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SAMS > Introduction to Fluid Therapy > Flashcards

Introduction to Fluid Therapy Flashcards

1
Q

Volume control

A

RAAS system

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2
Q

Osmolality control

A

Anti-diuretic hormone

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3
Q

Fluid gains vs fluid loss

A
  • gains: water and food, aerobic metabolism

- loss: sensible (2/3, urinary/fecal), insensible (1/3, skin/respiratory)

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4
Q

Total body water accounts for ____ body weight in dogs and cats

A

60%

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5
Q

Water movement is controlled by

A
  • osmosis

- starling’s forces

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6
Q

Important clinical concepts

A
  • water freely moves between all 3 compartments

- sodium containing fluids stay within extracellular space (interstitium and intravascular)

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7
Q

Pathologies in fluid homeostasis manifest in one of 2 main ways

A
  • volume of fluid compartment changes

- tonicity of fluid compartment changes

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8
Q

Fluid therapy is indicated to:

A
  • replace a deficit in a fluid compartment
  • change the electrolyte concentration of a compartment
  • shift fluids from one compartment to another
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9
Q

Other indications for fluid therapy

A
  • shock resuscitation
  • correct dehydration
  • maintain hydration
  • promote diuresis
  • anesthesia
  • increase oncotic pressure
  • correct electrolyte abnormalities
  • replace blood components
  • nutritional support
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10
Q

Intravascular

A

Shock

- perfusion parameters

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11
Q

Interstitial

A

Dehydration

- skin turgor, mucous membrane moisture

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12
Q

Intracellular

A

Hypernatremia

- [Na]

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13
Q

Perfusion parameters

A
  • mucous membrane color
  • capillary refill time
  • heart rate
  • pulse quality
  • temperature
  • mentation
  • bp
  • lactate
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14
Q

Look at the stages of shock!!!

A

Look at the stages of shock!!!

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15
Q

Interstitial evaluation

A

If severe enough, dehydration is an intravascular problem (>10%)
- only changes the intracellular compartment if the sodium is severe affected

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16
Q

Interstitial parameters

A
  • skin turgor: affected by BCS and age

- gingival moisture affected by: panting (falsely dry), nausea (falsely moist)

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17
Q

Estimating dehydration

A
  • <5%: not detectable
  • 5% tacky mm
  • 8%: dry mm, decreased skin turgor
  • 10%: retracted globes, persistent skin tent, hypovolemia
  • 12-15%: hypovolemic shock
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18
Q

______ compartment cannot be evaluated on physical exam

A

Intracellular

- [Na] loosely reflects volume status of intracellular compartment

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19
Q

Severe hypernatremia =

A

Intracellular deficit

  • as extracellular osmolality increases, water leaves intracellular space and cells become dehydrated
  • hypotonic fluid loss –> hypernatremia –> intracellular dehydration
20
Q

Fluids are categorized by _______

A
  • particle size: crystalloids (small), colloids (large)

- tonicity: hypotonic, isotonic, hypertonic

21
Q

Isotonic crystalloids

A

Freely distribute among extracellular spaces

  • great for rehydrating interstitial space
  • takes large volumes to expand intravascular space
  • balanced: LR, plasmalyte
  • unbalanced: 0.9% saline
22
Q

Balanced isotonic crystalloids

A

Fluid of choice due to:

  • buffer that combats metabolic acidosis
  • more physiologic amounts of Na and Cl
23
Q

Unbalanced isotonic crystalloids

A

Supra-physiologic amounts of sodium and chloride

  • reserved for situations bc it is an acidifying solution that lacks a buffer
  • used for metabolic alkalosis, hypercalcemia, drug incompatabilities
24
Q

Hypotonic crystalloids

A

Distribute evenly among all fluid compartments

  • only used for hypernatremia/free water loss
  • isotonic in vitro but hypotonic in vivo
  • sterile water is hypotonic in vitro and in vivo (NEVER give to patient)
25
Q

Hypertonic crystalloids

A

Used to manipulate fluid shifts in the body

  • increase intravascular expansion at a much lower volume –> short lived effect due to distribution between intravascular and interstitial space
  • used for shock or hemorrhage
  • can shift fluid out of intracellular compartment (cerebral edema)
26
Q

