Fluid Therapy

Question 1

ECF

Answer 1

Na+ primary cation for extracellular osmolarity

Question 2

ICF

Answer 2

K+ primary cation for intracellular osmolality

Question 3

Na+/K+ ATPase pump

Answer 3

Maintains balance of Na+ outside of cell and K+ inside cells

Question 4

CBC indicating fluid therapy

Answer 4

Hematocrit and plasma protein (dehydration)
PO2, PCO2, base excess, HCO3-, total CO2
Na+, K+, Cl-
BUN and creatinine

Question 5

Indication for fluid therapy in cats

Answer 5

Hypothermia, bradycardia and hypotension

Question 6

Shock and dehydration

Answer 6

Patient could be hypovolemic, hypotensive or dehydrated or all 3

Question 7

4% dehydration

Answer 7

History of fluid loss, moist mm, thirst

Question 8

5-6% dehydration

Answer 8

Subtle loss of skin elasticity
Dull hair coat
MM slightly dry, tongue moist

Question 9

7-8% dehydration

Answer 9

Delay in return to skin to normal
Dry tongue and MM
Eyes soft and sunken
Slight prolongation of CRT

Question 10

9-11% dehydration

Answer 10

Tented skin doesn’t return to normal
Prolonged CRT, sunken eyes, all mm dry
Tachycardia, cool extremities, rapid and weak pulses

Question 11

12-15% dehydration

Answer 11

Definite signs of shock, circulatory collapse
Death imminent

Question 12

Crystalloids

Answer 12

Water-based
Osmotically active small molecules permeable through the capillary
Isotonic and hypertonic solutions

Question 13

Crystalloid administration

Answer 13

Moves into interstitial and intracellular space within 45 mins of IV admin

Question 14

Colloids

Answer 14

Large molecules that don’t cross the capillary membrane
Natural (plasma/albumin) or synthetic (hydroxyethyl starch)

Question 15

Aims of fluid replacement

Answer 15

Correct existing deficits
Satisfy maintenance needs
Replace ongoing losses

Question 16

Step 1 of fluid therapy (correct hypovolemia)

Answer 16

Shock dose: 80-90 in dogs, 45-60 ml/kg in cats
25% given in first 15 min
Reassess condition (don’t over hydrate)- titrate to effect
Isotonic crystalloids and synthetic colloids

Question 17

Step 2 of fluid therapy (Rehydration)

Answer 17

Administered over 24 hrs
Isotonic crystalloid solution

Question 18

Calculating fluid deficit

Answer 18

L= (kg) x % dehydration / 100

Question 19

Step 3 of fluid therapy (maintenance)

Answer 19

Asses water or fluid intake by patient
60 in dogs, 45 in cats over 24 hrs
Can ↑ rates for diuresis benefits
Isotonic crystalloids

Question 20

Step 4 (ongoing fluid loss)

Answer 20

Estimate the loss in specific time periods
Addition to ongoing fluid admin

Question 21

Oral or nasogastric route

Answer 21

Least dangerous (don’t worry about tonicity vol and asepsis)
Combos of electrolyte salts and dextrose
Beneficial for epithelial lining of GI tract

Question 22

SQ route

Answer 22

Young or small animals
Absorbed more slowly than by IV
Use only isotonic fluids (LRS)

Question 23

IV fluids

Answer 23

Isotonic formulations
Maintaining asepsis during catheter placement or injection (catheters, clotting, hematomas)
Large vol too rapidly = overload circulatory system (pulmonary edema)

Question 24

Balanced (isotonic) electrolyte solutions - Crystalloids uses

Answer 24

Pre and post sx support
V/D
Renal Dz
Trauma and shock

Question 25

Balance electrolyte solutions

Answer 25

Resemble ECF High Na+ and low K+

Question 26

Replacement fluids

Answer 26

Plasma like composition High Na, Low K+ LRS, Plasmalyte, Normosol R

Question 27

Maintenace fluids

Answer 27

More free water Low Na, High K Normosol M

Question 28

How to give balanced (isotonic) electrolyte solutions - Crystalloids

Answer 28

Large vol. because they have a short lifespan in intravascular space Once given, diffuse out of vasculature and into ECF

Question 29

Normal Saline and LRS

Answer 29

Acidifying solution Used to tx patients with metabolic alkalosis High in Cl- (promotes renal excretion of bicarb)

Question 30

Normal Saline

Answer 30

Used to tx hyperkalemia and hypercalcemia

Question 31

Crystalloid hypertonic solutions (HSS)

Answer 31

↑ COP due to ↑ preload Peak occurs within 1 hr

Question 32

Crystalloid hypertonic solutions (HSS) uses

Answer 32

Shock associated with hemorrhage Trauma and GDV

Question 33

Crystalloid hypertonic solutions (HSS) MOA

Answer 33

High circulating Na+ attracts water into vasculature from interstitial and intracellular spaces Restore capillary flow and tissue perfusion

Question 34

Crystalloid hypertonic solutions (HSS) dose

Answer 34

3-5 ml/kg IV over 5-10 mins

Question 35

Crystalloid hypertonic solutions (HSS) contraindications

Answer 35

Hypernatremic patients Patients with ↑ plasma osmolality Don't use alone in dehydrated patients

Question 36

Colloids MOA

Answer 36

Balances the force that draws water into the capillaries with the hydrostatic pressure pushing water out into the tissues

Question 37

__________ is the major plasma protein that maintains COP

Answer 37

Albumin

Question 38

Colloids indication

Answer 38

Perfusion deficits Blood component deficiencies

Question 39

Adverse effects of colloids

Answer 39

Acute renal failure ↑ bleeding tendencies

Question 40

Which of the following do you need to administer if you want to replenish both intravascular and interstitial volume quickly?

Answer 40

Both crystalloids and colloids

Question 41

Whole blood

Answer 41

Anemia (acute and immune mediated) Blood loss (hemorrhage)

Question 42

Plasma

Answer 42

Clotting deficiencies Hypoproteinemia (V/D, sepsis)

Question 43

RBCs

Answer 43

To ↑ amount of RBCs after trauma or sx Tx anemia 42d in fridge or 10y in freezer

Question 44

Fresh frozen plasma

Answer 44

Correct deficiency in coagulation factors Tx shock due to plasma loss from burns or massive bleeding 1y in freezer

Question 45

Concentrate of platelets

Answer 45

Tx or prevent bleeding due to low platelet levels Correct functional platelet problems 5d @ room temp

Question 46

Cryoprecipitate

Answer 46

Tx fibrinogen deficiencies 1 yr in the freezer

Question 47

Blood substitutes oxyglobin

Answer 47

For blood loss and anemia Contain purified Hb removed from RBC and suspended in solution

Question 48

Oxyglobin

Answer 48

Only approved product in vet patients Derived from bovine Hb