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Mechanisms of Disease > Fluids > Flashcards

Fluids Flashcards

0
Q

Intracellular space contains how much of the total body water?

A

2/3 (about 40% of body weight)

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1
Q

Body weight is what % water?

A

60%

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2
Q

Extracellular space contains how much of the total body water?

A

1/3

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3
Q

Extracellular space can be divided into what 3 compartments?

Which compartment contains 3/4 of the extracellular fluid?

A
  • Interstitial (3/4 extracellular fluid)
  • Intravascular (within blood vessels)
  • Transcellular (specialized fluid/areas)
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4
Q

What is the fluid component of blood?

A

Plasma

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5
Q

What are 3 reasons to give fluids?

A
  • Maintenance
  • Dehydration
  • Shock
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6
Q

What are maintenance fluids?

A

The required volume of fluid needed per day to keep the patient in balance, with no change in total body water.

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7
Q

What is the maintenance fluid dose range?

A

40-60 ml/kg/day

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8
Q

What is dehydration?

A

Decreased fluid in intracellular or interstitial spaces.

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9
Q

What is seen with shock?

A

Decreased fluid in intravascular space.

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10
Q

Fluids are most commonly given via what route?

A

IV

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11
Q

T/F: The type of fluids given depends on the situation as to why they are being given.

A

True

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12
Q

What are the 2 basic types of non-blood fluid?

A
  • Crystalloids

- Colloids

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13
Q

If the diagnosis is unknown and there are no lab work results, which type of fluid should be used?

A

Crystalloid replacement fluid

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14
Q

Solutes (electrolytes and non-electrolytes) that can move freely around the fluid compartments are known as what?

A

Crystalloids

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15
Q

Crystalloids can be divided into 3 groups based on tonicity (ability to shift water across semipermeable membranes), what are these 3 groups?

A
  • Hypotonic
  • Hypertonic
  • Isotonic
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16
Q

What is hypotonic crystalloid fluid composed of?

A

0.45% NaCl, 5% dextrose and water

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17
Q

Where is fluid drawn with a hypotonic crystalloid solution?

A

Into the cells.

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18
Q

Where is fluid drawn with a hypertonic crystalloid solution?

A

Into the intravascular space.

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19
Q

With which type of crystalloid fluid is the osmolality the same as the blood cells and plasma so that the fluids neither exit or enter the cells?

A

Isotonic

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20
Q

What are 2 things isotonic crystalloid solutions used for?

A
  • Perfusion support

- Volume replacement

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21
Q

Which have a larger molecular weight, crystalloids or colloids?

A

Colloids

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22
Q

Where do colloids remain?

How does this affect fluid?

A
  • In intravascular space.

- Keeps fluid in intravascular space.

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23
Q

What are 2 examples of natural colloids?

A
  • Plasma

- Whole blood

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24
Q

What are 4 examples of synthetic colloids?

A
  • Hetastarch
  • Dextran
  • Pentastarch
  • “Oxyglobin”
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25
Q

What are 3 uses for crystalloids?

A
  • Correct dehydration
  • Expand vascular space in shock
  • Correct electrolyte/acid-base imbalances
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26
Q

After about a half hour of equilibration, how much crystalloid solution will still be within intravascular space?
Where did the rest go?
What can this lead to in large volumes?

A
  • 1/3
  • Interstitial space
  • Peripheral edema
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27
Q

What are the 2 major purposes isotonic fluids are designed for?

A
  • Fluid replacement

- Fluid maintenance

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28
Q

What is the most commonly used type of crystalloid?

A

Isotonic

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29
Q

With isotonic fluids used for fluid replacement, the Na+ concentration is close to what?

A

The normal plasma Na+ concentration of about 140 mmol/l.

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30
Q

With isotonic fluids used for fluid maintenance, the Na+ concentration is close to what?

A

The normal total body concentration of about 70 mmol/l.

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31
Q

What type of crystalloid is Ringers?

A

Isotonic replacement

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32
Q

What type of crystalloid is LRS?

A

Isotonic replacement

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33
Q

What type of crystalloid is Normosol M?

A

Isotonic maintenance

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34
Q

What type of crystalloid is Normosol R?

A

Isotonic replacement

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35
Q

What type of crystalloid is 0.45% NaCl with 2.5% dextrose?

A

Isotonic maintenance

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36
Q

What type of crystalloid is 0.9% saline?

A

Isotonic replacement

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37
Q

What type of crystalloid is PlasmaLyte?

A

Isotonic replacement

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38
Q

What type of crystalloid is PlasmaLyte 56?

A

Isotonic maintenance

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39
Q

What are isotonic replacement fluids designed to replace?

A

Fluid loss

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40
Q

What are isotonic maintenance fluids designed to replace?

A

Daily Na+ losses without Na+ overload.

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41
Q

Which type of isotonic fluid has a K+ concentration similar to that of plasma?