Colloids

A

Fluids that contain large molecules with oncotic pull that stay within the intravascular space

  • synthetic: hetastarch
  • natural: whole blood, plasma, albumin
27
Q

Colloid - confinement within the intravascular space provides ______

A

Volume expansion

  • intact and functional vessel is necessary!
  • improve oncotic pressure due to hypoalbuminemia
  • severe shock (esp w/ hemorrhage)
  • replace deficient blood product
28
Q

Synthetic colloids

A 
Advantages
- inexpensive and readily available
- increase volume expansion at lower doses
- increase colloid osmotic pressure
Disadvantages
- dose dependent coagulopathy
- worsens edema if escapes vasculature
29
Q

Peripheral IV

A

Short term

  • cephalic and saphenous
  • fastest = largest bore and shortest lenth
  • don’t perfuse a disease part of body
30
Q

Intraosseous

A

Used when peripheral cannot be obtained

  • severe shock or neonates
  • trochanteric fossa, iliac crest (large dogs)
31
Q

Central lines

A

Appropriate for long term catheterization, critical patients, multiple infusions, and extremely hypertonic fluids

  • jugular, femoral extending to caudal vena cava
  • permits frequent blood sampling
32
Q

Treating intravascular compartment

A
  • route: IV, IO
  • rate: fast, bolus over 10-20 min
  • fluid: balanced crystalloids, hypertonic saline, synthetic colloids
33
Q

Shock strategies

A
  • hypovolemic: large amounts of crystalloids, occasional use of hypertonic saline or colloids
  • hemorrhage and trauma benefit from limited volume resuscitation (smaller amounts of crystalloids, concurrent use of hypertonic saline, +/- blood products)
34
Q

Resuscitation goals

A

Continue fluid resuscitation until the following have normalized:

  • physical exam perfusion parameters
  • blood pressure
  • lactate
35
Q

Treating interstitial compartment

A
  • route: IV, IO, SQ, PO
  • rate: correct over 12-24 hrs
  • fluid: balanced isotonic crystalloids
36
Q

SQ fluids

A

Reserved for replacement of mild dehydration (5-8%)

  • isotonic crystalloids (hypertonic, hypotonic, or dextrose will cause tissue necrosis)
  • dose: 20-30 ml/kg
37
Q

IV rehydration plan

A
  • estimation of dehydration
  • provision of maintenance fluid requirements
  • estimate and replace on-going fluid losses
38
Q

Estimating dehydration

A

Fluid deficit = % dehydration x body weight (kg)

- convert to hourly rate based on how fast you wish to correct dehydration (12-24 hrs)

39
Q

Maintenance fluids

A

1 ml of fluid to metabolize 1 kcal of energy

  • maintenance fluids should match metabolic energy requirements
  • need to calculate using body surface area
40
Q

Ongoing losses

A

GI and urinary are most common

  • others: fever, drainage, burns/wounds, third spacing
  • weight used to monitor trends
  • urinary cath and drains allow precise measurement of fluid losses
41
Q

Discontinuing fluid therapy

A
  • underlying dz is corrected/controlled
  • fluid deficits corrected
  • fluid losses have stopped
  • animal can consume water to stay hydrated
42
Q

Treating intracellular compartment

A
  • route: IV, PO
  • rate: slow! 48-96 hrs
  • fluid type: 5% dextrose in water administered IV, water consumed orally
43
Q

Oncotic support

A

Indicated if albumin <1.5 g/dl or total protein <4.0 g/dl

  • synthetic colloids (most available option)
  • plasma is not ideal, albumin last resort
44
Q

Diuresis

A

Fluids will be delivered at higher than maintenance rates to ensure perfusion and promote diuresis

45
Q

Electrolyte supplementation

A

Potassium, calcium, magnesium

- all electrolytes affect hr and contractility if given too fast, CRI is ideal

46
Q

_____ is the most common electrolyte abnormality

A

Hypokalemia

- skeletal muscle weakness is most common consequence

47
Q

Hypokalemia

A

Potassium chloride may be added to any crystalloid

  • be cautious above 0.5 mEq/kg/hr of supplementation
  • risk for hyperkalemia and toxicity

SAMS (13 decks)

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