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RUSVM Anesthesiology > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

roles of water

A

solvent for reactions

transportation of substances

heat regulation

essential for organ function - circulation, renal excretion

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2
Q

total body water

A

~ 60% bodyweight in an average adult

~80% in new-born

less in obese animals

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3
Q

distribution of fluids

A

40% ICF

5% intravascular

15% interstitial

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4
Q

what is the skeleton of ICF

A

K+

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5
Q

what is the skeleton of ECF

A

Na+

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6
Q

what is the skeleton of IVF

A

protein (albumin)

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7
Q

osmolality

A

number of particles (osmoles) per kg of water

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8
Q

noraml osmolality in ECF and ICF

A

~300 mOsm/kg

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9
Q

osmolality of solutions are categorized on their effect on…

A

red cell volume

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10
Q

isotonic

A

no change in RBC volume

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11
Q

hypotonic

A

RBC volume increase (hemolysis)

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12
Q

hypertonic

A

RBC volume decreases

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13
Q

oncotic pressure

A

form of osmotic pressure exerted by proteins

tens to pull water into vasular space

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14
Q

physioogical plasma oncotic pressure

A

23 mmHg

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15
Q

edema formation is likely when albumin

A

<1.5 g/dL

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16
Q

hypoalbuminemia is common in

A

severely ill patients (sepsis)

prognostic factor

other causes: emaciation, liver disease, ongoing bleeding

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17
Q

hydrostatic pressure

A

drives fluids outward of vascular space

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18
Q

oncotic pressure

A

drives fluid inward

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19
Q

crystalloid solutions

A

crystalline solisd (NaCl, glucose etc) dissolved in water

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20
Q

T/F crystalloid solutions can be isotonic, hypotonic, or hypertonic

A

true

21
Q

balanced electrolyte solutions

A

have a composition similar to ECF

ringer, normosol

22
Q

balanced electrolyte solutions

A

= replacement solutions

can be given fast in large volumes

causes no change in plasma electrolytes

23
Q

how much replacement solution stays in intravascular compartment after 30 min

A

1/3

24
Q

when are replacement fluids indicated

A

rapid volume expansion

replacement of blood loss (3x the volume), initial phase of shock treatment

25
Q

maintenance solution

A

replace daily fluid loss

not generally appropriate for peri-operative use

daily volume demand: 40-60 mL/kg over 24 hours

26
Q

maintenance fluids contain

A

less Na

more K

27
Q

physiological saline

A

0.9% NaCl (308 mOsm/L)

used for rapid ECF volume expansion if balanced solutions are not available

28
Q

excessive use of physiological solution may lead to

A

dilution of other EC electrolytes

hyper-chloremic metabolic acidosis

29
Q

hypertonic saline

A

7.5 % NaCl

rapidly draw water from ICF to ECF

enhance cardiac function

fast onset but short duration

30
Q

dose of hypertonic saline

A

4-6 mL/kg over 3-5 min

1-4 mL/kg only for cats

31
Q

indications for hypertonic saline

A

quick IV volume expansion

severe shock (initial phase)

head injury with elevated ICP

32
Q

contraindications of hypertonic saline

A

uncontrolled hemorrhage

dehydration

cardiac dysrhythmias

33
Q

dextrose (glucose) solution

A

5% dextrose is isotonic

becomes hypotonic after metabolism

good source of free water (dehydration)

not generally appropriate for peri-operative use

34
Q

dextrose solutions are a component of

A

maintenance solutions

5% dextrose in combination with 0.9% NaCl and 20 mmol/L KCl

35
Q

colloids

A

large molecules that stay intravascular

increase plasma oncotic pressure and vascular volume

36
Q

indication for use of colloids

A

albumin is low (alb. <1.5 or TP < 3.5 g/dL)

or expected to become low (shock, SIRS-systemic inflammatory response syndrome)

37
Q

issues with colloids

A

volume overloading

allergic reaction

possible effect on hemostasis (tendency to bleed)

38
Q

types of colloids

A

hydroxy-ethyl starch (HES)

dextran

gelatin

albumin (5%)

plasma

whole blood

39
Q

HES

A

chemically altered starch

hetastarch, vetstarch

metabolized by serum amylase

eliminated by kidney or RES

40
Q

T/F HES may alter hemostasis at high doses and in already sick animals (von Willebrand disease)

A

true

41
Q

concerns with HES

A

renal failure in septic patients

42
Q

recommendations with HES

A

use crystalloids as first line of treatment of shock

try to delay use and minimize amount of given colloids

43
Q

max dose of HES

A

20 mL/kg/day

44
Q

routes of administration for crystalloid solutions

A

IV

IO
SQ
IP

anesthestized patients almost invariable IV

45
Q

types of water losses

A

physiological - renal, GI, respiration

pathological - vomitting, diarrhea, bleeding

anesthesia

46
Q

reasons for giving IV fluids during anesthesia

A

maintain patient IVC

compensate for drug induced vasodilation

compensate for dehydration (fasting)

increase preload therefore CO

replace ongoing fluid losses

47
Q

maintenance rate of crystalloids during anesthesia

A

10mL/kg/hr

48
Q

what should be given in cases of hypotension

A

10mL/kg fluid boluses (within 15 min)

49
Q

blood loss should be replaced immediately with

A

crystalloids (3x volume of lost blood) or

colloids (exact volume)

>20% total blood volume lost - consider whole blood transfer

FFP - tx of coagulopathy

RUSVM Anesthesiology (39 decks)

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