Fluid Therapy Basics

Question 1

How much of the body is water?

Answer 1

60%

Question 2

What percent of body water is in the intracellular space?

Answer 2

~40%

Question 3

What are the three compartments of extracellular space?

Answer 3

Interstitial
Intravascular
Transcellular

Question 4

What is the maintenance dose for fluids?

Answer 4

40 to 60mL/kg/day

Question 5

Where is fluid missing from in dehydration?

Answer 5

Intercellular or interstitial spaces.

Question 6

Where is fluid missing from in shock?

Answer 6

Intravascular spaces

Question 7

What are the 4 questions to make a fluid plan?

Answer 7

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

Question 8

What would be ideal to know before giving fluids?

Answer 8

RBC count and chem profile.

Question 9

What do you often only have before starting fluids?

Answer 9

Physical exam and history.

Question 10

What are the two types of fluids?

Answer 10

Crystalloids and colloids

Question 11

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

Answer 11

Crystalloids

Question 12

What are the 3 different tonicities of crystalloids?

Answer 12

Hypotonic
Hypertonic
Isotonic

Question 13

What is a hypotonic solution?

Answer 13

Lower osmolality that draws fluid into cells.

Question 14

What is a hypertonic solution?

Answer 14

Higher osmolality that draws fluid into intravascular space.

Question 15

What is isotonic solution?

Answer 15

Same osmolality, fluids neither or exit.

Question 16

What are colloids?

Answer 16

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

Question 17

What 3 things are crystalloids used for?

Answer 17

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

Question 18

What can large volumes of crystalloids lead to?

Answer 18

Peripheral edema

Question 19

What 2 things are isotonic fluids designed for?

Answer 19

Fluid replacement

Fluid maintenance

Question 20

What is the purpose of replacement fluids?

Answer 20

Replace fluid loss

Question 21

Can you give replacement fluids fast?

Answer 21

Yes

Question 22

Can you use replacement fluids for maintenance?

Answer 22

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

Question 23

What is the most often used replacement fluid?

Answer 23

LRS

Question 24

What is the purpose of maintenance fluids?

Answer 24

Replace daily Na losses without Na overload.

Question 25

Can you give maintenance fluids fast?

Answer 25

NO!

Question 26

Do all maintenance fluids have K?

Answer 26

No, some need it added.

Question 27

What are the two types of colloids?

Answer 27

Natural | Synthetic

Question 28

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

Answer 28

Restore RBCs Clotting factors AT III Albumin

Question 29

What are the two natural colloids?

Answer 29

Plasma | Whole blood

Question 30

What is the goal with synthetic colloids?

Answer 30

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

Question 31

What are two examples of synthetic colloids?

Answer 31

Dextran | Hetastarch

Question 32

What is the most commonly used synthetic colloid?

Answer 32

Hetastarch

Question 33

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

Answer 33

Need oncotic support, but not clotting fluids. Vasculitis, protein losing nephropathy, protein losing entropathies, liver failure, sepsis.

Question 34

How do cats commonly react to hetastarch?

Answer 34

Restless and salivation

Question 35

Name 4 side effects of colloid use.

Answer 35

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

Question 36

What tonicity do you use to correct dehydration?

Answer 36

Isotonic

Question 37

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

Answer 37

Maintenance.

Question 38

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

Answer 38

Na levels (hypernatremic)

Question 39

Can you combine colloids and crystalloids?

Answer 39

Yes.

Question 40

How do you combine colloids and crystalloids?

Answer 40

Subtract amount of colloid from dehydration deficit.

Question 41

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

Answer 41

Can unmask pre-clinical CHF resulting in volume overload.

Question 42

What are the "classic" fluids for cardiac patients?

Answer 42

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

Question 43

What will happen to patients who are not eating?

Answer 43

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

Question 44

What is the Kmax?

Answer 44

The max amount of K you would give.

Question 45

How do you calculate Kmax?

Answer 45

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

Question 46

What is the purpose of hypertonic saline?

Answer 46

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

Question 47

How long is hypertonic saline effective?

Answer 47

Short-lived.

Question 48

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

Answer 48

Large dogs in shock from GDV. | Head trauma/cerebral edema patients (should not receive large volumes of fluid)

Question 49

When is hypertonic saline indicated? (2 things)

Answer 49

Hypovolemic shock WITHOUT dehydration or hypernatremia | Head trauma cases

Question 50

When is hypertonic saline contraindicated?

Answer 50

Dehydration | Hypernatremia

Question 51

What are 4 routes to give fluids?

Answer 51

Enteral Intraosseus IV SQ

Question 52

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

Answer 52

Oral.

Question 53

What perfusion parameters must you monitor with patients on fluids?

Answer 53

``` HR CRT MM Pulse pressure Temp BP ``` NOTE: Shock will increase HR = longer CRT, poor pulse quality

Question 54

How often do you ideally weigh a fluid therapy patient?

Answer 54

Ideally BID, but at LEAST SID

Question 55

What volume of fluid does 1 lb equate to?

Answer 55

500mL