Fluid Therapy 2

Question 1

What is the recommended target fluid amount in 24 hrs?

Answer 1

80% within first 24 hrs

Question 2

What is the formula for fluid replacement?

Answer 2

% dehydration X BW (kg)= liters of fluid

Question 3

Concurrent losses should be added to what aspect of fluid replacement calculation?

Answer 3

Should be added to other losses/maintenance instead of immediate fluid replacement amount

Question 4

What is the typical fluid rate in equine?

Answer 4

10-20 ml/kg/hr (5-10 L/hr)

Question 5

What size catheter is recommended in a severely dehydrated patient?

Answer 5

10-12 G

Question 6

What size catheter is recommended in a moderately dehydrated patient?

Answer 6

12-14 G

Question 7

What size catheter is recommended in a miniature horse and weanlings with moderate dehydration?

Answer 7

14-16 G

Question 8

Define resuscitation

Answer 8

Replace estimated deficits rapidly within 1-2 hrs

Question 9

What is the rate that should be administered to a neonate in septic shock?

Answer 9

20 ml/kg over 10-20 minutes

Question 10

What is the maintenance fluid rate?

Answer 10

50-60 ml/Kg/day

Question 11

What is a situation where we would want to overhydrate the equine patient?

Answer 11

impaction, liquefaction of respiratory secretions

Question 12

What is the main source of K in a equine patient?

Answer 12

daily diet- ingest high quantity-excrete high quantities

Question 13

What do you see in terms of potassium when a horse is anorexic or in a state of colic?

Answer 13

Total body depletion of K

Question 14

Hypokalemia in horses is associated with what?

Answer 14

Alkalosis, decreased intake, sequestration loss, elevated plasma insulin

Question 15

What are the clinical effects of hypokalemia?

Answer 15

Arrhythmias, weakness, decreased intestinal motility

Question 16

What could cause hyperkalemia?

Answer 16

Hyperkalemic periodic paralysis, acidosis, uroabdomen, acute oliguric renal failure

Question 17

What is the rate of IV administration for K?

Answer 17

0.5 mEq/kg/hr

Question 18

Calcium is highly bound to what?

Answer 18

Proteins-mostly albumin

Question 19

What form of Ca are we most concerned about?

Answer 19

Ionized calcium

Question 20

T/F: Decreased in proteins can cause a decrease in total calcium while ionized calcium remains constant

Answer 20

TRUE

Question 21

What is seen in terms of Ca levels in an anorexic horse?

Answer 21

Total body depletion of Ca

Question 22

What is a major contributor to the development of synchronous diaphragmatic flutter?

Answer 22

Hypocalcemia

Question 23

SDF is associated with hyperresponsiveness of what nerve?

Answer 23

Phrenic nerve

Question 24

What are other disturbances seen with SDF?

Answer 24

Hypokalemia and metabolic alkalosis along with hypocalcemia

Question 25

What is the classic patient scenario of a horse with SDF?

Answer 25

endurance horse

Question 26

What are the clinical effects seen with hypocalcemia?

Answer 26

Muscle paresis, tremors, excitability, cramping, behavior changes, decreased myocardial contractility, hypotension

Question 27

What patients will you see hypercalcemia in?

Answer 27

Renal failure patients- chronic and oliguric acute renal failure

Question 28

If Ca supplementation is given too rapidly what is our main concern?

Answer 28

cardiotoxic effects- bradycardia

Question 29

What do sodium values represent?

Answer 29

water balance of the patient

Question 30

What is the most significant clinical sign seen with sodium imbalance?

Answer 30

Neurologic signs

Question 31

Define the following: Hypertonic fluid loss Hypotonic fluid loss Isotonic fluid loss

Answer 31

Hypertonic loss: loss of electrolytes in excess of water Hypotonic loss: loss of water in excess of electrolytes Isotonic loss: loss of electrolytes in same ratio as serum

Question 32

What is the normal type of dehydration seen in exercise horses and what is seen if excessive dehydration is sustained?

Answer 32

Isotonic losses typically | Sweat becomes hypertonic after a point of dehydration met

Question 33

How should you treat acute sodium disturbances?

Answer 33

rapid restoration to normal Na status recommended

Question 34

If an animal has chronic sodium disturbances with CS how would you correct this?

Answer 34

correct slowly over days to one week to bring to normal

Question 35

If an animal has chronic sodium disturbances with no CS how would you correct this?

Answer 35

Likely patient is still within compensated range and therapy should be undertaken to slowly restore serum/Na values over a week

Question 36

What happens if there is rapid restoration of chronic hypernatremia?

Answer 36

Increase CNS intracellular volume significantly resulting in brain edema leading to herniation, permanent neurologic deficits and lysis of myelin

Question 37

What is the standard method of acid base interpretation?

Answer 37

Carbinocentric model

Question 38

What is the treatment of metabolic acidosis?

Answer 38

alkalinizing solution-typically lactate | can undergo cystosolic gluconeogenesis in liver and mitochondrial oxidative metabolism in liver

Question 39

What is the most common cause of lactic acidosis?

Answer 39

Tissue hypoxia

Question 40

At what point should you administer bicarbonate solution to treat acidosis?

Answer 40

17-18 mEq/L

Question 41

What factors of bicarbonate distribution would you use for a conservative, typical and younger animal?

Answer 41

conservative: 0.3 typical: 0.4 younger: 0.5

Question 42

How should bicarbonate be administered if it were to be used?

Answer 42

Traditionally half of deficit given over 60 minutes as isotonic solution

Question 43

What is a major contraindication to administration of bicarbonate?

Answer 43

Presence of respiratory compromise-hypoventilation

Question 44

What is a situation where metabolic alkalosis occurs?

Answer 44

Endurance racing-sweat losses or high GIT disease

Question 45

Endurance horses typically show a loss in what electrolytes?

Answer 45

Na & Cl resulting in retention of HCO3 and metabolic alkalosis