Fluid Therapy

Question 1

define osmosis

Answer 1

the movement of water across a semi-permeable membrane from high water activity to low water activity

Question 2

define osmolality

Answer 2

the concentration of a solution expressed as the total number of solute particles per litre

Question 3

what are electrolytes?

Answer 3

minerals dissolved into ions

Question 4

define tonicity

Answer 4

the measure of osmotic pressure of two solutions separated by a semi permeable membrane

Question 5

define isotonic

Answer 5

two solutions have the same concentration of impermeable solutes

Question 6

define hypotonic

Answer 6

the solution contains a lower concentration of impermeable solutes than the body (cell) fluid so will move into the body (cell) and can cause lysis

Question 7

define hypertonic

Answer 7

the solution contains a higher concentration of impermeable solutes than the body (cell) fluid so will draw water out of body (cell) tissues

Question 8

name 2 examples of a normal fluid intake

Answer 8

eating and drinking

Question 9

name 2 examples of normal fluid outgoing

Answer 9

urination and defecation

Question 10

name 2 examples of abnormal fluid intake

Answer 10

water deprivation and anesthesia

Question 11

name 2 examples of abnormal fluid outgoing

Answer 11

vomiting and haemorrhage

Question 12

what may fluid loss be caused by?

Answer 12

dehydration and hypovolaemia

Question 13

what are two other potential causes of fluid imbalance?

Answer 13

electrolyte imbalance and altered fluid distribution (change in oncotic pressures e.g. loss of albumin)

Question 14

define dehydration

Answer 14

loss of fluid from extravascular space

Question 15

what would be the clinical findings of 0-4% dehydration?

Answer 15

none (very few)

Question 16

what would be the clinical findings of 4-6% dehydration?

Answer 16

tacky mucous membranes

Question 17

what would be the clinical findings of 6-8% dehydration?

Answer 17

loss of skin turgor (skin tent becomes less elastic), dry mucous membranes

Question 18

what would be the clinical findings of 8-10% dehydration?

Answer 18

loss of skin turgor (skin tent becomes less elastic), dry mucous membranes, sunken eyes

Question 19

what would be the clinical findings of 10-12% dehydration?

Answer 19

persistant skin tent, dry mucous membranes, retracted globe, dull corneas, pulse deficits (hypovolaemia)

Question 20

define hypovolaemia

Answer 20

reduction in blood volume or fluid in the intravascular space

Question 21

what are the clinical signs of mild (compensated) hypovolaemia?

Answer 21

mild tachycardia, pinker than normal mucous membranes, increased (<1 second) capillary refill time, bounding pulse

Question 22

define compensating/compensated

Answer 22

patients body is able to correct fluid loss using normal physiological processes (e.g. vasoconstriction, increased HR)

Question 23

define decompensated/decompensating

Answer 23

body is unable to keep up and maintain fluid volume

Question 24

what are the clinical signs of severe (decompensated) hypovolaemia?

Answer 24

severe tachycardia, white/grey mucous membranes, >2seconds (prolonged) capillary refill time, poor/thready pulse

Question 25

how does the presentation of severe (decompensated) hypovolaemia differ in cats?

Answer 25

causes bradycardia not tachycardia

Question 26

what are crystalliod fluids?

Answer 26

solutions which contain diluted minerals known as electrolytes

Question 27

what are the 3 main types of crystalloid fluids?

Answer 27

replacement maintenance hypertonic

Question 28

give 3 examples of replacement crystalloid fluids

Answer 28

Hartmann's Lactated Ringers 0.9% NaCl (normal saline)

Question 29

what is the tonicity of replacement crystalloid fluids compared to ECF?

Answer 29

isotonic - they will not cause any fluid movement and so increase the volume of intravascular space and ECF

Question 30

give an example of maintenance crystalloid fluids

Answer 30

0.45% NaCl + 2.5% dextrose

Question 31

what is the tonicity of maintenance crystalloid fluids, such as 0.45% NaCl + 2.5% dextrose, compared to ECF?