A

Replacement

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42
Q

Which isotonic solution can be given rapidly?

A

Replacement

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43
Q

Since maintenance fluids have lower Na+ which do not stay in vascular space and are poor at expanding blood volume, they are often combined with what in patients with low albumin?

A

Colloids

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44
Q

Which type of isotonic fluid can not be given rapidly?

A

Maintenance

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45
Q

What are 2 examples of non-buffered replacement fluids?

A
  • 0.9% saline

- Ringers solution

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46
Q

What are 3 examples of replacement fluids that are buffered?

A
  • LRS
  • Normosol R
  • PlasmaLyte
47
Q

What are 3 things that replacement fluids can be buffered with to maintain physiologic pH?

A
  • Lactate
  • Acetate
  • Gluconate
48
Q

What is an example of a buffered maintenance fluid?

A

Normosol M

49
Q

What is an example of a non-buffered maintenance fluid?

A

0.45% saline

50
Q

If replacement has to be used for maintenance, what must be added?
What must be monitored?

A
  • K+ must be added

- Serum Na+ must be monitored

51
Q

What is the most frequently used replacement fluid?

A

LRS (lactated ringer solution)

52
Q

Do all maintenance fluid have K+?

A

No, so it must be added to those that do not.

53
Q

Which type of colloid is used when the goal is to restore RBCs, clotting factors, AT III or albumin?

A

Natural

54
Q

Which type of colloid is used when the goal is to rapidly improve perfusion in a patient that does not have obvious blood loss or clotting problem?

A

Synthetic

55
Q

If albumin, AT III or clotting factors are needed, which type of natural colloid is used?

A

Plasma

56
Q

If RBCs are needed, which type of natural colloid is needed?

A

Whole blood

57
Q

What is the most commonly used synthetic colloid in veterinary medicine?

A

Hetastarch

58
Q

What is dextran composed of?

A

Polysaccharide

59
Q

What are 3 advantages of Dextran?

A
  • Isotonic
  • Stored at room temperature
  • Increases plasma volume 1.38x the volume infused.
60
Q

What are 4 disadvantages of Dextran?

A
  • Increase in BMBT
  • PTT but no clinical bleeding
  • Fibrinogen concentration decreases
  • Blood glucose level may increase
61
Q

What is the most common type of hydroxyethyl starch (HES)?

A

Hetastarch

62
Q

What is a synthetic high molecular weight starch made from maize or sorghum?

A

Hetastarch

63
Q

Which colloid should be used in cases that need oncotic support but don’t need clotting factors?
What is an example of such a case?

A
  • Hetastarch

- Cases with low albumin.

64
Q

How is hetastarch formulated?

A

As a 6% solution in saline.

65
Q

How much does hetastarch increase plasma volume?

A

By 1.37% of the volume infused.

66
Q

Which lasts longer in circulation, hetastarch or dextran?

A

Hetastarch

67
Q

What is the bolus dosing for hetastarch?

The CRI dosing?

A
  • 5-10 ml/kg over 5-10 min for hypovolemia

- 10-20 ml/kg/day = this is the maximum daily dose

68
Q

What is a contraindication of hetastarch?

A

Heart failure

69
Q

What are 2 possible side effects of hetastarch that can be seen in cats?

A
  • Restless

- Salivate

70
Q

What are 4 possible side effects of colloids in general, both natural and synthetic?

A
  • Fluid overload and pulmonary edema
  • Coagulopathy
  • Renal failure
  • Human albumin: could cause life threatening allergic reaction in dogs
71
Q

You first correct for dehydration by giving what?

Can this be given rapidly?

A
  • Isotonic replacement fluid

- Yes

72
Q

When do you switch from a replacement fluid to a maintenance fluid?

A

After water and electrolyte deficits have been corrected (usually 24 hours).

73
Q

What can happen to patients on a replacement fluid for several days?
Is this usually a serious clinical problem with patients with normally functioning kidneys?
When can it become a problem?

A
  • May become mildly hypernatremic.
  • No
  • When Na+ levels become greater than 170 mmol/l
74
Q

Can colloids and crystalloids be combined in dehydration or shock cases?

A

Yes

75
Q

Are colloids used to replace dehydration deficits?

Why?

A
  • No

- You need crystalloid to get into interstitial and intracellular spaces.

76
Q

What are 4 conditions colloids are used in since they keep fluids in intravascular spaces?

A
  • Low albumin
  • Vasculitis
  • Peripheral edema
  • Ascites
77
Q

What are 2 benefits of combining colloids and crystalloids?

A
  • Decrease the amount of crystalloid being used.

- Restore the fluid deficit of intravascular space more rapidly.

78
Q

Why do you have to be careful if using replacement fluids in patients with known or suspected cardiac disease?

A

The high sodium load can unmask pre-clinical congestive heart failure, as water follows sodium, and volume overload can result.

