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URI > Fluid therapy > Flashcards

Fluid therapy Flashcards

1
Q

List ways in which healthy animals lose body water

A
  • Urine
  • Sweat
  • Water vapour during breathing
  • Faeces
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2
Q

List abnormal ways in which water can be lost from the body

A
  • Vomiting
  • Diarrhoea
  • Burns
  • Haemorrhage
  • Polyuria
  • Third space oss
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3
Q

What is third space loss and give an example?

A
  • Fluid accumulates in body cavity but lost from circulation i.e. effusions, internal haemorrhages, peritonitis, obstructions etc
  • e.g. ascites
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4
Q

What are the kinds of fluid losses that can occur in an animal?

A
  • Primary water loss

- Mixed water and electrolyte loss

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5
Q

How does primary water loss occur?

A
  • Water intake decreased, only losing water
  • Hypotonic loss
  • When patient unable to increase intake sufficiently
  • Occurs from ECF, ICF to ECF translocation to compensate
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6
Q

Why do the clinical signs of primary water loss take time to develop?

A
  • Water moves from ICF to ECF to compensate

- ICF is a large reserve

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7
Q

What are the important factors to consider when estimating water loss?

A
  • Duration of illness
  • Vomiting/diarrhoea? frequency and volume
  • Water intake (quantify, unusual habits)
  • Source of loss e.g. open wounds, asscites ec
  • What kind of fluid loss has occured
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8
Q

How does mixed water and electrolyte loss occur?

A
  • Vomiting or diarrhoea

- Haemorrhage and effusion

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9
Q

What are the important features of mixed electrolyte and water loss?

A
  • Osmolarity does not change, no movement from ICF
  • Loss borne by ECF alone
  • Clinical signs develop quickly
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10
Q

What should be included in patient assessment when considering fluid loss?

A
  • Pulse quality (peripheral, changes sooner)
  • CR
  • Heart rate
  • Skin tenting
  • Regular blood pressure (can change with stress, may no be accurate)
  • Tackiness of mucus membranes
  • Eye position
  • Demeanour
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11
Q

What may happen to eye position in severe dehydration?

A
  • May sink into socket

- Third eyellid (nictitating membrane) may move over the top

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12
Q

How can the degree of hypovolaemia be assessed?

A
  • Using approximate ranges for heart rate, pulse quality, mucous memrbane colour, CRT, mentation and extremity temperature
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13
Q

What does loss of a distal pulse indicate?

A

Severe hypovolaemia

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14
Q

What is the difference between cats and dogs as hypovolaemia progresses?

A
  • Cats more likely to show bradycardia

- Dogs more likely to show tachycardia

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15
Q

How can fluid deficit be estimated?

A
  • %age
  • Comparison of clinical signs usually show when at a particular % fluid deficit
  • Multiply by animal’s weight to get volume of deficit i.e. 20kg dog with 10% dehydration = 2 litre deficit
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16
Q

What is the approximate maintenance fluid requirement for a dog?

A

(30xkg) +70

- or 1.5-4ml/kg/hour

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17
Q

List the main therapeutic fluids

A
  • Crystalloids (hypotonic, isotonic, hypertonic)
  • Colloids
  • Blood products
  • Haemoglobin based oxygen carrying solutions (HBOCS)
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18
Q

What are the main aims of fluid therapy?

A
  • Improvement of organ function (need adequate perfusion)
  • Correction of electrolyte disturbances
  • Correction of hypovolaemia
  • Correction of acid base disturbances
  • Total or partial parenteral nutrition (usually PPN)
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19
Q

What is Lactated Ringer solution?

A

Isotonic crystalloid solution

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20
Q

What is contained in LRS?

A
  • Na+: 130mEq/l
  • Cl-: 109mEq/l
  • Lactate as a bicarbonate precursor (so is buffered)
  • Tiny amounts of potassium
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21
Q

Why is LRS buffered?

A
  • Controlled alkalinisation

- Avoids dilutional acidosis

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22
Q

Why is LRS not suitable for long term administration?

A

Inadequate potassium

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23
Q

What is LRS used for?

A
  • Shock
  • Diuresis
  • Anaesthesia
  • Maintenance
  • Can add other things e.g. glucose
24
Q

What are the disadvantages of LRS?

A
  • Contains calcium, cannot use if hypercalcaemic

- Only 1/4 will remain in vascular space, rest is excreted, not efficiet in bringing up and maintaining fluid levels

25
Q

Describe hypotonicc crystalloid fluids

A
  • 0.18% NaCl, or 0.18% NaCl and 5% glucose
  • Hypotonic
  • Very few indications - Like giving pure water
  • Useless, causes dilution, likely to make patient sicker
26
Q

What is the effect of administration of hypertonic crystalloid fluid?

A
  • Draws water from interstitial space
  • Causes pulmonary-vagal reflex (vasoconstriction, bypass pulmonary circulation)
  • Transient effect (10-15 min)
27
Q

When is use of hypertonic crystalloid fluid indicated?