Answer 31

hypotonic - fluid will move into the intracellular space

Question 32

how does 0.45% NaCl + 2.5% dextrose avoid the issue of cell lysis associated with hypotonic solutions?

Answer 32

the solution remains isotonic until the dextrose is metabolised when it then becomes hypotonic. Shortens time cells are exposed to hypotonic solution

Question 33

give an example of a hypertonic crystalloid fluid

Answer 33

7.2% NaCl (hypertonic saline)

Question 34

what is the effect on cells of hypertonic saline (7.2% NaCl)?

Answer 34

pulls fluid from ICF into intravascular space

Question 35

when must hypertonic saline (7.2% NaCl) be avoided?

Answer 35

dehydration due to its likelihood to worsen it

Question 36

when can hypertonic saline (7.2% NaCl) be used effectively?

Answer 36

resuscitation of hypovolaemic cases

Question 37

what are colloids?

Answer 37

large molecules that increase the oncotic pressure of plasma and so hold fluid in the intravascular space and increase volume

Question 38

what are colloids introduced in?

Answer 38

fluid

Question 39

when are colloids useful?

Answer 39

hypovolaemia

Question 40

give 2 synthetic/artificial colloids

Answer 40

dextrans and gelatins

Question 41

what are natural colloids?

Answer 41

blood products, frozen plasma or whole blood

Question 42

what are the 5 methods of administration of fluids?

Answer 42

intravenous, subcutaneous, intra-osseus, oral, intraperitoneal

Question 43

which is the most common method of fluid administration?

Answer 43

IV - fast acting and large volumes

Question 44

when is subcutaneous most useful?

Answer 44

mild dehydration or feline kidney disease

Question 45

when is intra-osseus fluid given?

Answer 45

in puppies or kittens where their vessels are small and may be collapsed if dehydrated

Question 46

what is the issue with oral administration of fluids?

Answer 46

relies on the patient drinking

Question 47

when are intraperitoneal fluids given?

Answer 47

to small furries

Question 48

what are the slowest acting methods of fluid administration?

Answer 48

sub-Q and intraperitoneal

Question 49

what are the 5 Rs of a fluid plan?

Answer 49

``` resuscitation routine maintenance replacement redistribution re-assessment ```

Question 50

what is the amount of fluids required for routine maintenance?

Answer 50

50ml/kg/day

Question 51

what are the 3 most common types of giving set?

Answer 51

standard, pediatric burette, blood giving

Question 52

what is the difference between a standard giving set and a paediatric burette?

Answer 52

paediatric burette is smaller and offers much more control

Question 53

what does a blood giving set have that others do not?

Answer 53

filter to trap blood clots

Question 54

what differs between giving sets?

Answer 54

drip factors

Question 55

how should dehydration deficit be calculated?

Answer 55

dehydration deficit = %dehydration x BW(kg) x 10

Question 56

how should ongoing losses be calculated?

Answer 56

ongoing losses = 4ml x number of vomit/diarrhea episodes x BW(kg)

Question 57

what is the maintenance of fluid calculation?

Answer 57

maintenance = 50 ml/kg/day x BW(kg)

Question 58

how should a patients fluid requirement over 24 hours be calculated?

Answer 58

sum of: | dehydration deficit, ongoing losses and maintenance

Question 59

how can we convert fluid requirement over 24 hours to drip rate?

Answer 59

convert total fluid requirement over 24 hours to ml/min by dividing by 24 (hours) and then 60 (minutes).

Question 60

how should drops per minute be calculated from m per minute?

Answer 60

drops per minute = millilitres per minute x giving set factor

Question 61

what is the usual value of a giving set factor?

Answer 61

20 or 60

Question 62

how is the final drip rate (seconds/drop) calculated from drops per minute?

Answer 62

drip rate = 60 /drops per minute