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Fluid Therapy Flashcards

1
Q

Tell me about the fluid compartments of the body

A

Body is about 65% water

2/3 of that is found in the intracellular space

1/3 is in the extracellular space

The extracellular space is broken down into interstitial fluid and intravascular fluid

75% of the extracellular fluid is in the interstitial space and 25% is intravascular

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2
Q

Equation for total body water

A

BW x 0.65

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3
Q

Blood volume is about _____ml/kg water

A

90

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4
Q

How can you figure out how much plasma is in the body?

A

Find total blood volume (BW in kg x 90mL/kg)

Blood is made up of about 45% RBCs and 55% plasma

Multiply total blood volume by 0.55

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5
Q

T/F: the concentration of electrolytes varies based on the fluid compartment

A

True

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6
Q

Discuss electrolyte concentration in the extracellular space

A

High sodium (~140 mEq/L)
Low potassium (~4mEq/L)

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7
Q

Discuss electrolyte concentration in the intracellular space

A

High potassium (~140mEq/L)
Low sodium (~30mEq/L)

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8
Q

Water is to ________ as Bailey is to Paul Mescal

A

Sodium

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9
Q

What determine intravascular volume?

A

Sodium concentration

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10
Q

Total body sodium determines _______

A

Hydration

Ex. Whenever I eat a large quantity of ramen noodles, my fingers swell b/c I’ve got a lot of extra sodium for water to hang out with

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11
Q

What is an osmole?

A

The number of moles in a solution that contribute to its hold on water

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12
Q

What is osmolality?

A

Number of moles dissolved in a mass of solvent

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13
Q

What electrolyte has the greatest impact on osmolality?

A

Sodium

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14
Q

What does serum sodium concentration actually mean?

A

A reflection of total body water NOT total body sodium

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15
Q

Hyponatremia =

A

Water excess
Serum sodium concentration is low likely due to free water excess

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16
Q

Hypernatremia =

A

Water deficit
Severe dehydration

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17
Q

There are three types of fluids that can be lost - what are they

A

Hypotonic
Hypertonic
Isotonic

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18
Q

What type of fluid loss am I: more water loss than solute loss

A

Hypotonic

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19
Q

Give an example of hypotonic fluid loss

A

Diarrhea, vomit, sweat

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20
Q

What type of fluid loss am I: isotonic to ECF

A

Isotonic - sodium concentration likely unchanged

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21
Q

What could hypotonic fluid loss lead to?

A

Hypernatremia

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22
Q

What is the least common type of fluid loss?

