Fluid therapy Flashcards
Homeostasis?
Homeostasis?
.Maintaing the balance (equilibrium) of the body.
.Water or fluid provides the medium for homeostasis.
Distribution of fluids in the body?
Distribution of fluids in the body?
.60 = 40:20
.60% water/ 40% intracellular fluid/ 20% extracellular fluid.
.15% interstitial fluid
.Lese than 1% transcellular fluid
Intravenous fluids in renal failure?
Intravenous fluids in renal failure?
.These are used to restore good hydration and to flush out the substances that the kidneys are supposed to be removing from the bloodstream.
Packed cell volume (PCV)?
Packed cell volume (PCV)?
.Packed cell volume. The amount of red blood cells in the blood.
.Increased when dehydrated.
.Cat & dog PCV = 32 - 45%
.PCV >0.6 = polycythemia
Total protein (TP)?
Total protein (TP)?
.Measures the total amount of protein in the blood.
.Increased when dehydrated.
Skin turgor?
Skin turgor?
.Skin elasticity
Types of fluids?
Types of fluids?
.Isotonic crystalloids e.g. Hartmann’s
.Colloids e.g. Dextran 70, Hetastarch
.Hypertonic saline e.g. 7% Saline
Fluid administration routes?
Fluid administration routes?
.Oral .Subcutaneous
.Intravenous .Intraosseous
.Intraperitoneal
Colloids?
Colloids?
.For volume expansion e.g. hypovolemia and to provide colloid oncotic pressure.
.Colloids stay in the vascular space for longer than crystalloids.
.Used for hypoproteinemia, rapid intravascular expansion is required, when a longer duration of effect is required.
.If you give more than 20ml/kg/day of colloids there is a chance of coagulopathy.
Aims of fluid therapy?
Aims of fluid therapy?
.Replace fluid deficits
.Supply daily fluid needs
.Supply ongoing fluid losses
Pulmonary oedema?
Pulmonary oedema?
.Excess fluid in the lungs.
.The fluid collects in the air sacs in the lungs making it difficult to breathe.
Body water compartments?
Body water compartments?
.Interstitial fluid - bathes cells and tissues (24% of TBW).
.Plasma - constitutes most of the intravascular volume (8% of TBW).
.Transcellular fluid - synovial joint fluid, cerebrospinal fluid, bile and the fluid in the lining of the peritoneal cavity, pericardium and pleural space (2% of TBW).
Difference between dehydration and hypovolemia?
Difference between dehydration and hypovolemia?
.Dehydration - is a water deficit in the interstitial and intracellular compartments.
.Hypovolemia - is a loss of fluid in the intravascular space.
Electrolytes?
Electrolytes?
.Are salts and minerals.
.Sodium Na .Potassium K
.Calcium Ca .Magnesium Mg
.Chloride Cl .Mercury Hg
.Phosphorus P .Bicarbonate HCO3-
Interstitial fluid?
Interstitial fluid?
.The medium in which the cells are bathed and from it the cells extract all that they need, such as oxygen and nutrients.
.Osmosis - responsible for water movement from the interstitial fluid into cells.
Osmosis?
Osmosis?
.Is a significant factor in the maintenance of the fluid volume within the body fluid compartments.
.The osmotic pressure or tonicity of a rehydrating fluid is described relative to the osmotic pressure of blood plasma as follows;
.Isotonic - fluid with the same osmotic pressure as plasma.
.Hypotonic - fluid with a lower osmotic pressure than plasma.
.Hypertonic - fluid with a higher osmotic pressure than plasma.
Intravenous cannula?
Intravenous cannula?
.Provides a pathway into the vascular system for fluid, blood products or meds.
.Allows multiple blood samples to be drawn with minimal patient discomfort.
T - port?
T - port?
.Can reduce bulk at the insertion site and allow less disturbance to the catheter site.
Questions before giving fluids?
Questions before giving fluids?
.Do they require fluids?
.What type of fluids?
.Which route is appropriate?
.How much?
.For how long?
Sodium?
Sodium?
.Main cation in ECF.
.The primary cation of the ECF and it aids in maintaining the osmolality of the ECF.
