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Ti Critical care > fluids > Flashcards

fluids Flashcards

1
Q

Fluid Composition for Orally Administered Fluid Therapy

A

FOR EVERY 21 L OF WATER

  • NaCl 10 g
  • NaHCO3 15g
  • KCl 75 g
  • K2HPO4 60g
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2
Q

Advantages of hetastarch include maintenance of plasma oncotic effect for up to…

Disadvantages

A

up to 24 hours following administration and the ability to give as a rapid bolus

negative effect on coagulation has been demonstrated in healthy equids

in critically ill humans: increased risk of mortality and acute kidney injury in patients receiving hetastarch

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3
Q

MAP can also be calculated by

A

MAP = 1 ⁄3 × (SAP − DAP) + DAP

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4
Q

ideal cuff … ratio for BP measurement

A

width-to-circumference of 0.25 to 0.35

for use on the tail or limbs of horses

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5
Q

Normal pleural fluid values

A

protein concentration <25 g/L and

total nucleated cell count <5000/μL.

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6
Q

Pleural air is then evacuated via

A

placement of a cannula or 14-gauge catheter in the caudodorsal lung field.

The 12th or 13th intercostal space is a suitable location

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7
Q

Excess EDTA in a low-volume sample of peritoneal fuid will

A

falsely increase the total protein on refractometry (often by 9–10 g/L higher)

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8
Q

influence of abdominal surgery on abdo tap TP/TNCC

A

Typically, if no enterotomy was performed,

TNCC: increases for 4 to 7 days and normal by 14 days.

TP remain elevated for 3 to 4 weeks after surgery.

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9
Q

how much urine do helthy horses produce?

A

1 to 2 mL/kg per hour of urine.

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10
Q

What is Obstructive shock

A

from lack of blood flow through the heart or great vessels as a result of

  • thrombosis (atrial or pulmonary),
  • constrictive pericarditis,
  • cardiac tamponade, or
  • pleural space disease (e.g., pneumothorax).32

This condition is characterized by decreased preload OR increased afterload and results in circulatory failure.3

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11
Q

Maldistributive shock

A

vasodilatory shock

endothelial dysfunction in response to neutrophil generated cytokines, proteases, lipid mediators, and oxygenderived free radicals

septic, anaphylactic, or neurogenic causes

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12
Q

α1-Adrenergic receptor/ Alpha2-adrenergic stimulation have which effect on vascuature?

A

alpha1 - vasoconstriction

alpha2 - vasodilation

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13
Q

Which effects do Beta 1 and 2 adrenergic stimulation have on the cardiovascular system?

A

β1-Adrenergic receptor stimulation

  • primarily cardiac effects with
    • increases in heart rate (chronotropic effect) and
    • contractility (inotropic effect).

β2-Receptor stimulation

  • vasodilation of the
    • arteries of coronary vessels,
    • visceral organs, and
    • skeletal muscle
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14
Q

Effect of Dopaminergic stimulation on cardiovasc system

A

active at adrenergic (α and β) and dopaminergic receptors in a dose-dependent manner

  • improves myocardial contractility,
  • increases heart rate, and
  • results in peripheral vasoconstriction.

low doses: rather Beta (pos inotropy)

high doses: rather Alpha (vasopressor ++)

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15
Q

True or false?

Phenylephrine administration results in increased cardiac output.

A

False

α-agonist resulting in increased Systemic Vascular Resistance, MAP, and

decreased CO.

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16
Q

Vasopressin works on which receptors?

A

promotion of water conservation in the collecting tubule of nephrons (V2 receptor)

vasoconstriction via V1 receptors

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17
Q

Which signs indicate the limits to fluid resuscitation

A

60–80 mL/kg total volume,

CVP >15 mm Hg,

declining Pao2,

peripheral edema

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18
Q

Difference between Type A and B lactic acidosis

A

A: inadequate delivery of oxygen to peripheral tissues resulting from hypovolemia, hypoxemia, anemia, or decreased perfusion pressure

B: abnormal tissue utilization of oxygen, including mitochondrial dysfunction, or abnormal clearance of lactate

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19
Q

How is lactate eliminated from the circulation?

