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651 SA Midterm > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

Dr. Keating

1
Q

drug

A

exogenous substance that can alter physiology

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2
Q

are fluids considered a drug?

A

yes

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3
Q

total body water (TBW) is ____% of body weight

A

60%

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4
Q

What proportion of total body water is intracellular vs extracellular

A

intracellular = 2/3
extracellular = 1/3

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5
Q

plasma makes up what percentage of total body water

A

5%

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6
Q

what composes the extracellular fluid (2)

A

interstitial (lymph, fluid between cells)
intravascular (plasma)

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7
Q

plasma typically compromises ___% of blood

A

~50%

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8
Q

is total blood volume (mL/kg) the same across species?

A

no

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9
Q

total blood volume in cats

mL/kg

A

60 mL/kg

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10
Q

total blood volume in dogs

mL/kg

A

85 mL/kg

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11
Q

total blood volume in horses

mL/kg

A

75 mL/kg

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12
Q

total blood volume in cows

mL/kg

A

55 mL/kg

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13
Q

total blood volume in pigs

mL/kg

A

65 mL/kg

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14
Q

total blood volume in rabbits

mL/kg

A

55 mL/kg

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15
Q

Is the composition and volume of fluid in different compartments FIXED or NOT FIXED?

A

NOT fixed

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16
Q

intracellular electrolytes

A

K⁺, Mg⁺⁺, Ca⁺⁺

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17
Q

extracellular electrolytes

A

Na⁺, Cl⁻

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18
Q

osmolality

A

number of moles of osmotically active particles per kg of water

essentially the concentration - how much water does it pull?

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19
Q

what is osmolality dependent on:
a) size
b) weight
c) charge
d) number of particles

A

d) number of particles

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20
Q

tonicity

(the consequence of osmolality)

A

measure of osmotic draw across a semi-permeable membrane

fluid moves to where there are more particles

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21
Q

Isotonic fluids are what osmolality

mOsm/L

A

300 mOsm/L

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22
Q

hypotonic solution effect

A

pushes fluids into the cells

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23
Q

hypertonic solution effect

A

pulls fluids from the periphery into the bloodstream

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24
Q

what component of the blood is responsible for oncotic pressure?

oncotic pressure = colloid osmotic pressure (COP)

A

Proteins!

albumin is too big to leaky out of the average vessel

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25
Q

Do proteins contribute to the plasma osmolality?

A

yes, but minimally (<5%)

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26
Q
A

95%

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27
Q

are hypovolemia and dehydration the same thing?

A

no

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28
Q

hypovolemia

A

decreased volume in the intravascular space

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29
Q

dehydration

A

decreased whole body fluid/TBW

30
Q

Is our goal in anesthesia to address hypovolemia or dehydration?

A

Hypovolemia!

Goal is to maintain circulating volume

(dehydration can be fixed whenever)

31
Q

can hypovolemia and dehydration occur together?

A

of course they can

32
Q

5 Different Ways of Recognizing Fluid Deficits in our Patients

A

patient history
physical exam
laboratory tests
low blood pressure
pulse pressure variation

33
Q

patient history

(in terms of fluid deficits)

A

diarrhea, vomiting, bleeding?
volume of water consumption
food/food consumption
frequency/volume of urination

not super accurate but can nudge you in a certain direction

34
Q

cardiovascular changes on physical exam that may indicate fluid deficits (2)

A

elevated heart rate
low blood pressure

35
Q

Fill in the estimated percent dehydration:

A
36
Q

laboratory tests

(in terms of fluid deficits)

A

PCV/TP
USG
BUN/Creatinine
Blood lactate

37
Q

PCV/TP

(in terms of fluid deficits)

A

high = dehydration
low = anemia, hemorrhage

consider normal variations, dz processes, and RECENT hemorrhage

38
Q

how does a recent (peracute) hemorrhage affect your analysis of PCV

A

takes 3-6 hours for your PCV to change due to delays in fluid shifts and splenic contractions

the spleen is a resevoir for your RBC

39
Q

how does a recent (peracute) hemorrhage affect your analysis of TP

A

TP will increase more rapidly than your PCV

there isn’t a resevoir for additional protein

40
Q

what breed has a normally high PCV?

