Fluids 2 Flashcards
What are the possible routes of fluid administration?
- Oral
- Subcutaneous
- Intraperitoneal (exotics)
- Intravenous
- Intraosseous
How can fluids safely be administered to a patient with cardiac disease?
Orally through an NG tube
You cannot use subcutaneous fluids to correct a fluid deficit that is greater than ______%.
5%
What dose of subcutaneous fluids are typically given?
10-20 mL/kg (only give half the maintenance requirements at a time)
Typically it is standard to give cats ______mL of fluids subcutaneously.
100 mL
What are two limitations of subcutaneous fluids?
- Volume limit (there is only so much room in the subcutaneous space)
- Time (it takes too long for body to absorb)
True or False: Subcutaneous fluids can be used to treat shock.
False. It will take too long to absorb. This must be done IV.
Which electrolyte can we add to subcutaneous fluids?
Potassium
Which compound should we not add to subcutaneous fluids?
Dextrose (acidic and causes irritation)
Name two catheters we can place to give fluids IV.
- Central venous
- Peripheral intravenous
What are central venous catheters?
Catheters that are inserted so that the tip of the catheter rests within a central vein (usually the cranial or caudal vena cava)
Where do we typically place central venous catheters?
In the jugular vein
What are some disadvantages of central venous catheters?
- Expensive
- Patients need to be sedated
- More time consuming to place
- More skill required to place them
What catheter should be used to place in a very small animal (kitten)?
An intraosseous (IO) catheter
In which bones are IO catheters normally placed?
Femur or humerus
Why is lidocaine given in IO catheters as soon as they are placed?
Apparently putting the catheter in isn’t too painful, but the feeling of fluids rushing through is extremely painful. So we flush with lidocaine first to numb.
True or False: Anything that can be given IV can also be given IO.
True
Do IO catheters allow for rapid or slow absorption of fluids into the IV space?
Very rapid (considered synonymous with IV)
True or False: It is acceptable to place IO catheters in bones with fractures.
False
What are three possible complications of IO catheters?
- Osteomyelitis
- Bone marrow necrosis
- Discomfort/pain
What is an emergency venous cutdown?
The procedure involves making a small incision through the skin and underlying tissues to expose a superficial vein. Once the vein is visualized, a catheter is inserted directly into the vein to allow for the administration of fluids or medications. It is usually done on an extremity.
If you are adding medications to your fluid bag, what is important you do?
Mix/invert the bag well and label
Which type of crystalloid fluid is the best fluid to give to a blocked cat?
Balanced crystalloids
What are two questions you must ask yourself before treating a sodium disorder?
- Acute (< 24 hours) or chronic (> 24 hours)?
- Did the body have time to spit out or make intracellular iogenic osmoles?
What are iogenic osmoles?
Compounds produced by cells in response to changing osmolarity and can keep water where they are
How long does it take for a cell to produce iogenic osmoles?
24-48 hours
In sodium disorders, when is it acceptable to correct the Na concentration quickly?
When the change in Na is acute
In sodium disorders, when is it NOT acceptable to correct the Na concentration quickly?
When the change in Na is chronic or unknown. If you don’t know, air on the side of caution (assume chronic).
What is a consequence of correcting a chronic hyponatremia too quickly?
Pontine demyelination
What is a consequence of correcting a chronic hypernatremia too quickly?
Brain swelling/brain edema (causes neurological signs)
What is pontine demyelination?
The loss of myelin sheath in neurons of the pons (in brainstem). Without myelin, neurons cannot conduct electrical signals.
True or False: Pontine demyelination is reversible.
False
How fast can a sodium disorder be corrected?
No more than 0.5-1 mmol/L/h
Ex. A 20 mmol deficit would take 20-40 hours to correct.
Practice calculation: How long would a 30 mmol sodium deficit take to correct?
30-60 hours
Practice calculation: How long would a 12 mmol sodium deficit take to correct?
12-24 hours
How should we treat a patient with a hypochloremic metabolic alkalosis with concurrent hypokalemia?
- Treat hypochloremia (Give 0.9% NaCl CRI)
- Treat hypokalemia (supplement with KCl)
What are three things you could do for a patient in shock with hyperkalemia (ex. blocked cat)?
- Treat with calcium gluconate (to protect the heart from hyperkalemia)
- Dextrose bolus (to move K+ into cells)
- Give isotonic crystalloid
- Unblock
Which is better to use in a cat with hyperkalemia, 0.9% NaCl or a balanced crystalloid?
A balanced crystalloid. You might think that NaCl is better since it doesn’t contain any potassium, but because it has such high levels of chloride, this could cause hyperchloremia and a metabolic acidosis. Only use NaCl if it’s a patient with a hypochloremic metabolic alkalosis.
What are the steps to deciding how much Na to give to correct a deficit?
- Calculate deficient (normal Na-patient’s Na)