A
  • Usually large animals e.g. prior to colic surgery

- Low volume resus (life threatening hypovolaemia and raised ICP)

28
Q

When is use of hypertonic crystalloid fluid contraindicated?

A
  • Hypernatremia
  • Hypokalaemia
  • Haemolysis
  • Thrombosis
  • Fall in BP
  • Repeat use
29
Q

When is use of colloid fluids indicated?

A
  • Support of circulating blood volume is needed
  • Severe hypovolaemia
  • Systemic inflammatory response syndrome
  • Haemorrhage
  • Hypoproteinaemia
30
Q

What types of colloid fluids are available?

A
  • Artificial: oxypolygelatins, dextrans, starches, HBOCs
  • ## Natural: albumin, plasma etc
31
Q

Describe gelatin colloids

A
  • Oxypolygelatins
  • Plasma half life 2-4 hours
  • No need for concurrent crystalloid but often do give both
  • Produces osmotic diuresis
  • No direct coagulation effects
32
Q

Describe starch colloids

A
  • Plasma half life 25 hours due to molar substitution
  • Initial elimination by tissue uptake
  • Excretion by metabolism
  • Volume expanded by volume given
  • Reversal of microvascular permeability
  • Direct coagulation effects
33
Q

How do starch colloids reverse microvascular permeability?

A

Anti-inflammatory effect

34
Q

How do starch colloids have a direct coagulation effect?

A

Increase APT in dogs

- Factor VIII precipitation

35
Q

What are the indications for use of blood colloids?

A
  • Haemorrhage
  • Clotting disorders
  • Hypoproteinaemia
36
Q

Outline how hypertonic saline can be used for emergency fluid resuscitation in clinical practice

A
  • Life threatening hypovolaemia and raised intra-cranial pressure (ICP)
  • Draws water from interstitial space
  • Causes pulmonary vagal reflec
  • Expands blood palsma for short period of time
37
Q

Give an example of haemoglobin replacement products in fluid therapy

A
  • Haemoglobin based oxygen carrying HBOC
38
Q

When are haemoglobin replacement products commonly used and why?

A
  • Hypoxaemic crisis where there has been massive blood loss

- Artifically carries oxygen

39
Q

What are the limitations to using haemoglobin replacement products?

A
  • Very expensive
  • Many practices do not stock so difficult to get hold of in crisis
  • Exerts high osmotic pressure, need to infuse slowly and carefully
40
Q

List the ways in which fluids can be administered

A
  • Orally
  • IV
  • Rectal
  • SubCut
  • Intraosseous
  • Intraperitoneal
41
Q

What veins can be used for intravenous administration of fluids?

A
  • Cephalic
  • Saphenous
  • Jugular
  • Auricular
  • Lateral thoracic
42
Q

What complications can occur in fluid administration?

A
  • Extravasation
  • Thrombosis
  • Infection
  • Emboli (incl. catheter emboli)
  • Exsanguination
43
Q

What may cause an unexplained tachycardia following fluid therapy be indicative of?

A

Hypovolaemia

44
Q

What should a fluid plan consist of?

A
  • Replace what is already lost, maintain, and counteract ongoing losses
  • Sum of deficit, mainteance amount and ongoing losses
45
Q

What are the advantages of oral administration of fluids?

A
  • More physiological

- Non-invasive (lower risk of infection)

46
Q

What are the disadvantages of oral administration of fluids?

A
  • Too slow

- May be impossible due to clinical presentation (vomiting, unconscious, unable to swallow)

47
Q

What are the advantages of IV administration of fluids?

A
  • Large volume can be administered faster

- Precise (know how much is going in)

48
Q

What are the disadvantages of IV administration of fluid?

A
  • Can overload
  • Large volume too fast, come out of veins causing oedema
  • Invasive = risk of infection, thrombi and emboli
49
Q

What are the advantages of subcut administration of fluids?

A
  • Useful if can’t find vein

- Can train owner to do this

50
Q

What are the disadvantages of subcut administration of fluids?

A
  • Risk of infection
  • Slow
  • Can be painful (large pocket of fluid under skin)
51
Q

What are the advantages of intraosseus administration of fluids?

A
  • No veins found
  • Small animals e.g. puppies, kittens, rabbits, birds
  • veins in birds very fragile (prone to haematoma)
52
Q

What are the disadvantages of intraosseus administration of fluids?

A
  • pianful

- Cannot be done in humerus or femur of birds

53
Q

Why can intraosseus administration of fluids not be done in the humerus or femur of birds?

A
  • Pneumatic bones with air sacs

- Would drown bird

54
Q

What are the sites for intraosseus administration of fluids in dog or cat?

A
  • Femur
  • Humerus
  • Pelvis
55
Q

What are the sites for intraosseus administration of fluids in birds?

A
  • Ulna
  • Radius
  • Tibia

URI (15 decks)

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