Fluid Therapy Flashcards
what percentage of body weight is made up of water?
60%
what two subdivisions can body water be divided into?
extravascular and intravascular
what percentage of body water is found extravascularly?
55%
what percentage of body water is found intravascularly?
5%
what is maintenance of fluid balance in the body an example of?
homeostasis
what must fluid intake match?
fluid outgoing
give two examples of fluid intake
drinking
eating
give three examples of fluid outgoings
urination defecation body surfaces (respiratory tract and skin)
what percentage of extravascular fluid is located within cells?
40%
what percentage of extravascular fluid is located in between cells?
15%
what are the three main causes of fluid imbalance?
changes in fluid volume
changes in fluid content
changes in fluid distribution
what is the most common cause of a change in fluid balance?
change in fluid volume
what is a change in fluid volume often caused by?
dehydration and hypovolaemia
what are the two main physiological consequences of changes in blood volume?
hypovolaemia and dehydration
what occurs during hypovolaemia?
fluid is lost quickly from the intravascular space
how quickly is fluid lost during hypovolaemia?
quickly
what does hypovolaemia lead to within tissues of the body?
tissue hypoperfusion (shock)
does treatment of dehydration and hypovolaemia differ?
yes
what happens during dehydration?
fluid is lost slowly from the extravascular compartment and patient is unable to keep up with fluid gains and losses
during dehydration is there time for fluid levels to be redistributed across all body compartments?
yes
is water lost equally from all body compartments during dehydration?
yes
what are the main CVS physiological effects of hypovolaemia?
blood loss leading to reduced pre-load and so reduced stroke volume. This leads to a reduced cardiac output
what are the main ways which the body compensates for hypovolaemia?
vasoconstriction and tachycardia
what physical signs do vasoconstriction and tachycardia lead to?
maintenance of blood pressure (TPR)
changes in mucous membrane colour and CRT
what components of triage give information about the patients intravascular volume status?
heart rate pulse quality mucous membrane colour capillary refill time (CRT) blood pressure mentation temperature
what is the average canine heart rate during mild (compensated) hypovolaemia?
130-150 bpm
what is the usual mucous membrane colour of a canine with mild (compensated) hypovolaemia?
normal or slightly pinker
what is the usual CRT of a canine with mild (compensated) hypovolaemia?
<1
what is the pulse quality of a canine with mild (compensated) hypovolaemia?
bounding
what is the usual systolic blood pressure of a canine with mild (compensated) hypovolaemia?
> 90 mmHg
what is the usual mentation of a canine with mild (compensated) hypovolaemia?
normal
what is the average canine heart rate during moderate hypovolaemia?
150-170 bpm
what is the usual mucous membrane colour of a canine with moderate hypovolaemia?
pale pink
what is the average CRT of a canine with moderate hypovolaemia?
2
what is the average pulse quality of a canine patient with moderate hypovolaemia?
weak
what is the average systolic blood pressure of a canine with moderate hypovolaemia?
> 90 mmHg
what is the usual mentation of a canine with moderate hypovolaemia?
normal/obtunded
what is the average canine heart rate during severe (decompensated) hypovolaemia?
170-220
what is the usual mucous membrane colour of a canine with severe (decompensated) hypovolaemia?
pale pink/white
what is the average CRT of a canine with severe (decompensated) hypovolaemia?
> 2 - prolonged
what is the average pulse quality of a canine patient with severe (decompensated) hypovolaemia?
very weak
what is the average systolic blood pressure of a canine with severe (decompensated) hypovolaemia?
<90 mmHg
what is the normal mentation of a canine with severe (decompensated) hypovolaemia?
obtunded as the brain is starved of oxygen and nutrients
what happens when the body is compensating for hypovolaemia?
blood pressure is maintained so tissues remain perfused
what environmental factors can alter a physical exam in normal patients?
cold or ambient temperatures
what species typically have paler mucous membranes than canines?
felines
what must you be familiar with when assessing intravascular volume?
to be familiar with what is normal and look at the entrire clinical picture
what components of triage/physical exam will give information about the patients extravascular volume status?
moistness of mucous membranes skin turgor (skin tenting) weight globe position within orbit of skull (urine output)
what are the signs of <5% body weight estimated dehydration?
