Fluid therapy

Question 1

crystalloids vs. colloids

Answer 1

• colloids: increase BP
  
  • no matter the cause of hypotension
  • can cause reaction, get into tubules, renal failure, death (inflammation), coagulopathy
• crystalloids: better well being/survival

Question 2

Use of colloids in a septic patient can lead to:

Answer 2

coagulopathy and renal failure

Question 3

using blood products

Answer 3

when PCV is < 22%

PCV is not always reliable though

Question 4

fluid therapy for hypovolemia

Answer 4

fix losses: 10-20 mL/kg crystalloid, 2-4 mL/kg hypertonic

maintenance: 3 mL/kg/hr in cats, 5 mL/kg/hr in dogs

Question 5

hypovolemia

Answer 5

low blood pressure

hemorrhagic shock

abdominal bleeding

head trauma (mannitol to decrease ICP)

catastrophic bleeding

Question 6

cerebral pressure

Answer 6

blood pressure - intracranial pressure

mannitol can decrease ICP

still need to address BP

Question 7

if patient has abdominal trauma and hypovolemia:

Answer 7

maintain permissive hypotension SAP 80 mmHg

Question 8

if patient has catastrophic trauma:

Answer 8

aggressive large volume resuscitation

goal:

SAP = 100 mmHg

MAP = 80 mmHg

Question 9

if patient has severe trauma without head injury:

Answer 9

hypotensive resuscitation

goal:

SAP = 80-100 mmHg

MAP = 60 mmHg

Question 10

if patient has severe trauma with head injury and/or lung contusion:

Answer 10

small volume resuscitation with HRS, HRS-D, or other hyperosmolar colloids

goal:

SAP = 100 mmHg

MAP = 80 mmHg

Question 11

hypernatremia

Answer 11

• free water loss
  
  • dehydration
  • vomiting, diarrhea
  • endocrine
  • iatrogenic
• clinical signs
  
  • CNS (edema cerebral)
  • physiological adaptation

Question 12

cat presents with severe hypernatremia:

Answer 12

administer 2 L glucose 5% (D5W) IV

no salt

fix slowly!!! rapid overcorrection can lead to brain edema

lower Na 0.5-1 mEq/L/hr

Question 13

hyponatremia

Answer 13

• loss of volume
• hypoadrenocorticism
• iatrogenic (diuretics)
• increase Na 0.5-1 mEq/L/hr
  
  • LRS + D5W

Question 14

complications of fixing hyponatremia too fast:

Answer 14

• de-myelinolysis
  
  • ataxia, paralysis, CNS
  • days post treatment