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BVetMed3 POS - Pharmacology > Fluid Therapy And Parenteral Nutrition > Flashcards

Fluid Therapy And Parenteral Nutrition Flashcards

1
Q

What are the two considerations when giving fluid therapy?

A

Replacement of fluids lost

Maintenance of fluid needs

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2
Q

How can fluids be lost?

A

Haemorrhage
Excessive urination (polyuria)
Vomiting and diarrhoea
Sequestered fluid

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3
Q

What percentage of body weight is made up of total body water?

A

60%

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4
Q

What can total body water be subdivided into?

What proportions?

A

Extracellular fluid (1/3) and intracellular fluid (2/3)

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5
Q

What can extracellular fluid be subdivided into?

A

Interstitial fluid 3/4

plasma (intravascular volume) 1/4

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6
Q

How can we calculate blood volume?

A

Plasma volume / (1-haematocrit)

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7
Q

Why are fluids indicated for general anaesthesia?

A

Replacement of blood lost from surgical bleeding
Counteract CV depression from anaesthetic drugs - vasodilation leads to lowered BP
Replace insensible fluid loss
Maintain normal fluid volumes despite reduced intake pre and post op
Warmed fluids can help maintain body temp

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8
Q

What is meant by insensible fluid losses?

A

Evaporation from surgical site etc.

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9
Q

What are some other indications for fluid therapy ?

A

Flushing things out
Animals with azotaemia (pre, renal and post) may help improve glomerular filtration rate and removing renal toxins
Animals intoxicated with water soluble substances - flush out - e.g. chocolate, NSAIDs
Correction of acid-base disturbances

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10
Q

How can fluids be used to correct electrolyte disorders?

A

Fluids may be supplemented with potassium and glucose if needed .

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11
Q

When might drugs be delivered using fluid therapy?

A

Some drugs have to be diluted before administration

Some drugs require constant infusion over sever hours

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12
Q

What are the common types of fluids available?

A

Crystalloids

Synthetic colloids

Blood products

Osmotic diuretics

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13
Q

What are the three types of crystalloids?

A

Isotonic

Hypertonic

Hypotonic

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14
Q

What is the most common type of fluid to administer?

A

Isotonic crystalloids

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15
Q

What are crystalloids composed of ?

A

Water and small molecules which can freely move out of the intravascular space.

Vary in exact composition

  • Electrolytes - Na+,Cl-, K+, Mg2+, Ca2+
  • Buffers - lactate, gluconate
  • Dextrose
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16
Q

How does hypertonic fluid affect blood volume?

A

Water is attracted into blood

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17
Q

How does hypotonic fluid affect blood volume?

A

fluid moves into interstitial space

Causes cellular oedema

18
Q

What are some examples of isotonic crystalloids?

A

Hartmann’s

Compound Sodium Lactate (CSL)

0.9% NaCl

Lactated Ringer’s Solution (LRS)

19
Q

What happens after isotonic fluid is administered?

A

Fluid distributes equally amongst all fluid compartments

Only a third of volume remains intravascularly after equilibration due to the movement of sodium

20
Q

What are the complications which can be associated with isotonic crystalloid therapy?

A

-Inadequate volume resuscitation or replacement

  • VOLUME OVERLOAD
    - Peripheral oedema formation
    - Pulmonary oedema or pleural effusion

-Possible dilutional coagulopathy

21
Q

When might hypertonic saline be indicated?

A

SEVERE shock, particularly larger patients

Cerebral oedema - attracts water into blood from brain

MUST NOT USE AS A CONSTANT INFUSION

22
Q

What is a contraindication of hypertonic fluids?

A

Dehydration / hypernatremia

23
Q

When might hypotonic crystalloids be indicated?

A

Hypernatraemic patient or for some drug infusions

NOT USED OFTEN

24
Q

What are synthetic colloid fluids composed of?

A

LARGE molecules (>30 KDa) suspended in an ISOTONIC crystalloid

25
Q

How are Synthetic Colloids useful?

A

Need molecules which persist in the vascular space and continue to attract water - Generate COLLOID OSMOTIC PRESSURE with PROLONGED EFFECT

This delays equilibration of fluid with other compartments

26
Q

When may synthetic colloids be considered?

A

Hypoperfusion (shock)

To restore circulating volume

27
Q

When are synthetic colloids indicated?

A

Require rapid intravascular resuscitation - mainly haemorrhagic

Want to increase COP in patients with low protein
- hepatic synthetic failure, protein losing conditions (e.g. PLE, PLN), haemorrhage

TYPICALLY when the patient is oedematous or does not respond to isotonic crystalloids

28
Q

What are some possible complications of using synthetic colloids?

A

Fluid overload (more likely than isotonic crystalloids) - NOT AS SAFE

Coagulopathy
-Dilution of platelets and clotting factors and other additional effects

Inaccuracy of total solids and urine specific gravity measurements

Risk of acute kidney injury

29
Q

How can synthetic colloids potentially result in a coagulopathy?

A

Dilute platelets and clotting factors

Additional direct effects on coagulation

30
Q

What lab diagnostics can be effected by the use of synthetic colloids?

A

Total solids

Urine specific gravity

31
Q

What are natural colloid solutions?

A

Blood products
- whole blood, plasma, packed RBCs

Concentrated albumin solutions
-human or canine

32
Q

Give an example of an osmotic diuretic.

What is its effect?

A

Mannitol

Shift fluid into intravascular space to be excreted by kidneys - Increased vascular volume

33
Q

When is mannitol indicated?

A

Most common: BRAIN OEDEMA

Also, acute glaucoma, oliguric acute kidney injury (AKI)

34
Q

What do you need to monitor when giving mannitol?

A

Fluid depletion or volume overload

35
Q

What does parenteral nutrition contain?

When should it be given?

A

A mixture of amino acid solutions, dextrose, and lipids (via IV line)

When animals cannot receive nutrition via the GIT (enteral nutrition)

36
Q

What are the advantages of enteral nutrition?

A

Directly supports enterocytes
Preserves mucosal barrier - prevents bacterial translocation
Immunomodulatory
Stimulates motility, secretions and neuroendocrine pathways
Fewer complications
Relatively inexpensive

IF THE GUT WORKS, USE IT !!!

37
Q

What are some options for enteral nutrition?

A

Nasogastric feeding tube
Oesophagostomy feeding tube
Gastrotomy/PEG tube
Jejunostomy tube (bypass stomach)

38
Q

When is parenteral nutrition indicated?

A

Uncontrolled GI dysfunction - V/R
Existing malnutrition or high risk malnutrition
Individualised feeding
Contraindication for enteral feeding (e.g. CV instability or unable to protect airway)

Reserved for cases of convincing GIT failure

39
Q

What are some negatives associated with parenteral nutrition?

A

More expensive than enteral feeding

More challenging to manage in practice

Needs a central venous catheter

Can cause sepsis

40
Q

Why does total parenteral nutrition need to be delivered via the jugular vein?

A

High osmolarity fluid

Can cause vasculitis in small peripheral vessels

41
Q

When would you see parenteral nutrition used?

A

In referral practice
- requires special expertise and equipment for patient specific prescriptions

Needs to be handled COMPLETELY ASEPTICALLY

Metabolic complications possible

42
Q

What negatives are associated with parenteral nutrition?

A 
Expensive
Often can give nutrition enterally 
Can cause sepsis
Need a central venous catheter 
Need 24/7 monitoring

BVetMed3 POS - Pharmacology (2 decks)

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