A

2% unchanged in urine

metabolisation in liver and kidney to glucose or

pyruvate –>> AcCoA

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20
Q

treatment of hypoventilation secondary to head trauma, encephalitis, or hypoxic-ischemic encephalopathy

A
  • Caffeine: most frequently used in practice because of ease of administration, cost, and wide therapeutic index.
  • Doxapram has a short duration of action requiring frequent or CRI administration, which limits use despite evidence of improved ventilation. increase in myocardial oxygen consumption!!!
  • Theophylline is similar to caffeine; however, it has a narrow therapeutic index with adverse effects
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21
Q

Is rectal fluid administration useful? When and how?

A

rectal administration at a rate of 5 mL/kg/h TAP WATER

equivalent to more than twice the accepted maintenance fluid rate, was well tolerated by the horses and was technically easy to perform.

a significant decrease in albumin concentration was seen only with i.v. treatment,

not with NGT or rectal fluid treatment.

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22
Q

Why is albumin a high contributor to oncotic pressure in the blood vessels?

A

Albumin,

  • due to its small size (69 kDa),
  • negative charge and
  • high concentration,

exerts 60–80% of the oncotic pressure (Magdesian 2003).

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23
Q

Size of particles in HES

A

Older products, such as hetastarch, have higher molecular weights, ranging from 450 kDa to 600 kDa,

whereas newer formulations have much lower molecular weights (e.g. tetrastarch, 130 kDa) only disadvantage: Tetrastarch is cleared quicker

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24
Q

True or False?

The effect of a colloid on oncotic pressure is determined by the number of oncotically active particles in a solution, not the size of the particles.

A

True

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25
Q

How is HES cleared from the blood?

A
  1. Hydroxyethyl starch molecules are excreted primarily (approximately 70%) by the kidneys with a smaller portion being taken up from the plasma by the reticuloendothelial system.
  2. Small molecules (45–60 kDa) are excreted rapidly into the urine, whereas larger molecules must first be broken down by amylase into a size that can be filtered through the glomeruli (<60 kDa in humans)
26
Q

effects of HES solutions on the equine kidney

A

controversy in equids

.No changes were identified in urine GGT:creatinine ratios after infusion of TES in healthy neonatal foals for 24 h after infusion and in healthy adult horses for 4 h after infusion of PES, respectively

  • increased glomerular oncotic pressure > decreased urine output (Honore et al. 2008).
  • accumulation of starch molecules within the nephrons, leading to swelling of the proximal tubular epithelial cells, termed osmotic nephrosis
27
Q

effects of HES on coagulation

A
  • Decreases in fibrinogen have been repeatedly documented after HES administration in horses
  • incorporation into clots>> weaker clots
  • binding of vWF and Factor VIII by HES molecules
28
Q

which values of routine haematology and biochemistry measurands in the horse might vary more individually, which less?

A

High individuality

  • Haematology (red blood cell count, mean corpuscular haemoglobin and mean cell volume) and
  • biochemistry measurands (total protein, globulins, albumin, gamma-glutamyl transferase, aspartate aminotransferase)

low individuality

  • Two haematology (mean corpuscular haemoglobin concentration and platelets) and
  • three biochemistry measurands (chloride, glucose and sodium)
29
Q

are there meds that can reduce lactate in the blood?

A

beta-adrenergic antagonists effectively reduce [LAC].

