A

triggering central brain receptor mechanism

62
Q

What is the overall effect of hypertonic saline?

A

Improvement in CO, MABP urine production and decrease in systemic vascular resistance
- do so by increasing preload and decreasing afterload

63
Q

What can be a major complication of hypertonic saline administration?

A

Uncontrolled hemorrhage due to the improved CO

64
Q

Can dehydration be a contraindication for hypertonic saline administration?

A

Not dehydration alone. However- hypertonic dehydration state can be contraindicated for hypertonic saline administration due to the increased swelling in the brain

65
Q

What type of inotropic effect does hypertonic saline have?

A

Negative inotrope-cardiotoxic

66
Q

T/F: shocky patients are severely dehydrated

A

FALSE- shocky patients are severely hypovolemic

RUSVM LAM I (9 decks)

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