Fluid Therapy

Question 1

roles of water

Answer 1

solvent for reactions

transportation of substances

heat regulation

essential for organ function - circulation, renal excretion

Question 2

total body water

Answer 2

~ 60% bodyweight in an average adult

~80% in new-born

less in obese animals

Question 3

distribution of fluids

Answer 3

40% ICF

5% intravascular

15% interstitial

Question 4

what is the skeleton of ICF

Answer 4

K+

Question 5

what is the skeleton of ECF

Answer 5

Na+

Question 6

what is the skeleton of IVF

Answer 6

protein (albumin)

Question 7

osmolality

Answer 7

number of particles (osmoles) per kg of water

Question 8

noraml osmolality in ECF and ICF

Answer 8

~300 mOsm/kg

Question 9

osmolality of solutions are categorized on their effect on…

Answer 9

red cell volume

Question 10

isotonic

Answer 10

no change in RBC volume

Question 11

hypotonic

Answer 11

RBC volume increase (hemolysis)

Question 12

hypertonic

Answer 12

RBC volume decreases

Question 13

oncotic pressure

Answer 13

form of osmotic pressure exerted by proteins

tens to pull water into vasular space

Question 14

physioogical plasma oncotic pressure

Answer 14

23 mmHg

Question 15

edema formation is likely when albumin

Answer 15

<1.5 g/dL

Question 16

hypoalbuminemia is common in

Answer 16

severely ill patients (sepsis)

prognostic factor

other causes: emaciation, liver disease, ongoing bleeding

Question 17

hydrostatic pressure

Answer 17

drives fluids outward of vascular space

Question 18

oncotic pressure

Answer 18

drives fluid inward

Question 19

crystalloid solutions

Answer 19

crystalline solisd (NaCl, glucose etc) dissolved in water

Question 20

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

Answer 20

true

Question 21

balanced electrolyte solutions

Answer 21

have a composition similar to ECF

ringer, normosol

Question 22

balanced electrolyte solutions

Answer 22

= replacement solutions

can be given fast in large volumes

causes no change in plasma electrolytes

Question 23

how much replacement solution stays in intravascular compartment after 30 min

Answer 23

1/3

Question 24

when are replacement fluids indicated

Answer 24

rapid volume expansion

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

Question 25

maintenance solution

Answer 25

replace daily fluid loss not generally appropriate for peri-operative use daily volume demand: 40-60 mL/kg over 24 hours

Question 26

maintenance fluids contain

Answer 26

less Na more K

Question 27

physiological saline

Answer 27

0.9% NaCl (308 mOsm/L) used for rapid ECF volume expansion if balanced solutions are not available

Question 28

excessive use of physiological solution may lead to

Answer 28

dilution of other EC electrolytes hyper-chloremic metabolic acidosis

Question 29

hypertonic saline

Answer 29

7.5 % NaCl rapidly draw water from ICF to ECF enhance cardiac function fast onset but short duration

Question 30

dose of hypertonic saline

Answer 30

4-6 mL/kg over 3-5 min 1-4 mL/kg only for cats

Question 31

indications for hypertonic saline

Answer 31

quick IV volume expansion severe shock (initial phase) head injury with elevated ICP

Question 32

contraindications of hypertonic saline

Answer 32

uncontrolled hemorrhage dehydration cardiac dysrhythmias

Question 33

dextrose (glucose) solution

Answer 33

5% dextrose is isotonic becomes hypotonic after metabolism good source of free water (dehydration) not generally appropriate for peri-operative use

Question 34

dextrose solutions are a component of

Answer 34

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

Question 35

colloids

Answer 35

large molecules that stay intravascular increase plasma oncotic pressure and vascular volume

Question 36

indication for use of colloids

Answer 36

albumin is low (alb. \<1.5 or TP \< 3.5 g/dL) or expected to become low (shock, SIRS-systemic inflammatory response syndrome)

Question 37

issues with colloids

Answer 37

volume overloading allergic reaction possible effect on hemostasis (tendency to bleed)

Question 38

types of colloids

Answer 38

**hydroxy-ethyl starch (HES)** dextran gelatin albumin (5%) plasma whole blood

Question 39

HES

Answer 39

chemically altered starch hetastarch, vetstarch metabolized by serum amylase eliminated by kidney or RES

Question 40

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

Answer 40

**true**

Question 41

concerns with HES

Answer 41

renal failure in septic patients

Question 42

recommendations with HES

Answer 42

use crystalloids as first line of treatment of shock try to delay use and minimize amount of given colloids

Question 43

max dose of HES

Answer 43

20 mL/kg/day

Question 44

routes of administration for crystalloid solutions

Answer 44

**IV** IO SQ IP **anesthestized patients almost invariable IV**

Question 45

types of water losses

Answer 45

physiological - renal, GI, respiration pathological - vomitting, diarrhea, bleeding anesthesia

Question 46

reasons for giving IV fluids during anesthesia

Answer 46

maintain patient IVC compensate for drug induced vasodilation compensate for dehydration (fasting) increase preload therefore CO replace ongoing fluid losses

Question 47

maintenance rate of crystalloids during anesthesia

Answer 47

10mL/kg/hr

Question 48

what should be given in cases of hypotension

Answer 48

10mL/kg fluid boluses (within 15 min)

Question 49

blood loss should be replaced immediately with

Answer 49

crystalloids (3x volume of lost blood) or colloids (exact volume) \>20% total blood volume lost - consider whole blood transfer FFP - tx of coagulopathy