Fluid Therapy In Practice Flashcards
Describe hypovolaemia? What can you assess it based on?
•Loss of circulating volume (ECF). Can assess it based on:
–HR
–CRT
–PCV/TS
–Lactate
–Urine Output
- Salt and water loss
- Mainly seem in small animals, loss blood from ECF in circulation volume
With hypovolaemia, how quickly should we aim to replace deficit?
Replace deficit 6-8 hours – want to get perfusion back to kidneys
What is dehydration?
How quickly do we want to replace the deficit?
•Loss of body water (2/3 ICF and 1/3 ECF)
–Dec BW (not that useful unless we weighed it healthy previously!)
–Sunken eyes
–Tacky MM
–Inc skin tent
- Replace deficit 12-24 hours
- Just water loss – always hypernatremic
What is the definition of shock?
- Inadequate cellular energy production
- Most commonly secondary to poor tissue perfusion
–Low or unevenly distributed blood flow
•Leads to critical decrease in oxygen delivery (DO2) compared to oxygen consumption in the tissues (VO2)
What i hypovolaemic shock?
•Hypovolaemic (decreased circulating blood volume)
–Fluid loss from intravascular space
–Trauma
–Haemorrhage
What is cardiogenic shock?
•Cardiogenic (decreased forward flow from the heart) – NEED TO BE CAREFUL WITH THIS TYPE OF SHOCK
–Congestive heart failure
–Cardiac dysrhythmias
–Cardiac tamponade
–Drug overdose (anaesthetic agents, beta-blockers, calcium channel blockers)
–One type of shock we sort of have to be more careful with when administering fluids as all of the other shock types, we can do the same thing with, but if suspect this, particular where we might have tamponade of CHF, if you give more fluid – forward flow made worse and back up of fluid within the heart
Which type of shock is the only real type of shock that we need to be careful with adminstering fluids to?
•Cardiogenic (decreased forward flow from the heart) – NEED TO BE CAREFUL WITH THIS TYPE OF SHOCK
–One type of shock we sort of have to be more careful with when administering fluids as all of the other shock types, we can do the same thing with, but if suspect this, particular where we might have tamponade of CHF, if you give more fluid – forward flow made worse and back up of fluid within the heart
What is distributive shock?
•Distributive (loss of systemic vascular resistance)
–Sepsis
–Obstruction (saddle thrombosis, heartworm)
–Anaphylaxis
What is metabolic shock?
•Metabolic (deranged cellular metabolic machinery)
–Hypoglycaemia
–Cyanide toxicity
–Mitochondrial dysfunction
–Cytopathic hypoxia of sepsis
What is hypoxaemic shock?
•Hypoxaemic (decreased oxygen content in arterial blood)
–Anaemia
–Severe pulmonary disease
–Carbon monoxide toxicity
–Methaemoglobinaemia
What is cryptic shock?
•Cryptic (normal global circulation but poor microcirculation)
–SIRS
–Sepsis
For all types of shock (apart from cardiogenic and perhaps cryptic) what is the mainstay of treatment?
- Early recognition
- Rapid restoration of CV function, quickly
- Normalise tissue oxygen delivery as soon as possible
- For all types of shock (except cardiogenic and perhaps cryptic)
–Mainstay:
- Large volumes of IV fluids
- Short, large bore catheters
–Ideally central or IO rather than peripheral vv
»But with canine and feline, often just need catheters as large as we can into both cephalic
What are the clinico-pathological signs associated with <5% fluid deficit?
No clinically detectable signs
What are the clinico-pathological signs associated with 5-7% fluid deficit?
- Mild depression
- Slightly prolonged CRT
- Slightly increased heart rate
- Increased blood lactate concentration
- Creatinine concentration concentrated urine
What are the clinico-pathological signs associated with 10% fluid deficit?
- Depressed
- May have cold extremities
- Dry mucous membranes with a CRT >3 seconds
- Heart rate >50% above the normal reference range
- Increased blood lactate concentration
- Increased creatinine concentrations
- Small volume of very concentrated urine