Increased lactate concentrations [LAC]

30
Q

effects of xylacine on cerebral perfusion and intracran pressure

A

6 horses, 15 minutes, 1 mg/kg

Administration of xylazine to anesthetized horses resulted in an

  • increased Cerebral Persuion Press due to
  • decreased intracranial pressure with
  • with concurrent increased MAP.
  • >>>>suggesting vasoconstriction

Administration of xylazine to standing horses did not result in a change in ICP but it is likely to increase it with time

31
Q

How do Plasma-Lyte 148 and Normosol-R differ from LRS

Indications?

A

more physiologic sodium:chloride ratio and contain magnesium rather than calcium

INDICATED: may be administered concurrently with blood products and bicarbonate

CONTRAINDICATED: in cases where neuromuscular blockade is a concern (e.g., botulism).

32
Q

Outcome and complications in horses administered sterile or non-sterile fluids intravenously

A

no difference in s_urvival to discharg_e

Horses that received no sterile fluids were

  • more likely to develop a jugular vein complication
  • more likely to have electrolyte abnormalities consistent with hyperchloremic metabolic acidosis
33
Q

prolonged treatment with balanced electrolyte solutions can result in which electrolyte derangements?

how can these be avoided?

A

Hypernatremia

hypo kalemia, magnesemia, calcemia

start with adding 0,05meq Potassium/HOUR (max 0.5)

add 1g MgSo4 per L

add 10ml Calcium 23% per L

34
Q

Bicarb - how much and how to administer

A

Bicarbonate defcit=

(Bicarbonate desired −Bicarbonate measured) × body weight (kilograms) × 0,3 (extracellular fuid compartment coeff)

First, administer 50% of the bicarbonate deficit (see later) rapidly over 1 to 2 hours followed by the remaining 50% over 12 to 24 hours.

DONT MIX WITH CALCIUM

35
Q

1 g NaHCO3 = ………….mEq

A

1 g NaHCO3 = 12 mEq NaHCO3

36
Q

dose and side effects of hypertonic saline administration

A

2 to 4 mL/kg, administered as rapidly as possible

Iatrogenic metabolic acidosis, hypernatremia, and hypokalemia

37
Q

For horses with a pH ≤7.2 caused by metabolic derangements (nonrespiratory) following shock - which fluids are indicated?

A

crystalloid dosing (80 mL/kg in 1 h),

isotonic bicarbonate (1.3%) therapy is indicated.

First, administer 50% of the bicarbonate deficit (see later) rapidly over 1 to 2 hours followed by the remaining 50% over 12 to 24 hours.

38
Q

vascular space (VS) and extracellular ECF space contain which amount of volume

A

ECF is roughly 30% of body weight,

VS is roughly 8% of body weight

39
Q

administration of hypertonic fluid has which side effects

A

Iatrogenic metabolic acidosis,

hypernatremia, and hypokalemia

may occur after hypertonic saline administration

40
Q

metaanalyses in humans failed to support the theory of improved resuscitation through the use of colloids over crystalloids;

however, colloids may be indicated in patients with

A

hypoproteinemia,

severe blood loss, or

those in need of clotting factors or immunoglobulins. (naturak)

!!! side effects of synthetics!!!!!

41
Q

half life of hetastarch

A

24h

42
Q

True or False?

Synthetic colloids do not register on a refractometer.

A

TRUE

evaluation of oncotic pressure requires the use of a colloid osmometer

43
Q

Side effects of Hetastarch. Is there an alternative?

A

increased risk of mortality (human med)

coagulopathies (Equine)

acute kidney injury (human)

use of hetastarch in horses with underlying renal insufficiency is cautioned, and its use is restricted to those with clinical signs of acute hypoproteinemia.

Recently tetrastarch (6%) was evaluated and shown to have a more sustained effect on COP with fewer adverse coagulopathic effects than hetastarch.

Both hetastarch and tetrastarch can be dosed at 10 mL/kg.

44
Q

Blood transfusions: If cross-matching is unavailable, use a……as donor.

