Fluid Therapy & Transfusion Module

Question 1

What is osmolality?

Answer 1

the number of solute particles contained in a solution

Question 2

Explain osmotic pressure?

Answer 2

Pressure exerted but particles confined between a certain compartment. Water moves toward the highest osmotic pressure

Question 3

What is effective osmolarity

Answer 3

Particles that exert osmotic pressure

Question 4

What is oncotic pressure?

Answer 4

the contribution of colloid particles to osmotic pressure, a small particle of osmotic pressure
Mainly albumin

Question 5

What is the glycocalyx?

Answer 5

Gel like negatively charged matrix of membrane-bound proteoglycans + glycoproteins on the luminal vessels

Question 6

What is hypovolaemia

Answer 6

Deficit of fluid fro intravascular space, the interstitial and intracellular fluid is unchanged

Question 7

What causes relative hypovolaemia?

Answer 7

Caused by abnormal vasodilation. fluid volume in vessels unchanged but due to dilation of vessels leads to hypovolaemia and malperfusion
- results in glycocalyx shedding, increased vascular permeability

Question 8

Explain what the haemostatic response to fluid loss is?

Answer 8

There is an immediate response and longer-term homeostatic reponse.
Immediate response: in place to maintain O2 delivery to the tissues, BP and heart rates spikes. triggered by baroreceptors deteching decreased stretch in the vessels. Also transcapillary refill: borrowing of fluid from interstitium with altered starlings forces
Longer term response: RAAS activation caused by decreased circulating volume, results in retention of water and sodium and stimulates thirst
ADH/vasporessin release

Question 9

Cons of synthetic colloids

Answer 9

coaguloapathy, renal dysfunction, contraindicated in septic, critically ill or burn patients (haemorrhage resus good)

Question 10

How do you calculate fluid losses?

Answer 10

Maintenance fluids + Dehydration percentage + Ongoing losses, replaced over 6-12 hours

Question 11

Maintenance fluids calculation

Answer 11

(BWx30) + 70

Question 12

How to differentiate pre-renal azotaemia?

Answer 12

CS: evidence of dehydration or hypovolaemia
USG: usually but not always well concentrated
Response to fluids: rapid correction of azotaemia within 24-48 hours
Urinalysis: unremarkable
Urine output: usually but not always low

Question 13

Signs of renal azotaemia?

Answer 13

CS: varying
USG: inadequate concentration
Response to fluids: persistent or slowly correcting azotaemia
Urinalysis: changes consistent with underlying kidney injury
UO: high, normal or low

Question 14

Traumatic Brain Injury fluid management

Answer 14

Fluid resus must be aggressive to keep MAP 100mmHg (outdated to think contributes to cerebral edema)
- Saline best as less likely to exacerbate edema
- When hypotension fixed can then reach for hypertonic saline or mannitol

Question 15

What are the indications for transfusions

Answer 15

21% and below PCV - consider
CS of hypoperfusion: dull mentation, tachy/bradycardia, poor pulse quality, high lactate

Question 16

How to treat euvolaemic anaemia?

Answer 16

Will not benefit from fluid boluses
Need to transfuse with blood products

Question 17

What products are best for primary bleed transfusions

Answer 17

fresh whole blood or fresh frozen plasma

Question 18

What blood products can be used for oncotic support?

Answer 18

FP and FFP good to help draw fluid in to vascularture, safer than colloids but need to give large amounts and very expensive

Question 19

What are storage lesions with blood products?

Answer 19

Longer blood is sotred, cells will degenerate the longer they are stored leading to increased morbidity/mortality

Question 20

How are blood types determined?

Answer 20

molecules on RBCS that can induce an immune reaction during transfusion (antigens) - antibodies binding to the RBC antigen leading to cell destruction

Question 21

What are the feline blood types?

Answer 21

Type A- most common - low titres anti-b antibodies
Type B - high titres of anti-a antibodies
Type AB - rare and uncommon sometimes called C - Can have type A but best AB blood

Question 22

What is neonatal isoerythralis?

Answer 22

emergenfy disorder when type B queen mates with a type A tom - some kittens have type A, AB and mums colostrum has type B and has anti-a antibodies leading to fading kittens

Question 23

What are the available blood products?

Answer 23

WB –> Spun down to packedRBCs + FFP
FFP —> FP, Cryopoor, Cryopercipitate

Question 24

What can cryopoor blood products be used for?

Answer 24

Cheaper alternative than FFP/FP and WB for treating rodenticides
Contains clotting factors, 2, 7, 9, 10