not clinically detectable, suspected from clinical history
what are the signs of 5-6% body weight estimated dehydration?
tacky mucous membranes
mild delay in skin tent return
what are the signs of 6-8% body weight estimated dehydration?
dry mucous membranes
mild increase in CRT
mild to moderate delay in skin tent return
+/- sunken eyes
what are the signs of >10-12% body weight estimated dehydration?
dry mucous membranes CRT >2-3 seconds \+/- signs of shock prolonged skin tent sunken eyes
why may hypersalivation affect the assessment of dehydration?
may hide dry or tacky mucous membranes
what are two other factors aside from hypersalivation that can complicate the assessment of dehydration?
subcutaneous fat
skin’s collagen content (elasticity)
what haematology/biochemistry parameters may be affected by a patients hydration status?
PCV
total proteins
urea and creatinine
what urinalysis parameters may be affected by a patients hydration status?
urine specific gravity
what other tools can be used during patient assessment of dehydration?
urinalysis
biochemistry
haematology
when assessing a patients level of dehydration/hypovolaemia what must be considered?
all physical exam and clinicopathological parameters must be taken into consideration and none interpreted in isolation
can hypovolaemia and dehydration exist in the same patient?
yes and they commonly do
how is a patients stability classed if they are hypovolaemic?
they are unstable and their condition could become rapidly life threatening
at what speed is hypovolaemia treated with fluid in the patient?
quickly - via a bolus
how will fluid be given to the hypovolaemic patient?
stabilised with rapid fluid resuscitation of the patient
how is a patients stability classed if hypovolaemia is not present?
they are stable
at what speed should extravascular fluid losses be corrected?
slowly
what effect can rapid rehydration of dehydrated patients have?
intravascular volume increases rapidly raising atrial pressures and causing production of diuretic hormone causing increased urination
why is rapid rehydration of dehydrated patients so dangerous?
can cause even more severe dehydration
define hypovolaemia
state of decreased intravascular volume
define hypervolaemia
also known as fluid overload, the medical condition where there is too much fluid in the blood
define normovolaemia
normal blood volume
define hypoperfusion
critical condition brought on by sudden and global defecit in tissue perfusion. Results in inadequate delivary of oxygen and nutrients to vital organs
define shock
state of cellular and tissue hypoxia, most commonly caused by hypoperfusion
define dehydration
excessive loss of body water from the extra vascular compartment
define oncotic pressure
form of osmotic pressure induced by proteins
what is appropriate fluid selection influenced by?
what is trying to be achieved with the patient
what are the most common types of fluid?
crystalliods
what do crystalliod fluid contain?
solutes (dissolved compounds e.g. Na)
can crystalloid fluids move between different fluid compartments of the body?
yes
what has happened to crystalloid fluids 1hr after administration?
distributed throughout all body compartments
what are the 3 main categories of crystalliod fluids?
isotonic
hypertonic
hypotonic
which is the most common type of crystalliod fluid?
isotonic
what are isotonic crystalliods used for?
replacement fluids
give two examples of isotonic crystalliods
0.9% NaCl and Hartmann’s
how do crystalloid fluids mimic the intravascular electrolyte concentrations?
high Na and low K
what do replacement fluids mimic?
intravascular electrolyte concentrations
why may Hartmann’s be seen as more balanced?
electrolyte composition is more similar to that of serum
what is useful for acidosis that usually accompanies hypovolaemia?
a buffer such as lactate
in what type of crystalloid fluid is lactate found?
hartmann’s
what are the three main indications for the use of Hartmann’s and 0.9% NaCl?
hypovolaemia
dehydration
replacement of ongoing losses
what are the preferred uses for 0.9% saline over Hartmann’s?
management of hypochloraemia, hypercalcaemia and hyperkalaemia
what are the two key things that must not be mixed with Hartmann’s?
blood products
sodium bicarbonate
what are the two key issues with 0.9% NaCl?
can exacerbate acidosis as no buffer
requires care with hypernatremia and hyponatramia
what electrolyte must be monitored when giving either Hartmann’s or 0.9%NaCl?
serum K+ to prevent hypokalaemia
give one example of hypotonic crystalliods
0.18% NaCl and 4% glucose
why is glucose included with 0.18% NaCl hypotonic crystalloid?
