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Medicine III > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

Obj: Distribution of water in the body

A
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2
Q

Obj: How to calculate bicarbonate and potassium deficits

A
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3
Q

Obj: how to calculate the volume of fluid for a patient

A
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4
Q

Obj: familiarity with fluid and electrolyte therapy options

A
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5
Q

How can a patients level of dehydration be assessed?

A
  • Clinical signs:
    • tachycardia
    • reduced jugular fill
    • cold extremities
    • tacky mucous membranes
    • sunken eyes
    • reduction in body weight
  • Laboratory estimates:
    • PCV
    • Plasma protein - ⇡
    • Creatinine Concentration - ⇡
    • Urine Specific gravity - >1.030
    • Blood lactate concentrations
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6
Q

What is the normal USG in foals?

A

1.001 - 1.005

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7
Q

How are maintenance fluids calculated for adult horses?

A
  • 60 ml/kg/day OR 30ml/lb/day
    • 500kg horse = 30L a day
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8
Q

How are maintenance fluids calculated for foals?

A
  • 80 - 120 ml/kg/day
  • Can be concerned for overhydration in premature foals, or in foals with perinatal asphyxia:
    • 1st 10 kg = 100 ml/kg/day
    • 2nd 10kg = 50 ml/kg/day
    • further 10kg = 25 ml/kg/day
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9
Q

What causes ongoing water losses in horses?

A
  • colitis
  • nasogastric reflux
  • renal failure
  • sweat loss
  • third spacing of fluid (peritonitis, pleuritis)
  • hemorrhage
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10
Q

How can fluids be administered to horses? When would this route be indicated? Pros/Cons of each?

A
  • Oral - mild dehydration, impactions
    • given as a bolus (4L q 30-60min) or as a CRI
    • Pro - easy, least expensive
    • Con - horse cannot be refluxing
  • Intravenous - critically ill patients, when rate/volume of fluids are high
    • Jugular vein used most commonly
      • can use cephalic, lateral thoracic, saphenous
    • Cons - Expense, complications (thrombophlebitis)
  • Subcutaneous - not commonly used
    • lack of subcutaneous space
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11
Q

What is the fluid administration rate for horses in shock?

A
  • 60 - 80 ml/kg/hr
    • usually only 1 hour at this rate, the rest over a 12-24 hr period (horse dependent)
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12
Q

What are crystalloid fluids?

A
  • contain electrolytes and non-electrolyte substances capable of entering all body fluid compartments
  • distribute to the ECF w/in a few minutes of administration
  • Most common: isotonic polyionic fluids
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13
Q

What buffers are used in crystalloid fluids? where are they metabolized?

A
  • Lactate - liver
  • Acetate & Gluconate - plasma
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14
Q

Why would lactic acid production be increased in horses?

A
  • tissue hypoxia
    • poor tissue perfusion
  • bacterial production of lactic acid absorption from the GIT
    • rumen acidosis
    • grain overload
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15
Q

When would hypertonic saline (7% NaCl) be administered?

A
  • to expand intravascular volume quickly
    • short lived, needs to be followed by large volume of isotonic fluids
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16
Q

What is the ideal maintenance fluid for horses?

A
  • Preferably less sodium and more Ca, Mg, K (15-30 mEq/L)
  • No commercially available product
    • often add calcium gluconate (25-50 ml to 5L LRS) and Potassium Chloride (20 mEq/L to LRS)
17
Q

What fluids are used for hyponatremia?

A
  • < 120 mEq/L
  • concern for cerebral edema
    • Correct slowly
  • Options:
    • LRS
    • 0.9% NaCl
18
Q

What fluids are used for hypernatremia?

A
  • >160 mEq/L
  • Concern for Cerebral dehydration, blindness, depression, seizures
    • Correct slowly
  • Options:
    • 5% dextrose
    • 2.5% dextrose in 0.45% NaCl
19
Q

How do changes in acid-base balance affect intra/extracellular potassium?

A
  • Acidosis promotes K leaving ICF
  • Alkalosis promotes K entering ICF
20
Q

What fluids are used for hyperkalemia?

