Fluid therapy Flashcards
what is the primary fluid in the body?
water
distributed amongst: cells, blood vessels, tissue spaces
where can water be found (cell wise)?
- intracellular
- extracellular
-can be intravascular (within blood vessels) or interstitial (in tissue spaces between blood vessels and cells
how much of the body weight does water make up?
60% of the body weight
how much of the water in the body is intracellular?
40%
the remaining 20% is extracellular fluid and found in the plasma and in the interstitial fluid between cells
what do healthy animals have an equilibrium of?
(water based)
equilibrium between amount of water taken in and amount lost
what is body water made up of?
solutes and solvents
solutes
substances that dissolve into solvents
ex: electrolytes
solvents
what the substances dissolve into
ex: body water
how do you correct an imbalance of fluid or electrolytes?
fluid therapy
what is important to know about balancing body fluids?
fluid balance depends on electrolyte balance
when fluid volume changes, electrolyte concentration changes
which electrolytes are the most important in electrolyte regulation?
sodium and potassium
osmotic pressure
pressure/force that develops when 2 solutions of different concentrations are separated by a selectively permeable membrane
osmolality
measures the number of dissolved particles per kg of water
how can you determine dehydration?
pulse rate and quality, CRT, mm, eye position, patient history, skin turgor test
what are reasons why fluid would need to be administered?
correct electrolyte balance, promote kidney diuresis, maintain tissue/organ perfusion rate while under anesthesia, replace fluid loss, medicine
what are the routes for giving fluids?
oral: short-term, given by drinking, syringe, or nasogastric tube
SQ: used to correct mild dehydration or imbalances, 5-10 mL of fluid per lb of body weight per site
IO: via bone marrow using sterile technique and anesthesia, rapid and precise administration, useful for birds and exotics
IV: preferred for sick and/or critical patients, rapid delivery at precise dosage, requires close monitoring, higher possibility of fluid overload
what are the two categories of fluids?
crystalloids and colloids
crystalloid solutions
solutions that contain electrolytes/salts and can be with or without glucose
what are the different ways crystalloid solutions can be categorized?
isotonic, hypertonic, and hypotonic
hypovolemic shock
condition in which the liquid portion of the blood is low
can be caused by excessive vomiting, diarrhea, or blood loss
what are some examples of isotonic crystalloid solutions?
isotonic saline, LRS, normosol and plasma-lyte A or R
isotonic crystalloid solutions
same solute concentration as blood, used to replace fluid loss, similar composition as plasma, commonly used for hypovolemic shock
hypertonic crystalloid solutions
greater solute concentration than blood, have high sodium concentrations and cause water to rapidly move out of cells and into blood vessels, often used for edema and shock, work rapidly but have a short duration of action so usually used alongside colloid solutions
what are some examples of hypertonic crystalloid solutions?
0.9% normal saline with 5% Dextrose, 3% normal saline
hypotonic crystalloid solutions
less solute concentration than blood, fluids with less sodium concentration than ECF, cause a portion of the fluid to move out of the intravascular space, can be used in patients who have high sodium levels or patients who can’t tolerate solutions with sodium
what are some examples of hypotonic crystalloid solutions?
5% Dextrose in water, 0.25% normal saline, 0.45% normal saline
colloid solutions
solutions with large molecules that stay in the vessels longer, causes fluids to pull water into the circulatory system
oncotic pressure
osmotic pressure exerted by colloids in a solution
(pressure exerted by plasma proteins)
what can colloid solutions be used to treat?
used for vascular space expansion, treats hypovolemic shock and hypoproteinemia (low blood protein)
what are some examples of colloid solutions?