A

non-Thoroughbred gelding

45
Q

Abdominocentesis: Excess EDTA in a low-volume sample will falsely

A

increase the total protein on refractometry (often by 0.9–1.0 g/dL higher)

46
Q

With intestinal strangulation how does abdominal fluid change in the first 6 hours?

A

first 1–2 hours: TP increases such that the fluid is clear but more yellow.

After 3 to 4 hours: red blood cells also leak, and the fluid is more orange or pink.

After 6 hours or more, white blood cells increase gradually, with the progression of intestinal necrosis.

47
Q

Which percentage of neutros is in abdo fluid?

A

neutrophils make up approximately 40% to 50% of cells, with the remainder being lymphocytes, macrophages and peritoneal cells.

48
Q

When does abdo fluid normalize post colic sx without enterotomy?

A

white blood cell count increases for 4 to 7 days and returns to normal by 14 days

total protein elevated for 1 month

49
Q

Normal horses produce how much urine per hour?

A

1 to 2 mL/kg per hour of urine.

50
Q

Obstructive shock results from

A

lack of blood flow through the heart or great vessels as a result of

thrombosis (atrial or pulmonary),

constrictive pericarditis,

cardiac tamponade, or

pleural space disease (e.g., pneumothorax).

51
Q

Obstructive shock is characterized by which changes in pre- and afterload?

A

decreased preload

or

increased afterload

and results in circulatory failure

52
Q

Administration of IV emergency boluses is stopped when normalization or plateau of perfusion parameters is observed or when limits to fluid resuscitation are reached.

Name three reasons to stop bolusing

A

60–80 mL/kg total volume,

CVP >15 mm Hg,

declining Pao2,

peripheral edema

53
Q

Reihenfolge des einsatzes von vasoactive medication in equine patients

A
  1. dobutamine (2–5 μg/kg/min)
  2. Norepinephrine
  3. Vasopressin
54
Q

types of lactic acidosis

A

TYPE A :

inadequate delivery of oxygen to peripheral tissues resulting from hypovolemia, hypoxemia, anemia, or decreased perfusion pressure

TYPE B:

abnormal tissue utilization of oxygen, including mitochondrial dysfunction, or

abnormal clearance of lactate

55
Q

Hypercapnia (elevated Paco2) is commonly observed in cases of

A

hypoventilation and V/Q mismatch

56
Q
A

V/Q mismatch

57
Q

Oxygen supplementation is indicated when the Pao2 falls below

A

Pao2 falls below 60 mm Hg or Sao2 < 90%

58
Q

Indications for mechanical ventilation include….

Name diseases where this might become necessary

A

marked hypoxemia or hypoventilation

(pHa <7.3 with Paco2 >65 mmHg or Pao2 <60 mmHg) despite maximal medical therapy, and

fatigue or excessive work of breathing:

botulism,

hypoxemic-ischemic encephalopathy, or

ARDS

59
Q

Delayed blood gas analysis may result in

A

increased PaCo2,

decreased pH,

decreased glucose, and

increased lactate

as blood cells continue to metabolize nutrients

60
Q

PAo2 and its relation to fraction of inspired oxygen (Fio2) in the horse

A

Pao2 = 5x Fio2 in the healthy standing horse;

therefore, in a patient breathing room air at sea level (Fio2 = 21%), expected Pao2 concentration is approximately 100 mm Hg with an Sao2 >93%

61
Q

The causes of hypoxemia can be further differentiated through the administration of supplemental oxygen and evaluation of oxygen saturation.

failure to increase Pao2 to 100 mm Hg suggests…

Improvement of Pao2 above 100 mm Hg suggests

A

failure to increase Pao2 to 100 mm Hg:

right-to-left shunting or

massive pulmonary thromboembolism

Improvement suggests:

V/Q mismatch or a diffusion disturbance

62
Q

Nutritional Maintenance requirements for healthy adult horses at rest are estimated to be

A

30 to 40 kcal/kg per day

Ti Critical care (9 decks)

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