A
  • > 5mEq/L
  • Concern for cardiac arrhythmia (bradycardia, cardiac arrest)
  • Choices:
    • Dextrose - promotes intracellular movement of K+
    • Insulin
    • Calcium gluconate - cardioprotective
    • NaHCO3
    • Avoid Calcium containing fluids
21
Q

What is the concern for ongoing hypokalemia? What fluids are used for hypokalemia?

A
  • < 3.0 mEq/L
  • Could lead to neuromuscular, GI and cardiac conduction abnormalities
  • Treat when low levels, anorexia for several days, or when low normal & ongoing acidosis
  • Maximal rate to supplement is 0.5 mEq/kg/hr
  • Options:
    • LRS
    • Plasmalyte A
22
Q

How is potassium deficit calculated?

A
  • (4.0 - [K+]) x Vd(0.4) x BW
23
Q

When does hypochloremia occur? What fluids can be used for Hypochloremia?

A
  • Occurs with: proximal enteritis, loss of saliva (long standing choke), colitis, renal failure
  • Options:
    • 0.9% NaCl
    • LRS
24
Q

When does hyperchloremia occur? What fluids can be used for Hyperchloremia?

A
  • Occurs with: renal tubular acidosis, severe colitis
  • Options:
    • 5% dextrose (if accompanied with hypernatremia
    • Sodium bicarbonate
25
Q

How is calcium affected by albumin? by Acid-base balance?

A
  • Total calcium = Protein bound Ca+ + Ionized Ca++
    • tCa+ decreases with hypoalbuminemia
  • Acidosis increases Ca++
26
Q

When does hypocalcemia occur? What fluids can be used to correct hypocalcemia?

A
  • Occurs: canthardin toxicosis and GI disturbances
  • Clinical signs: muscle fasiculation, synchronis diaphragmatic flutter
  • Options:
    • 23% Cagluconate
    • *do NOT use calcium fluids with bicarbonate
27
Q

When are dextrose fluids used?

A
  • hypoglycemia
  • hyperkalemia
  • hyperosmolar states (loss of free water and hypernatremia)
28
Q

How is Acid-Base Status determined?

A

H+ + HCO3- ⇠⇢ H2CO3 ⇠⇢ H2O + CO2

  • Normal:
    • pH 7.4 (Rang 7.35 - 7.45)
    • HCO3 = 24 (range 22 - 26)
    • PaCO2 = 40mmHg (Range 30-40)
  1. Assess pH (acidosis <7.4; alkalosis > 7.4)
  2. Assess HCO3 (metabolic acidosis < 24; metabolic alkalosis > 24)
  3. Assess PaCO2 (respiratory alkalosis <35 mmHg; Respiratory acidosis >45-50
29
Q

What are the most common acid-base abnormalities with GI disease?

A
  • Metabolic acidosis
    • lactic acidosis (due to tissue hypoxia/poor perfusion)
    • Loss of HCO3 (feces/urine)
  • Metabolic alkalosis
    • Hypochloremic metabolic alkalosis due to proximal enteritis or esophageal obstruction
30
Q

How is metabolic acidosis treated in horses?

A
  • Correct Dehydration - Volume expansion****
    • LRS (w/ healthy liver), Plasmalyte, or 0.9% Saline (okay)
  • Reassess blood gas - determine further treatment
  • Use of sodium bicarbonate indicated when HCO3 < 10-15 mEq/L despite fluid therapy
    • HCO3 deficit = (24 - HCO3) x Vd x BW
      • Vd = 0.3 - 0.6
        • 0.4 - 0.5 in most cases
  • Replace ½ of calculated deficit in first 1-2hrs, the rest over 12-24hrs
    • 5% NaHCO3 = 595 mEq/L of HCO3 but hypertonic (Osm = 1190) - Should Dilute
    • 1.3% NaHCO3 = 156 mEq/L isotonic
    • Oral NaHCO3 can be given 1gm NaHCO3 = 12 mEq of HCO3
31
Q

What is the Anion Gap?

A
  • (Na+ + K+) - (Cl- + HCO3) = ~10-17
  • Provides a measure of unmeasured anions:
    • lactate
    • ketones
    • sulfate
    • phosphate
    • albumin
32
Q

When do horses have an increased anion gap?

A
  • metabolic acidosis due to lactate

Medicine III (32 decks)

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