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LAM 1 > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

What is the first question to ask concerning fluid therapy?

A

Does the patient need fluids?

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2
Q

With what percent dehydration can you see the following:

  • 1-3 sec skin tent
  • Most to slightly tacky MM
  • Normal CRT
  • Normal HR
  • Decreased urine output
A

5 % dehydration

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3
Q

With what percent dehydration can you see the following:

  • 3-5 sec skin tent
  • Tacky MM
  • Often 2-3 sec CRT
  • 40-60 beats/min HR
  • Decreased arterial BP
A

8%

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4
Q

With what percent dehydration can you see the following:

  • 5 or more sec skin tent
  • Dry MM
  • Often >4 sec CRT
  • 60 beats/min HR or greater
  • Reduced jugular fill
  • Barely detectable peripheral pulse
  • Sunken eyes
A

10-12%

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5
Q

With what percent dehydration can you see the following:

  • 5 or more sec skin tent
  • Dry MM
  • Often >4 sec CRT
  • 60 beats/min HR or greater
  • Obvious sunken eyes
  • Obvious shock
A

12-15%

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6
Q

At what percent dehydration is death imminent?

A

15%

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7
Q

Horses can have high PCVs under stress due to what?

A

Splenic contraction

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8
Q

Do you want to correct a fluid deficit slowly or rapidly with large animals?

A

Rapidly (within an hour)

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9
Q

What are 6 possible routes of fluid administration?

A
  • SQ
  • PO
  • IV
  • IO
  • Per rectum
  • IP
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10
Q

What are 3 important factors used in making decisions concerning fluid therapy?

A
  • Rate of flow required
  • Minimize thrombogenicity
  • Vessel sparing
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11
Q

What is the most commonly used route of fluid administration in horses?

A

PO

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12
Q

What is one of the most commonly used set ups for IV fluid administration in horses?

A

STAT IV set

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13
Q

What are 4 components of the STAT IV set?

A
  • Gravity flow
  • 4 x 5 L bags
  • Large bore coil system
  • 8’ from base of heart
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14
Q

What are 2 things the rate of flow of a STAT IV set determined by?

A
  • Size of tubes

- Height from heart

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15
Q

What is the flow rate of a 10 G catheter?

A

36.5 L/hr

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16
Q

What is the flow rate of a 12 G catheter?

A

26.9 L/hr

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17
Q

What is the flow rate of a 14 G 5.25” catheter?

A

13.1 L/hr

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18
Q

What are 4 factors the flow in a free flow system is determined by?

A
  • Height of horse (heart)
  • Size of all tubing in system
  • Length of system
  • Fluid viscosity
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19
Q

What are 4 possible complications that can be seen with the use of catheters?

A
  • Thrombosis
  • Septic phlebitis
  • Perivascular leakage/cracking
  • Breakage of catheter
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20
Q

Perivascular leakage/cracking can lead to what 3 possible complications?

A
  • Abscessation
  • Neurologic dysfunction
  • Sloughing
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21
Q

What are 2 factors on which to base the decision of what electrolytes to use?

A
  • Based on disease

- Based on animal

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22
Q

What are 4 characteristics of fluids?

A
  • Tonicity/osmolality
  • Composition
  • Effect in organism
  • Category/type
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23
Q

What are 3 variations of tonicity?

A
  • Isotonic
  • Hypertonic
  • Hypotonic
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24
Q

What are 5 significant electrolytes that should be evaluated?

A
  • Na+
  • K+
  • Ca++
  • HCO3-
  • Lactate
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25
Q

What are 2 main types of fluid?

A
  • Colloid

- Crystalloid

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26
Q

What are 3 examples of crystalloids?

A
  • Saline
  • LRS, Normosol, Plasmalyte
  • Dextrose
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27
Q

What are 3 types of saline crystalloids?

A
  • Isotonic
  • Hypotonic
  • Hypertonic
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28
Q

What percentage saline is isotonic?

A

0.9%

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29
Q

What percentage saline is hypotonic?

A

0.45%

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30
Q

What are 2 variations of hypertonic saline?

A
  • Twice strength: 1.8%

- Hypertonic saline: 7-7.4%

31
Q

What is the most common fluid used for horses?

A

LRS

32
Q

What are 3 percentage variations of dextrose?

A
  • Isotonic: 5%
  • Half-strength: 2.5%
  • Hypertonic: 50%
33
Q

Which percentage of dextrose is similar to giving a fair amount of free water?

A

5%

34
Q

What effect does hypertonic saline have on CO?

On TPR?

A
  • Rapid increase in CO

- Decrease in TPR

35
Q

What are 5 advantages of hypertonic saline?

A
  • Small volume
  • Easy to carry around
  • Hypertonicity makes it unlikely to be support bacterial growth
  • Inexpensive
  • Requires no special management
36
Q

What is a local effect of hypertonic saline?

A

Draws fluid from 3rd space and intracellular environment.

37
Q

What is a central effect of hypertonic saline?

A

Stimulates a CNS response favoring CV stability.

38
Q

What are 2 possible types of adverse reactions to fluids that can be seen in the horse?

A
  • Hemolysis

- Cardiovascular alterations

39
Q

What are 2 possible cardiovascular alterations that can be caused by fluid therapy?