A

Hypertonic

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23
Q

What kind of fluid loss am I: more solute loss than water loss

A

Hypertonic

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24
Q

Give an example of how hypertonic fluid loss could occur

A

Replacing losses with only water and not the solutes

Could lead to hyponatremia

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25
T/F: Dehydration and hypovolemia are the same thing, one is just more severe.
False - differ in where the fluid is lost from, how quickly it is lost, and how quickly it needs to be replaced
26
What is dehydration?
Fluid losses from the interstitial space Usually occurs over longer period of time Can be replaced more slowly
27
What is hypovolemia?
Loss of fluid form intravascular space Usually occurs more rapidly than with dehydration Requires rapid restoration of blood volume
28
What is the one similarity between hypovolemia and dehydration?
Both should be replaced with fluids that are higher in sodium
29
What are some good reasons to give fluids?
Dehydration Hypovolemia Anorexia (>12-24) Severe losses General anesthesia As a vehicle to get other stuff in the patients
30
Name some characteristics of a crystalloid fluid
Salt water Freely moves within the EC space Redistributes into interstitium rapidly
31
Name some characteristic about colloids
Contains molecules that don’t readily leave the IV space Theoretically stays in IV space longer Synthetic and natural available
32
What determines the immediate effect of a fluid on blood volume?
Volume delivered Greatest absolute increase in blood volume seen with crystalloids
33
What determines the later effect of a fluid on the blood volume?
Type of fluid given Most sustained increase in blood volume seen with colloids
34
What are the cons to crystalloids?
Large volume Transient effect b/c rapidly redistributes to interstitium Might potentiate edema
35
What are some cons to colloids?
Potential interstitial leak may lead to edema formation Changes in coagulation Kidney injury Cost
36
What is tonicity?
Basically osmolality but just looking at the effect of salts
37
____________ fluids have similar tonicity to ECF
Isotonic fluids
38
LRS, 0.9% NaCl (normal saline), Normosol R, and Plasmalyte A are examples of _______
Isotonic fluids
39
T/F: hypotonic fluids are the best choice for patients presenting in hypovolemic shock
False - hypotonic fluids should never be bolused as this will lead to cell lysis
40
How does hypertonic saline work?
Pulls free water from interstitial and intracellular spaces to increase IV volume
41
What are the positive physiologic and immunomodulatory effects of hypertonic saline?
Increased tissue oxygen delivery Vagally mediated reflex to sustain HR and CO Decreased cellular edema (great for cerebral edema)
42
When is hypertonic saline contraindicated?
Hypernatremia Dehydration - minimal fluids in interstitium to pull from
43
What is mean by balanced versus unbalanced fluids?
Referring to overall electrolyte make up of the fluid Balanced = major electrolytes are in similar proportion to ECF (lower chloride) Unbalanced = electrolytes are not in proportion with ECF though often are isotonic
44
Name some isotonic and balanced fluids
LRS Normosol R Plasmalyte A
45
Name some isotonic and unbalanced fluids
Normal saline (0.9%) 5% dextrose in water (D5W)
46
Maintenance fluids are ________ in sodium and chloride, but ______ in potassium
Lower; higher
47
Replacement fluids mimic ________, so they are higher in sodium.
ECF
48
Name some replacement fluids
LRS Normal saline Normosol R Plasmalyte 148
49
Name some maintenance fluids
Normosol M 0.45% NaCL (half strength saline) D5W Plasmalyte 56
50
T/F: Though oral fluids are best whenever possible, IV fluids are the best option when PO is not feasible.
True
51
A dog in suspected hypovolemic shock is in the ER with a potential GDV. You want to give fluids for resuscitation. The vet student says, “since he’s not drinking, we should give them subcutaneously.” What do you say back?
SC fluids are only for stable patients. To best address the hypovolemia, we need to give and intravenous bolus of a replacement fluid like LRS, Normosol R, or 0.9 NaCl.
52
The delivery rate for crystalloids for shock and hypotension is ________.
10-20mL/kg given as fast as possible or over about 10 minutes Reassess and repeat as needed (up to 3 times?)
53
What is the delivery rate for colloids for patients in shock or hypotension?
5-10mL/kg bolus then reassess
54
What is the delivery rate for hypertonic saline in a shocky or hypotensive patient?
4-6mL/kg bolus
55
A patient is assessed to be 7% dehydrated. How do we correct this?
% dehydration x BW (in kg) = fluid deficit in L Replace the deficit over 6, 12, 24, 48 hours.
56
When blousing fluids, use a _______ diameter and _______ catheter
Large; short
57
Formulas for maintenance fluids
(BW x 30) + 70 = mL fluid per day 70 x BW^0.75 = mL fluid per day
58
T/F: once you set a maintenance rate, you are good to go and can leave the patient to rehydrate.
False - should be reassessing hydration status frequently and adjusting fluid rate as needed
59
T/F: in general, the smaller the dog, the smaller the fluid rate
False - the opposite. Large/giant breeds - 40mL/kg/dag Medium dogs and cats - 50mL/kg/day Small dogs - 60mL/kg/day
60
What is the maintenance fluid rate for neonates?
80-100mL/kg/day
61
Complication of fluid therapy
Electrolyte imbalances Fluid overload Iatrogenic CHF Phlebitis Extra cost Prolonged hospitalization
62
When do we stop administering fluids?
Rehydration is complete Patient is eating and drinking sufficiently to maintain daily losses Ongoing losses are under control
63
What are some ways we can monitor fluid therapy?
BW!!!!! USG PE Ins and Outs Central venous pressure Left ventricular end-diastolic diameter Electrolytes

SA Emergency (11 decks)

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