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RUSVM Anesthesiology > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

How much total body water is in the ECF?

A

1/3

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2
Q

Extracellular fluid is made up of what two components and how much of total body water do they constitute ?

A

Intravascular fluid —> 1/12 TBW

Interstitial fluid —> 3/12 TBW

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3
Q

Intracellular fluid makes up ________ total body water

A

2/3

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4
Q

T/F: total body water is more in obese and old animals

A

False

Less

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5
Q

What influences fluid movement from the interstitium to venous system?

A

Capillary wall
—> permeable to water and ions
—> impermeable to protein

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6
Q

What influence fluid movement form the intracellular to intersitial?

A

Cell membrane
—> permeable to water
—> impermeable to ions

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7
Q

What is the main ion in the intracellular fluid?

A

K+

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8
Q

What is the main ion in the extracellular fluid?

A

Na+

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9
Q

What is the approximate osmolality in both ECT and ICF?

A

300 mOsm/kg

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10
Q

Plasma protein have a net ______ charge

A

Negative

-essential for driving fluid into the IVF

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11
Q

What protein is most important in determining colloid onctoic pressure

A

Albumin

—>edema can be cause by hypoalbuminemia

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12
Q

What is the physiological osmotic pressure ?

A

23mmHg

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13
Q

What are the three types of fluids?

A

Cyststalloids
Colloids
Blood and products

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14
Q

What are crystal lords?

A

Contain water, electrolytes, and non-electrolytes

Can enter all body fluid compartments

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15
Q

Crystalloids replace small blood losses at a __________ v/v ratio

A

3:1

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16
Q

What are the replacement (balanced) crystalloid solutions?

A

Ringers
Ringers lactate
Plasmalyte R (normosol R)

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17
Q

_____________ types of fluids are used to replace body water and electrolytes

A

Crystalloids - replacement solutions

Eg ringers/ plasmalyte R

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18
Q

T/F: replacement solutions cause no changes in electrolytes

A

True

  • electrolyte composition is similar to the ECF
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19
Q

Large volumes of crystalloids can cause rapid re-expansion of ECF, but approx ______ remains IVF after 30 minuteus, and ______ will remain IVF after 1 hour

A

1/3; 1/4

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20
Q

Besides electrotyes, replacement solutions normally contain what type of agents?

A

Alkalinizing

Eg lactate, acetate, gluconate

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21
Q

What products are crystalloids maintenance solutions?

A

Plasmalyte M (Normosol M) in Dextrose 5%

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22
Q

When do we used a crystalloid maintenance solution?

A

Patients that have been stabilized by replacement fluids

Patients not taking in adequate amounts to meet daily requirements

Meant to replace daily fluid loss

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23
Q

What is the amount of maintenance fluid requirements?

A

40-60mL/kg/day

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24
Q

T/F: Plasmalyte M is used commonly for peri-anesthetic use

A

False

Maintenance solutions are not appropriate for peri-anesthetic use

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25
Does Plasmalyte M contain more sodium or potassium
More K+ than Na because the body secretes K+ relatively quick than Na
26
What is the maximum infusion rate of maintenance solutions?
0.5mEq/kg/hour
27
What is the concentration of physiological saline?
0.9% NaCl
28
When is use of physiological saline recommended?
Hyperkalemia patients Hyperkalemia, hyponatremic patients with hypoadrenocorticism
29
What would you be concerned about if you have high volumes of physiological saline?
Dilute other electrolytes
30
What is the concentration of hypertonic saline?
7.5% NaCl
31
What is the main use of hypertonic saline?
Rapid IVF compartment expansion —> temporary cardiac function improvement (fast onset and short duration) Can be used to treat cerebral edema if BBB is intact
32
What is Dextrose 5% used for?
Not much use, glucose rapidly metabolized with water by-product Essentially provides water —> component of maintenance fluids
33
What are colloid fluids?
Large molecular weight, stay in vasculature a long time
34
What is the main purpose of colloid fluids?
Expand and maintain IVF space volume - oncotic pull - volume administered - volume retained
35
Colloids replace low volume blood loss at a _____ v/v ratio
1: 1
36
Colloids can be co-administered with what to minimize ISF deficits
2-3x crystalloids
37
What are the synthetic colloids ?
Hydroxyl-ethyl starch (HES) Dextran Gelatin
38
What are the natural colloids?
Whole blood plasma | Albumin
39
What re the Hb-based oxygen carrying solution colloids ?
Oxyglobin
40
What is the most commonly used colloid?
Hetastarch | Molecular weight 420kDa
41
What affect does hetastarch have on hemostatis?
Saves oncotic pressure Decrease factor VIII and von willebrands factor concentrations
42
Where is hetastarch metabolized and eliminated//
Metabolized by serum amylase Eliminated by kidneys (associated with osmotic nephropathy - avoid in septic patients)
43
T/F: dextrans are colloids with a similar weight to hetastarch
True Polymer of glucose More hyper-oncotic than plasma
44
What is the main contributor to oncotic pull of plasma
Albumin
45
T/F: plasma contains clotting factors
True -can be used to treat coagulopathies
46
Why are fluid and electrolyte/ acid-base disturbances common during anesthesia ?
``` Open body cavities High fresh gas flow driven fluid loss Bleeding Drug induced polyuria Effects from drug-induced respiratory and cardiovascular depression ```
47
Why should we give peri-anesthetic fluids?
Maintaining IV catheter patency Correction of deficits (fasting) and ongoing normal fluid losses Maintenance of whole body fluid during procedure Support cardiovascular function (BP) - > maintain preload and SV - > compensate for peripheral vasodilation from drugs
48
T/F: all anesthetized patients should ideally be on fluid therapy
True
49
What vein do we commonly use in pigs and ruminants for IV fluid therapy?
Auricular
50
When do we use the intraosseous route for fluid therapy?
Very dehydrated or difficult to catheterize (young or small)
51
T/F: Subcutaneous fluid therapy can be used for shock therapy
False Only use for mild deficits
52
What is the best catheter size for fluids?
Largest, and longest
53
For adult horses and cattle, what side of catheter is appropriate?
14g or 12g
54
For dogs, what catheter sizes are generally used?
Large dog - 18g Med- 20g Small-22g
55
In cats, what catheter size is used
22g (adult) | 24g ( kitten)
56
In calves, sheep and goats, what catheter size is used?/
16 or 14g
57
What is the standard fluid type used peri-anesthetically, and the rate used?
Replacement crystalloids eg ringers 10ml/kg/hour
58
In what cases is the standard rate for peri-anesthetic fluid too high?
Young animals Long procedures Heart failure Renal disease
59
What should you do if you have acute hypotension during anesthesia ?
Decrease anesthetic depth Extra fluid over standard rate -crystalloid 10ml/kg/hour over 15mins If no change with crystalloid, turn to colloids
60
What should you do if your patient is still acutely hypotensive after decreasing anesthetic depth, and administering 2 blouses of fluid?
Cardio active drugs - ephedrine - phenylephedrine - atropine
61
How would you address acute hemorrhage with fluid therapy?
Minimal (less than 10% blood vol) - crystalloids (3x volume lost) - colloids (exact volume lost) ``` Excessive loss (more than 20% blood vol) -consider blood transfusion ```
62
What are potential complications of fluid therapy
Fluid overload (cats high risk) Hypothermia (cold fluids) Coagulation deficits Reduced tissue oxygenation (low PCV) -> reducing TP and PCV Electrolyte disturbances Acid base imbalances

RUSVM Anesthesiology (32 decks)

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