~60

A

greyhounds

41
Q

USG

(in terms of fluid deficits)

A

high = dehydration
low = significant urinary losses

42
Q

BUN/Creatinine

(in terms of fluid deficits)

A

can see a prerenal azotemia d/t decreased circulating volume

interpret alongside USG; BUN will increase first

43
Q

Blood lactate

(in terms of fluid deficits)

A

hyperlactemia (>4mmol/L) can occur secondary to low circulating volume and poor tissue perfusion

44
Q

Do all hypotensive patients need more fluids?

A

NO
bolusing fluids in a hypotensive patient that is euvolemia will not help, and could even be detrimental

45
Q

Explain how to check for pulse pressure variation.

This checks for decreased circulating volume!

A
  • Give a breath to your intubated patient.
  • Intrathoracic pressure will increase and compress the heart and vena cava.
  • Euvolemic patients will be able to account for this and your blood pressure will not change.
  • HYPOVOLEMIC patients will have their vena cava ‘squashed’ by the breath –> decreasing venous return –> blood pressure DROPS
  • When you release the breath, the blood pressure improves again.

This can be done visually (BP trace) or audibly (Doppler).

46
Q

positive pressure breath

A

inflating lungs and squishing everything

opposite of physiologic normal (negative MAKES space)

47
Q

3 Main Categories of Fluids

A

Crystalloids
Colloids
Blood Products

48
Q

crystalloids

A

aqueous solutions of mineral salts or other water soluble moelcules (like dextrose)

most common

49
Q

3 subtypes of crystalloids

A

hypertonic
isotonic
hypotonic

50
Q

3 Most Common Isotonic Crystalloids

A

Plasmalyte
Normosol-R
LRS

51
Q

why is LRS being used less frequently?

A

LRS contains calcium which can cause certain drug interactions and cannot be used with blood products

52
Q
(looking for a fraction)
A

~1/3

53
Q

why is physiologic saline (0.9% NaCl) not given as a primary replacement fluid?

A

not balanced (only 2 electrolytes) and has proportionally more chloride than sodium which can lead to hyperchloremic acidosis

54
Q

In waht situations do we used physiologic saline (0.9% NaCl)?

A

FLUSH!
and rapid resuscitation

55
Q

Isotonic crystalloids have an electrolyte composition similar to ______

A

extracellular fluid (ECF)

also buffered to maintain the blood pH

56
Q

Most common hypertonic crystalloid?

A

hypertonic saline (7.2% NaCl)

osmolality = 2567 mOsm/L

57
Q

physiologic normal osmolality

A

300 mOsm/L

58
Q

Hypertonic Saline Uses

A

when rapid intravascular expansion is needed (ICF pulled into vascular space)
* ER
* large patients (can administer significantly less volume than isotonics for hydration effect)

example: colicky horse

59
Q

Hypertonic Saline Cautions

A

unbalanced, and repeated use creates a “tolerance” per se (you will need to administer more volume for the same effect)

Mainly for your resuscitation (immediate need) situations

60
Q

example of hypotonic crystalloid

A

D5W

usually given to supplement blood glucose

61
Q

2 Categories of Colloids

A

naturally occurring (plasma, albumin)
synthetic (hydroxyethel starches)

62
Q

Colloid Uses

A

support oncotic pressure
rapid volume expansion
prolonged effect (molecules stay in circulation much longer)

63
Q

complications of hydroxyethyl starches

A

coagulopathy
kidney injury
volume overload

it really “gums up” the blood

64
Q

complications from using blood products

A

transfuson reactions
electrolyte abnormalities
volume overload
hypothermia

blood comes straight from the fridge!

65
Q

Maintenance Solution

A

crystalloid with an electrolyte composition matching regular losses (more K⁺ and less Na⁺ than replacement solutions)

66
Q

Considerations in a fluid therapy plan for a Hospitalized Patient (3)

A

maintenance requirements
dehydration status
ongoing losses

67
Q

Total Fluid Rate Equation

A
68
Q

Ideal fluid rate for each species?

A

there isn’t a fixed rate!

trick question, bitch

(but if you were to pick one it’s like 5 mL/kg/hr)

69
Q

Signs of Fluid Overload (4)

A

chemosis (edema of the conjunctive)
clear discahrge from the nose/ET tube
limb/facial edema
pulmonary edema

70
Q

At what % loss of blood volume do we need to consider replacement in hemorrhage?

A

> 20% total blood volume

sooner if organ disease or pre-existing anemia; assess BP and HR

651 SA Midterm (2 decks)

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