natural: plasma, albumin, whole blood
synthetic: vetstartch, hetastarch (Hydroxyethyl starch), Dextran
whole blood
colloid solution
treats severe anemia/blood loss
contains RBC, WBC, platelets and plasma components of blood
collected and stored in anticogulants
good for 28-30 days
crossmatching done before use
plasma
colloid solution
can be stored frozen for years
contains albumins and globulins
use within 6 hours of thawing
adverse reactions: fever, urticaria, hypotension
albumin
colloid solution
main protein in blood
too much or too rapidly can cause fluid to be retained in lung vessels
adverse reactions: fever, anorexia, sudden death, 1-2 week delayed reaction can be fatal
available: lyophilized canine albumen, human albumin products
Hydroxyethyl starch (HES)
synthetic colloid that expands plasma volume
derivative of amylopectin (starch that structurally resembles glycogen)
treats hypovolemic shock and hypoproteinemia
adverse reactions: urticaria, periorbital edema, dyspnea, coagulopathies
not used in patients with fluid overload, pulmonary edema, congestive heart failure
tetrastarches (Vetstarch)
safer, more expensive, less adverse effects
Dextran
can come in saline or dextrose
has large polysaccharides derived from sugar beets
2 concentrations: 40 and 70
expands circulating blood volume within 1 hour and effects last 24 hours or more
treats shock
adverse effects: increased bleeding time, anaphylactic reactions, development of acute renal failure, GI effects, increased blood glucose levels when metabolized
what are crystalloid solutions commonly used for?
more common in GP
only 25-35% remains within intravascular space after 30 minutes of administration
great for dehydration and electrolyte imbalances
what are colloid solutions commonly used for?
more common in emergency
remain in intravascular space longer
great for treating shock or critical patients
stay in vessels longer
what should be written on a fluid bag label?
patient’s name, date opened, name and amount of additive, date and time of administration started, flow rate, expiration date, initials
how fast should you give fluids?
rate depends on severity of dehydration, usually replaced rapidly at first then tapered to a maintenance dose
shock fluid rates are higher than maintenance fluid rates
rate of replacement of deficit depends on cardio and renal status of patient
-might need to decrease rate in cardio/renal issue patients to avoid overloading
how are fluids usually given?
over 24 hour period, administered using fluid pumps that are programmed by the user to deliver fluids at a specified rate
or via drip administration sets that deliver a constant number of drops/mL of fluid
drip administration sets
set has a spike to penetrate container of fluids, a drip chamber, and a long flexible tube that connects to the patient’s catheter
how can the fluid rate be adjusted on the drip administration sets?
adjust rate by adjusting the diameter of the line delivering the fluids
roller clamps can be adjusted to increase or decrease amount of fluid delivered
adult administration set rate
15 gtt/mL
pediatric administration set rate
60 gtt/mL
VTBI
volume to be infused
PRI
primary rate of infusion
Dextrose fluid additive
carbohydrate that corrects hypoglycemia
used for patients with high metabolic needs or anorexic patients with sepsis
not a calorie source but serves as an energy source for the brain
adverse effects: hyperosmolar syndrome (if given too fast), decreased mentation, weakness, ataxia
potassium additive
necessary for contraction of smooth, cardiac, and skeletal muscles and other physiologic processes
must be consumed daily
can’t be stored in body
easily lost through kidneys and urine
supplemented to anorexic patients, fluid losses
given IV slow to avoid bradycardia
low potassium term and signs
hypokalemia
signs: lethargy, muscle weakness, vomiting
what happens if you give potassium too fast?
heart stops
KCl additive
supplement solution used to add potassium to fluids
sodium bicarbonate additive
plays a vital role in acid-base balance
added to fluids to correct metabolic acidosis
adverse effects: alkalosis, electrolyte abnormalities
needs to be given slowly
incompatible with several solutions
signs of metabolic acidosis
severe shock, diabetic acidosis, severe renal disease, prolonged cardiac arrest
calcium additive
necessary for functioning of nerves and muscles, clotting of blood, building of bones and teeth, and other physiologic processes
give slowly to avoid hypotension, cardiac arrhythmias, and cardiac arrest
can be given in combo with magnesium, potassium, phosphorus, and Dextrose
give IV, monitor cardiac and respiratory rate and rhythm
what are the causes of hypocalcemia?
milk fever, eclampsia, endocrine disease
what are calcium supplements?
calcium gluconate and calcium chloride
why can vitamins be used as additives?
vitamins are lost rapidly by anorexic or debilitated animals
what is an example of a vitamin additive?
vitamin B complex
frequently added to IV fluids
can cause pain SQ
sensitive to light