.Acute elevations of extracellular sodium concentration lead to intracellular dehydration.
Chloride & bicarbonate?
Chloride & bicarbonate?
.Main anion in ECF.
Potassium & magnesium?
Potassium & magnesium?
.Potassium - is the primary cation in ICF.
.Magnesium - is the second most abundant cation in ICF.
Phosphorus?
Phosphorus?
.Main anion in ICF.
Osmolarity?
Osmolarity?
.Osmotic concentration.
Osmotic pressure?
Osmotic pressure?
.The osmotic pressure of blood is referred to as the colloid oncotic presence (COP).
Hydrostatic pressure?
Hydrostatic pressure?
.Thought of as the power of the pressure within the capillary to cause fluid to leave the vessel.
Colloid oncotic pressure?
Colloid oncotic pressure?
.Thought of as the power of larger molecules (colloids) within plasma to hold/ pull fluid within/ into vessels.
.These two forces balance themselves out across the capillary bed of a healthy animal.
Fluid loss per day?
Fluid loss per day?
.20ml/kg/ day lost through urine
.10ml/kg/ day is lost from faeces
.20ml/kg/ day lost respiratory and cutaneous evaporation.
.50ml/kg/ day
Fluid deficit?
Fluid deficit?
.For every 1% increase in PCV there is a fluid loss of 10ml/kg
Multiplications of maintenance?
Multiplications of maintenance?
.Maintenance is 2ml/kg/hr
.So ‘twice maintenance’ will be 2×2 = 4ml/kg/hr
Hypotonic fluid loss?
Hypotonic fluid loss?
.Is where water is lost in excess of sodium.
.Seen in some animals with vomiting, diarrhoea and chronic renal failure.
Anaesthesia fluid therapy reason?
Anaesthesia fluid therapy reason?
.Most anaesthetic agents will alter fluid homeostasis, so it should allow for maintained fluid balance.
.To improve cardiac output and tissue perfusion.
Bicarbonate?
Bicarbonate?
.Is continually regenerated by the kidneys and returned to the circulation.
Dog blood pH?
Dog blood pH?
.7.35 - 7.45
.If lower will be acidemia caused by acidosis.
.If higher will be alkalemia caused by alkalosis.
Hypertonic saline?
Hypertonic saline?
.Rich in sodium.
.Draws large amounts of water into the vascular space quickly, so is good for hypovolemia.
.Be careful not to cause hypernatremia if given too much.
Hypotonic crystalloids?
Hypotonic crystalloids?
.Used for patients with pure water deficits.
Central venous catheters?
Central venous catheters?
.Insertion sites are the jugular vein and the lateral or medial saphenous veins.
Peripheral catheters?
Peripheral catheters?
.Insertion sites;
.Cephalic or accessory cephalic
.Saphenous medial or lateral
.Auricular
.Dorsal common digital veins
Catheter connects to?
Catheter connects to?
.A bung
.T-port - clamp after flushing
.Giving set
Infusion pump?
Infusion pump?
.Controls the rate of flow of the fluids being delivered to the patient.
.If it beeps it means there may be a blockage of air in the line or a medicine is finished infusing.
.Can deliver very slow or very fast infusion rates.
Indwelling catheter?
Indwelling catheter?
.Bladder catheter
.Insertion sites are urethral and suprapubic
Fluid imbalances can affect?
Fluid imbalances can affect?
.The patient’s electrolyte balance and electrolyte imbalances can result in fluid imbalances.
Mosm/kg?
Mosm/kg?
.The concentration of osmoles in a mass of solvent.
Hypernatremia?
Hypernatremia?
.Commonly loss of water greater than the loss of sodium from the ECF.
.Treatment - replace the water deficit
Hyponatremia?
Hyponatremia?
.Treatment give NaCl fluids
Chloride?
Chloride?
.Changes in levels are consistent to particular disease processes.
Hyperkalemia?
Hyperkalemia?
.Always give IV fluids. Giving glucose alone will aid in lowering potassium levels.
Hypercalaemia?
Hypercalaemia?
.Give IV fluids to dilute the calcium
Phosphorus?
Phosphorus?
.Cell membranes are composed of phospholipids.