fluid is isotonic at time of administration to prevent damage to tissues around where IV is placed
what electrolyte imbalance are crystalliod fluids commonly used for?
management of severe and acute hypernatraemia
what is hypernatraemia?
rise in serum Na+?
what are hypotonic crystalloids commonly used for?
management of severe and acute hypernatraemia
why are hypertonic crystalloids used often in large animals?
speed of correction of hypovolaemia due to the amount of fluid required to replace the loss
give an example of hypertonic crystalloid fluids
7.5% NaCl
what is the risk with hypertonic fluids?
very dangerous if used by mistake and particularly in already dehydrated patients
what is the main effect of hypertonic saline?
prolongs intravascular volume expansion
what do colloid fluids contain?
large molecules (proteins or carbohydrates) that cannot pass semi permeable membranes
what is the usual tonicity of colloids?
isotonic
what are the two types of colloid?
natural (plasma)
artificial (gelatine)
what is the main effect of colloids?
exert an increased colloid osmotic pressure
compared to crystalliod fluids, how long do colloids remain in the intravascular space?
much longer
how do colloids leave the intravascular space?
through kidneys and lymphatic system
what effect does the prolonged length of time in the intravascular space of colloids compared to crystalloids mean for amount of fluid needed for volume resuscitation?
smaller fluid volume needed to have same effect
when is the effectiveness of colloids reduced?
in disease processes where vascular permeability is increased
what are the potential uses of colloids?
management of hypovolaemia
treatment of coagulopathies with plasma
management of hypoproteinaemia
what does the prolonged length of time in the intravascular space mean for the duration of effect of colloids?
longer duration of effect
what are colloids not suitable for?
treatment of dehydration and management of electrolyte abnormalities
why are colloids not suitable for treatment of dehydration?
fluid will not move from intravascular to extravascular space
what are the 7 main risks of colloids?
coagulopathy
allergic reactions
anaphylaxis
associated with increased risk of death when patient has sepsis
associated with increased AKI risk in humans (so potentially in animals)
may not be as effective as first thought
expensive and rarely used
what are two key complications of fluid therapy?
they are drugs and so require prescribing and come with risks of side effects
co-morbidities must be considered before fluid therapy is prescribed
what are the 3 main co-morbidities that must be considered before prescription of fluid therapy?
cardiac disease and heart failure
renal disease
respiratory disease
what is the main complication involved in fluid therapy?
volume overload
what are the key effects of volume overload?
pulmonary oedema
venous engorgement
peripheral oedema and chemosis
cavity effusions
what are the signs of pulmonary oedema?
tachypnoea, dyspnoea and crackles upon lung field auscultation
what are the signs of venous engorgement?
jugular distention and pulsations
what is chemosis?
oedema of conjunctiva due to fluid excess
how can volume overload be avoided?
frequent monitoring and cautious administration
what are the 5 main methods of fluid administration?
per os subcutaneous intravenous central venous access intra-osseous
how does per os fluid therapy occur?
through the mouth either through the animal drinking by itself or feeding tubes (NG or PEG)
what are 2 advantages of per os fluid therapy?
natural
body can regulate amount of fluid taken up and electrolytes required
what are 2 disadvantages of per os fluid therapy?
slow
trauma to mouth/throat may prevent this method
how does subcutaneous fluid therapy occur?
injection of fluids into subcutaneous space where fluid is slowly absorbed into regional capillaries and distributed equally into fluid compartments
what way may subcutaneous fluids be given?
through needle and syringe or via needle attached to giving set and bag
what are 2 advantages of subcutaneous fluid therapy?
useful in animals with very small vessels or those with mild dehydration (cats and kidney failure)
what are 2 disadvantages of subcutaneous fluid therapy?
slow
no infusion possible
how does intravenous fluid therapy occur?
absorbed through IV catheter placed in peripheral vein (cephallic, saphenous or marginal ear)
what are 2 advantages of IV fluid therapy?
quick access and potential infusion
what are 2 disadvantages of IV fluid therapy?
potential infection site
not always easy to place due to anatomy and temperament of animal
how does central venous access fluid therapy occur?
IV is placed in larger vessels (e.g. jugular)
when is central venous access often used?
critically ill small patients or large patients
what are two benefits of central venous access for fluid therapy?
quick
large fluid volumes possible