A
  • Arrhythmias

- Ventricular premature contractions

40
Q

What are 3 possible contraindications for fluid therapy?

A
  • Uncontrolled hemorrhage
  • Severe hypernatremia
  • Severe hypokalemia
41
Q

What is a possible complication of fluid therapy?

When is this especially problematic?

A
  • Hypokalemia

- Dilution is especially problematic if decreased intake.

42
Q

How should bicarbonate be administered when correcting a deficit?

A

1/2 calculated dose over 1 hour then re-evaluate if more is needed.

43
Q

Typically in horses with a bicarbonate level greater than or equal to 17-18, what type of fluid should be given?

A

LRS

44
Q

What is the maximum rate at which potassium can be administered?

A

0.5 mEq/kg/hr

45
Q

What is the common general recommendation for potassium supplementation in horses?

A

10-20 mEq/L

46
Q

What is a good rule of thumb for administering potassium in horses?

A

Not put in the bags an amount greater than the maximum in view of the fastest rate on the administration set-up.

47
Q

Even though there may be a total body deficit of K+ and Ca++, what might be normal?

A

Plasma levels of K+ and Ca++ may be within normal levels.

48
Q

Always supplement fluid with what electrolyte, especially if there is decreased intake?

A

K+

49
Q

What electrolyte can be added to fluids, though more conservatively?

A

Ca++

50
Q

What electrolyte should not be added to deficit replacement fluids?
Why?

A
  • K+

- Deficit replacement fluids are running very fast, chance of going over K-max.

51
Q

When giving fluids, never hang more than how much K+?

A

Max dose for one hour.

52
Q

Horses typically have one type of losses as it relates to GIT disease?

A

Isotonic losses

53
Q

If a horse experiences chronic diarrhea and is only provided with water to drink, what can happen to electrolyte levels?

A

Electrolytes will be diluted.

54
Q

What are 3 possible complications associated with restoring normal sodium concentrations?

A
  • Acute or chronic alterations
  • Hypo or hypernatremia
  • Development of altered CNS osmolarity
55
Q

Slowly, progressively decreasing sodium can result in what?

A

Results in compensatory decrease in neuronal intracellular tonicity.

56
Q

If there is no difference between tonicity within and outside the cell, what happens to the fluid?

A

No fluid shift occurs, so no dysfunction occurs.

57
Q

Acute fluid administration with chronic hyponatremia can lead to what?

A

Cell shrinkage and neurological dysfunction.

58
Q

What happens to cells with acute hypernatremia?
Chronic compensation?
Chronic past the point of compensation?

A
  • Acute: Cell shrinkage
  • Chronic with compensation: Cell swelling
  • Chronic past compensation: Cell shrinkage
59
Q

What happens to cells with acute hyponatremia?
Chronic compensation?
Chronic past the point of compensation?

A
  • Acute: Cell swelling
  • Chronic with compensation: Cell shrinkage
  • Chronic past compensation: Cell swelling
60
Q

What are 3 anticipated alterations seen with esophageal obstruction?

A
  • Hypochloremia
  • Hyponatremia
  • Metabolic alkalosis
61
Q

What are 3 patterns of electrolyte disturbance seen with endurance racing horses?

A
  • Hypocalcemia and hypokalemia
  • Metabolic alkalosis
  • Synchronous Diaphragmatic Flutter (SDF)
62
Q

Is synchronous diaphragmatic flutter a disease?

A

No

63
Q

The presence of synchronous diaphragmatic flutter is an indication of what?

A

Underlying electrolyte acid/base imbalance.

64
Q

What is the main electrolyte disturbance seen with synchronous diaphragmatic flutter?
What 2 other disturbances are seen?

A
  • Hypocalcemia

- Hypokalemia and metabolic alkalosis

65
Q

With synchronous diaphragmatic flutter, there is hyperexcitability of what nerve?
There is contraction of this nerve with what?

A
  • Phrenic nerve

- With each atrial contraction.

66
Q

What does synchronous diaphragmatic flutter look like clinically?
What is the respiration rate equal to?

A
  • Hiccups

- Respiration rate is equal to heart rate

67
Q

What are 2 anticipated alterations seen with intestinal accidents?

A
  • Hypovolemia

- Metabolic acidosis

68
Q

What are 5 anticipated alterations seen with diarrhea dependent on cause and duration?

A
  • Substantial sodium and potassium deficits
  • Hyponatremia
  • Hypochloremia
  • Hypokalemia
  • Metabolic acidosis
69
Q

What are 2 anticipated alterations seen with peritonitis/pleuritis?

A
  • Volume and electrolytes WNL

- Large protein losses

70
Q

What are 3 independent variables of Stewart’s acid/base?

A
  • Strong ion difference
  • P CO2
  • Total weak acid concentration
71
Q

What are 2 possible free water effects?

A
  • Dilutional acidosis

- Concentrational alkalosis

72
Q

With dilutional acidosis, an increase in water leads to an increase in what?

A

Acid load

73
Q

With concentrational alkalosis, a decrease in water leads to a decrease in what?

A

Acid load

74
Q

Free water and proteins act similarly because they are both what?

A

Weak acids

LAM 1 (8 decks)

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