Fluids Flashcards
Human serum albumin (HSA) can be used for volume expansion but is utilized more often for treatment of severe hypoalbuminemia. Hypoalbuminemia is often a consequence of critical illness and is associated with increased morbidity and mortality in both humans and dogs (Box 4-4). HSA has been shown to effectively increase__________, ___________, and ___________ in critically ill dogs (Trow etal, 2008). However, administration of HSA is controversial, as it is associated with potentially serious adverse reactions. Data in the veterinary literature regarding the incidence of complications with HSA use are variable, with a low number of mild adverse reactions reported in some studies (Viganó etal, 2010; Mathews and Barry, 2005), and several serious complications potentially attributable to HSA administration in others (Trow etal, 2008). In addition, HSA has been shown to be highly antigenic in both ill and normal dogs and presents a significant risk if administered more than once (Martin etal, 2008). Goals for HSA administration in dogs are to increase serum albumin to 2.0 to 2.5g/dl and COP to 14 to 20mmHg (see Box 4-5). (Fossum 36)
Fossum, Theresa Welch. Small Animal Surgery Textbook, 4th Edition. Mosby, 2013. .
Human serum albumin (HSA) can be used for volume expansion but is utilized more often for treatment of severe hypoalbuminemia. Hypoalbuminemia is often a consequence of critical illness and is associated with increased morbidity and mortality in both humans and dogs (Box 4-4). HSA has been shown to effectively increase serum albumin, total solids, and COP in critically ill dogs (Trow etal, 2008).
Data in the veterinary literature regarding the incidence of complications with HSA use are variable, with a low number of mild adverse reactions reported in some studies (Viganó et al, 2010; ???, and several serious complications???? potentially attributable to HSA administration in others (Trow et al, 2008).
Vigano: no severe hypersensitivity reactions reported
Trow: 23% had at least 1 immediate complication and 4% had severe delayed complications
Goals for HSA administration in dogs are to increase serum albumin to___- ___ g/dl and COP to ___ -___ mmHg (ranges)
increase albumin to 2.0 to 2.5 g/dL
COP 14-20 mm Hg
Normal COP in an animal with TP of 7.3 is __mmHg. Albumin’s colloidal oncotic pressure is __ mmHg
The plasma half-life of albumin is ___ hours and >90% of infused alb remains in the intravascular space.
• HES is a complex carb similar to glycogen. HES COP is __ mmHg; average ___% increase in plasma volum. Plasma half-life of HES is ___ hours and duration of volume expansion is 12-48 hrs. HES is hydrolyzed in the plasma by a-amylase, resulting in hyperamylasemia.
Normal colloid oncotic pressure in an animal with 7.3 g/dl protein is 28mmHg. Albumin’s colloidal oncotic pressure is 25mmHg
The plasma half-life of albumin is 16 hours and >90% of infused alb remains in the intravascular space.
• Hetastarch: Hydroxyethyl
Hydroxyethyl is a complex carbohydrate similar to glycogen
Hydroxyethyl’s colloidal oncotic pressure is 30mmHg ® average 141% increase in plasma volume
The plasma half-life of hydroxyethyl is 25.5 hours and duration of volume expansion is 12-48 hrs
Hydroxyethyl is hydrolyzed in the plasma by a-amylase, resulting in hyperamylasemia.
• Dobutamine: MOA and Dosage
• Dobutamine: Synthetic sympathomimetic increases cardiac output without dramatic BP changes
o Dosage is 2-5 mg/kg/min
o Exerts effects on the b1 myocardium adrenoceptors to force of contraction
o Exerts weak effects on the b2 blood vessels adrenoceptors to produce mild vasodilation.
• Dopamine: MOA
o Low dosage
o Intermediate dosage
o High dosage
• Dopamine: norepinephrine precursor with dose dependant effects (table 6-8 pg 88 Tobias)
Low dosage is 0.5-2mcg/kg/min is dopaminergic causes vasodilation renal, coronary, cerebral arterial dilation
Intermediate dose is 2-10mcg/kg/min is sympathomimetic on the b1 myocardium adrenoceptors stimulates contractility (greater effect on BP than dobutamine)
High dose 10-20mcg/kg/min effects a1 adrenergic receptors in the arterial walls causing vasoconstriction
Bohr Effect?
reduced hemoglobin is 3.5 times as effective as oxyhemoglobin in buffering H+
Haldane effect?
Haldane effect: the fact that deoxygenated blood increases its ability to carry CO2
Hemoglobin: responsible for __% of the non-bicarbonate buffering capacity of blood and __% of the body’s buffering capacity.
Hemoglobin: responsible for 80% of the non-bicarbonate buffering capacity of blood and 60% of the body’s buffering capacity.
HbO2 + H2O + CO2 « (finish equation)
HbO2 + H2O + CO2 « H+ · Hb + O2- + HCO3-
Another Buffer: protein- Albumin is responsible for __% of non-bicarbonate buffering and how?
20% via histidine rings
___________: buffers only in the face of pathologic changes such as renal failure.
(Name that body buffer!)
Phosphate
Bicarbonate Buffering System: ____% of the body’s buffering system?
Equation = ????
30%
H2O + CO2 « H2CO3 « H+ + HCO3-
Name the enzyme catalyst for this reaction H2O + CO2 « H+ + HCO3-
Carbonic anhydrase is the enzyme catalyst for this reaction H2O + CO2 « H+ + HCO3-
where is carbonic anhydrase found? (name 4 places) and not found? (1 important place you will not find me!)
Carbonic anhydrase is found in renal epithelium, pulmonary tissue, erythrocytes, vascular endothelium, but not the plasma
