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URI2 > Fluid therapy > Flashcards

Fluid therapy Flashcards

1
Q

What is the approximate % fluid deficit in an animal with tacky mucous membranes?

A

5-6%

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2
Q

What is the approximate % fluid deficit in an animal with skin tenting and dry mucous membranes?

A

6-8%

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3
Q

What is the approximate % fluid deficit in an animal with increased pulse rate and sunken eyes?

A

8-10%

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4
Q

What is the approximate % fluid deficit in an animal with weak pulses, dry corneas, dull mentation?

A

10-12%

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5
Q

What is the approximate % fluid deficit in a collapsed animal?

A

12-15%

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6
Q

Describe the clinical signs of overhydration

A
  • Wet MM
  • Increased skin elasticity
  • Shivering
  • Nausea
  • V++
  • Restlessness
  • Serous nasal discharge
  • Chemosis
  • Tachypnoea
  • Dyspnoea
  • Pulmonary crackes
  • Pulmonary oedema
  • Pleural effusion
  • Ascites
  • Diarrhoea
  • SC oedema
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7
Q

Discuss the use of central venous catheters in hospitalised patients

A
  • Measure central venous pressure
  • Gives indication of intravascular filling
  • CVP <0cm = volume depleted
  • CVP >10cm H2O = volume overload or CHF
  • Pleural effusion falsely elevates CVP
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8
Q

In severe acute uraemia, what occurs in 80% of dogs?

A

Hypertension

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9
Q

When does lactic acidosis occur?

A

Dehydration, poor tissue perfusion (may compound acidosis in renal failure)

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10
Q

What may lead to an increased PCV and increased TP?

A

Dehydration

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11
Q

What may lead to an increased PCV and normal or decreased TP?

A

Splenic contraction (polycythaemia, hypoproteinaeima)

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12
Q

What may lead to a normal PCV and increased TP?

A
  • Normal hydration with hyperproteinaemia

- Anaemia and dehydration

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13
Q

What may lead to a decreased PCV and increased TP?

A
  • Anaemia with dehydration

- Anaemia with hyperproteinaemia

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14
Q

What may lead to a decreased PCV and normal TP?

A

Non-haemorrhagic anaemia with normal hydration

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15
Q

What may lead to a normal PCV and normal TP?

A
  • Normal
  • Acute haemorrhage
  • Dehydration with anaemia and hyporptoeinaemia
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16
Q

What may lead to a decreased PCV and decreased TP?

A
  • Blood loss
  • Anaemia and hypoproteinaemia
  • Overhydration
17
Q

List the routes for fluid administration

A
  • Oral (best if possible)
  • Rectal
  • Subcut (good for small furries)
  • Intraosseous
  • Intravenous
  • Intraperitoneal
18
Q

When is the use of colloids indicated? Give an approximate rate

A

Patient suffering from hypoalbuminaemia

20-50ml/kg/day (depending on colloid)

19
Q

Give an example of fluid rate that may be used in an animal with hypovolaemic shock

A

60-90ml/kg in dogs, 45-60ml/kg in cats

- Give 1/4 over 5-15 mins then repeat if no improvement

20
Q

Compare the fluid replacement rates in AKI and CKD

A
  • AKI: fast replacement (6-8 hours)
  • CKD slower replacement (12-24hours)
  • Slower rates for animals with cardiac insufficiency
21
Q

Outline your approach to the fluid therapy of a dehydrated animal

A
  • First replace losses + maintenance over 8 hours
  • Then the rest of the maintenance fluids over the next 16 hours
  • Continual reassessment of ongoing losses and response to fluid therapy, may need to reduce or increase
22
Q

Outline your approach to the fluid therapy of an oliguric patient

A
  • Oliguria can be pathological or physiological
  • To determine which, give fluid push (3-5% BWT over short period of time) and assess urine output: if no urine produced, is pathological (i.e. something wrong with urinary tract)
  • Rule out obstruction or leakage before assuming renal damage
  • Consider diuretics if pre-renal factor correct but no urine output
23
Q

Describe the fluid therapy of an anuric patient

A

Replace insensible losses only i.e. 22ml/kg/day, unless overhydrated in which case withhold insensible losses

24
Q

What is the normal urine output for small animals and what constitutes oliguria?

A

Normal: 1-2ml/kg/hour

Oliguria <1-2ml/kg/hour

25
Q

What features can be monitored to assess fluid therapy?

A
  • Weight
  • MM, Hr, RR
  • Urine output
  • Arterial blood pressure
  • PCV, TP
  • Electrolytes, urea, creatinine, blood gas values
26
Q

Outline your approach to taking a patient off fluids and how you know when to do this

A
  • Once animal is drinking and eating and producing urine
  • Taper fluids as azotaemia resolves, taper by 25% each day
  • Should see appropriate decrease in urine production but must continue
  • If urine production not decreasing, kidneys unable to concentrate so taper more slowly
27
Q

Discuss the use of outpatient fluid therapy

A
  • Can be offered to some owners
  • Daily/EOD SC injection
  • Devices can be implanted
  • Use LRS or 0.9% saline
28
Q

What cardiac derangements are typical with hyperkalaemia

A
  • Bradycardia
  • Tall T waves, short QT interval, wide QRS, small wide or absent P waves
  • Sinoventricular rhythm, ventricular fibrillation, ventricular standstill
29
Q

List drugs that may exacerbate hyperkalaemia in a patient with renal disease

A
  • Beta blockers
  • Digoxin
  • ACE-I
  • NSAIDs
  • TPN
  • Cyclosporine
  • Trimethoprim

URI2 (9 decks)

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