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Mechanisms of Disease > Fluid Therapy Basics > Flashcards

Fluid Therapy Basics Flashcards

1
Q

How much of the body is water?

A

60%

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2
Q

What percent of body water is in the intracellular space?

A

~40%

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3
Q

What are the three compartments of extracellular space?

A

Interstitial
Intravascular
Transcellular

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4
Q

What is the maintenance dose for fluids?

A

40 to 60mL/kg/day

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5
Q

Where is fluid missing from in dehydration?

A

Intercellular or interstitial spaces.

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6
Q

Where is fluid missing from in shock?

A

Intravascular spaces

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7
Q

What are the 4 questions to make a fluid plan?

A

Why are you giving fluids?
What type of fluid do you need?
Which route is needed?
What parameters do you need to monitor?

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8
Q

What would be ideal to know before giving fluids?

A

RBC count and chem profile.

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9
Q

What do you often only have before starting fluids?

A

Physical exam and history.

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10
Q

What are the two types of fluids?

A

Crystalloids and colloids

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11
Q

What fluids should you choose if you have an unknown diagnosis or no lab results.

A

Crystalloids

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12
Q

What are the 3 different tonicities of crystalloids?

A

Hypotonic
Hypertonic
Isotonic

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13
Q

What is a hypotonic solution?

A

Lower osmolality that draws fluid into cells.

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14
Q

What is a hypertonic solution?

A

Higher osmolality that draws fluid into intravascular space.

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15
Q

What is isotonic solution?

A

Same osmolality, fluids neither or exit.

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16
Q

What are colloids?

A

Larger molecular weight that remains in intravascular space and keep fluid in intravascular space.

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17
Q

What 3 things are crystalloids used for?

A

Correct dehydration
Expand vascular space in shock
Correct electrolyte/acid-base imbalances

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18
Q

What can large volumes of crystalloids lead to?

A

Peripheral edema

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19
Q

What 2 things are isotonic fluids designed for?

A

Fluid replacement

Fluid maintenance

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20
Q

What is the purpose of replacement fluids?

A

Replace fluid loss

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21
Q

Can you give replacement fluids fast?

A

Yes

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22
Q

Can you use replacement fluids for maintenance?

A

Yes, but you must add K and monitor serum Na.

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23
Q

What is the most often used replacement fluid?

A

LRS

24
Q

What is the purpose of maintenance fluids?

A

Replace daily Na losses without Na overload.

25
Q

Can you give maintenance fluids fast?

A

NO!

26
Q

Do all maintenance fluids have K?

A

No, some need it added.

27
Q

What are the two types of colloids?

A

Natural

Synthetic

28
Q

What is the purpose of natural colloids? (4 things)

A

Restore RBCs
Clotting factors
AT III
Albumin

29
Q

What are the two natural colloids?

A

Plasma

Whole blood

30
Q

What is the goal with synthetic colloids?

A

Improve perfusion in a patient that doesn’t have obvious blood loss or clotting problems.

31
Q

What are two examples of synthetic colloids?

A

Dextran

Hetastarch

32
Q

What is the most commonly used synthetic colloid?

A

Hetastarch

33
Q

What are some examples of cases that hetastarch is used for?

A

Need oncotic support, but not clotting fluids.

Vasculitis, protein losing nephropathy, protein losing entropathies, liver failure, sepsis.

34
Q

How do cats commonly react to hetastarch?

A

Restless and salivation

35
Q

Name 4 side effects of colloid use.

A

Fluid overload/pulmonary edema
Coagulopathy
Renal failure
Allergic reactions (human albumin)

36
Q

What tonicity do you use to correct dehydration?

A

Isotonic

37
Q

What fluids do you switch to after fluid and electrolyte imbalance has been corrected?

A

Maintenance.

38
Q

If patient are not switched from a replacement fluid to a maintenance fluid for several days, what mus be monitored?

A

Na levels (hypernatremic)

39
Q

Can you combine colloids and crystalloids?

A

Yes.

40
Q

How do you combine colloids and crystalloids?

A

Subtract amount of colloid from dehydration deficit.

41
Q

Why must you be careful using Na-containing fluids in cardiac patients?

A

Can unmask pre-clinical CHF resulting in volume overload.

42
Q

What are the “classic” fluids for cardiac patients?

A

0.45% NaCl, made isotonic through the addition of dextrose.

43
Q

What will happen to patients who are not eating?

A

They will become hypokalemic d/t obligate renal K loss.

44
Q

What is the Kmax?

A

The max amount of K you would give.

45
Q

How do you calculate Kmax?

A

0.5mEq/kg/hr (1/2 patients BW)

46
Q

What is the purpose of hypertonic saline?

A

Pulls fluid into vascular space to replace volume deficit with less fluid in hypovolemic shock.

47
Q

How long is hypertonic saline effective?

A

Short-lived.

48
Q

Who are the ideal candidates for hypertonic saline? (2 groups)

A

Large dogs in shock from GDV.

Head trauma/cerebral edema patients (should not receive large volumes of fluid)

49
Q

When is hypertonic saline indicated? (2 things)

A

Hypovolemic shock WITHOUT dehydration or hypernatremia

Head trauma cases

50
Q

When is hypertonic saline contraindicated?

A

Dehydration

Hypernatremia

51
Q

What are 4 routes to give fluids?

A

Enteral
Intraosseus
IV
SQ

52
Q

What route can you use in large animals, but not small?

A

Oral.

53
Q

What perfusion parameters must you monitor with patients on fluids?

A 
HR
CRT
MM
Pulse pressure
Temp
BP

NOTE: Shock will increase HR = longer CRT, poor pulse quality

54
Q

How often do you ideally weigh a fluid therapy patient?

A

Ideally BID, but at LEAST SID

55
Q

What volume of fluid does 1 lb equate to?

A

500mL

Mechanisms of Disease (7 decks)

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