79
Q

Which fluid is classically used for cardiac patients?

How is it modified?

A
  • 0.45% NaCl

- Made isotonic through addition of dextrose.

80
Q

Due to obligate renal K+ loss, what can happen to patients who are not eating?

A

They can become hypokalemic within days.

81
Q

Too much K+ can lead to what?

A

Cardiac arrhythmias

82
Q

What is used to determine the amount of K+ to be added?

What measuring devise is used?

A
  • Based on the patients existing K+ level.

- Sliding scale of Scott

83
Q

What is the Kmax for how rapidly you can give fluids with K+ added?

A

0.5 mEq/kg/hr

84
Q

Life threatening hyperkalemia can result in what?

A

Death

85
Q

Even though hypertonic saline is technically a crystalloid, what is notable about its osmolality?

A

It is much higher than replacement or maintenance crystalloids.

86
Q

How does hypertonic saline act?

A

It pulls fluid into vascular space from interstitial and intracellular spaces.

87
Q

Are the effects of hypertonic saline short-lived or long-lived?

A

Short-lived

88
Q

How does hypertonic saline act in hypovolemic shock?

A

It replaces volume deficit with less fluid and improves blood flow.

89
Q

What type of fluid is useful in patients that need to receive a large amount of fluid quickly but for which it is difficult to administer quickly enough?

A

Hypertonic saline

90
Q

For large dogs that are in shock due to gastric dilatation-volvulus, what fluid should be used?

A

Hypertonic saline

91
Q

Patients who should not receive large volumes of fluid, such as those with head trauma or cerebral edema, should receive what type of fluid?

A

Hypertonic fluid

92
Q

Hypertonic saline comes in what 2 forms?

A
  • 7%

- 23%

93
Q

What has to be done to 23% hypertonic saline before it can be administered?
How can this be done?

A
  • It has to be diluted to a 7.5% solution.

- Add 17 ml of 23% hypertonic saline solution to 43 ml of a colloid solution in a 60 ml syringe.

94
Q

What is hypertonic saline solution normally diluted with?

A

A colloid solution.

95
Q

What are 2 examples of when hypertonic saline should be used?

A
  • Cases of hypovolemic shock that do not have dehydration or hypernatremia.
  • Head trauma cases.
96
Q

What are 2 contraindications for the use of hypertonic saline?

A
  • Dehydration

- Hypernatremia

97
Q

What are 3 side effects that can be seen with rapid administration of hypertonic saline?

A
  • Bronchoconstriction
  • Bradycardia
  • Hypotension
98
Q

What is the recommended dose of hypertonic saline for dogs?

For cats?

A
  • 4 to 7 ml/kg over a 20 minute period

- Half this dose.

99
Q

What is the most physiologic route of fluid administration?

A

Enteral

100
Q

Which route of fluid administration is used in mild dehydration cases if GI function is normal (no vomiting), if the airway is controlled and if mental status is ok?

A

Enteral

101
Q

Which route of fluid administration is used mainly in pediatrics?
Where are 2 common locations of needle placement with this route?

A
  • Intraosseus

- Femur (trochanteric fossa) or humerus (greater tubercle)

102
Q

Where are 3 common locations for IV fluid administration?

A
  • Cephalic
  • Saphenous
  • Jugular
103
Q

You may occasionally have to do a “cut down” to find a vein with what route of fluid administration?

A

IV

104
Q

Which route of fluid administration is most appropriate for dehydration and shock?

A

IV

105
Q

What is the most commonly used route of fluid administration used in chronic renal failure cases?

A

Subcutaneous

106
Q

Don’t swab the site of administration with alcohol with which route of fluid administration?

A

Subcutaneous

107
Q

You should warm fluids in warm water prior to giving them with which route of fluid administration?

A

Subcutaneous

108
Q

Avoid solutions with glucose with which route of fluid administration?
Why?

A
  • Subcutaneous

- It is a great medium for bacteria.

109
Q

How do you administer fluids enterally in large animals?

A

Through a tube.

110
Q

What is one way to administer fluid to a cat enterally?

A

Add water to food.

111
Q

Which route of administration should be avoided in a severely dehydrated patient?

A

Subcutaneous

112
Q

What are 6 perfusion parameters?

A
  • Heart Rate
  • Capillary refill time
  • Mucus membrane
  • Pulse pressure
  • Temperature
  • Blood pressure
113
Q

Ideally how often should you weigh an animal when administering fluids?

A

BID

114
Q

One pound is equal to how much fluid?

A

500 ml(cc)

115
Q

What are 4 things that should be monitored when administering fluids?

A
  • Weight
  • Urine output
  • PCV/TP
  • Electrolytes
116
Q

What are 4 examples of things that may need to be monitored in some cases when a patient is on fluids?

A
  • Central venous pressure
  • Lactate
  • Arterial blood gas
  • “ins & outs”

Mechanisms of Disease (8 decks)

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