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IV fluid therapy Flashcards

1
Q

What is the formula for enteral/isotonic balanced electrolyte fluid therapy?

A

-table salt (noniodized): 14 cc
-lite salt: 2.5 cc Lite salt
-baking soda : 11 cc
-water: 4 liters of water

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2
Q

What is the 60-40-20 rule?

A

60% of total body weight is water
40% of total body weight is intracellular fluid
20% of total body weight is extracellular fluid

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3
Q

What is the normal osmolality made up of (280-300 mosm)

A

{2X (Na +K)} + (glucose/18) + (BUN/2.8)

**some sources choose to exclude potassium (b/c small) or BUN (ineffective osmole)

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4
Q

blood Pressure=

simple equation

A

flow (cardiac output) X resistance (total peripheral resistance)

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5
Q

Stroke volume equation

A

End-diastolic volume - end-systolic volume

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6
Q

Cardiac output equation

A

HR X SV

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7
Q

blood Pressure =

A

{HR x (end-diastolic volume-end systolic volume)} x total peripheral resistance

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8
Q

What is central venous pressure of adults and foals?

A

adults: 5-15 cmH2O
foals: 2-12 cm H2O

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9
Q

What is the equation for fractional excretion?

A

{(serum creatinine)/ (urine creatinine)} x {(urine electrolyte)/ (serum electrolyte)}

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10
Q

What is normal FE of sodium?

A

<1%

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11
Q

causes of pseudohypernatremia

A

hyperlipemia
hyperproteinemia

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12
Q

What electrolyte abnormalities are seen with a ruptured bladder?

A

hyponatremia
hypochloremia
hyperkalemia
peritoneal fluid crea 2x that of systemic creainine

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13
Q

Describe the characteristics of syndrome of inappropriate antidiuretic hormone

A

-increased concentrations of ADH
-decreased osmolality
-Normovolemia
-inappropriate urinary concentration
-increased urinary sodium

**r/o kidney & endocrine disorders

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14
Q

What is the hyponatremia correction rate?

A

0.5 mEq/h

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15
Q

What is the hourly fluid rate in adults and neonates?

A

adults: 2-3 ml/kg/hour

neonates: 4-6 ml/kg/hour (double that of adults)

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16
Q

When on fluids, what should be the urine production rate?

A

urine production should be half of the fluid rate

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16
Q

What is the dextrose CRI rate?

A

adult: 1-2 mg/kg/min

neonates: 4-8 mg/kg/min

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17
Q

what is the osmolarity of hypertonic saline (7.2% NaCl)?

A

2462 mOsm/L

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18
Q

what is the dose of hypertonic saline?

A

4-5 ml/kg IV once

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18
Q

What are the advantages of hypertonic saline?

A

-volume expansion (increases plasma volume 3-4x the volume administered)
-anti-edema
-immunomodulation & anti-inflammatory
-anti-apoptosis
-free radical scavenge
-inhibition of leukoactivation
-prevention of immunosuppression
-positive inotrope by improving (INC end-diastolic volume, leading to inc stroke volume and inc CO— effect lasts 1 hour following infusion)

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19
Q

How much is a shock bolus?

A

60-90 ml/kg IV once

*dividing equally into three separate doses (ie: 20 ml/kg three times)
*stop when you see PINK-PERK-PEE

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20
Q

What are doses of hetastarch?

A

2-10 ml/kg IV once

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21
Q

What are contraindications for hetastarch administration?

A

renal disease
coagulopathies

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22
Q

For any electrolyte correction, what is the quation?

A

mEq to be infused = volume of distribution X body weight (kg) X deficit

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23
Q

What is the volume of distribution in foals vs adults?

A

foals: 60%= 0.6
adults: 30% =0.3

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24
Q

For neonates, what is the goal to which to restore the sodium level if hyponatremic?

A

125 mmol/L
**calculated amount of sodium required in first 6 hours to raise sodium level to 125 mmol/L

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25
Q

what is the maximum rate for sodium administration?

A

0.5 mEq/kg/hour

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26
Q

1 gram of baking soda has how much HCO3

A

12 mEq

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27
Q

isotonic bicarbonate is what osmolarity?

A

150 mmol/L

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28
Q

organic acidosis is due to

A

hyperlactatemia

29
Q

inorganic acidosis is due to

A

hyperchloremia (or hyponatremia)

30
Q

What are electrolyte abnormalities that worsen or potentiate hepatic encephalopathy?

A

-alkalosis
-hypokalemia

31
Q

What fluids should be avoided in liver disease & why?

A

lactated fluids– since the lactate is the buffer solution & its conversion to bicarbonate in the liver is required
(ie: LRS will become acidifying solution the face of liver dz d/t the inability to convert lactate to bicabronate)

32
Q

Which form of ammonium/ammonia can/cannot cross the blood brain barrier?

A

Ammonium (NH4) cannot cross the blood brain barrier
**longer word, pos charge molecules cannot cross BBB)

Ammonia (NH3) can cross the blood brain barrier

33
Q

Describe why hypokalemia worsens hepatic encephalopathy?

A

–potassium will displace from inside the cell
–H will then be displaced to maintain electroneutrality (inside the cell)
– And excreted into urine, H will be exchanged for ammonia in the renal tubules

34
Q

What are example of acetated/gluconated fluids to be administered in liver disease?

A

–Normosol-R
–Plasma-Lyte

35
Q

The anion gap equation is calculated to estimate

A

the accumulation of unmeasured anions as strong acids are produced

36
Q

What are examples of unmeasured anions

A

lactate, ketoacids, sulfates, toxins, salicylates, methanol, ethylene glycol

37
Q

What is the anion gap equation?

A

AG = (Na + K) - (Cl + HCO3) = ~18 mEq

rr: 9-19 mEq

38
Q

What are reasons for an increased anion gap?

A

** an increase in unmeasured anions

39
Q

What is the equation for strong ion difference?

A

SID = (Na + K) - (Cl + lactate) = 40

40
Q

What is the equation for strong ion gap (SIG)?

A

SIG= UC-UA = 0

SIDe= {(Na + K +iCa + iMg) - (Cl + lactate)} - (HCO3 + (2.25 x Albumin) + (1.4 x globulins) + (0.59 x P04)} = 0

41
Q

Define type A lactic acidosis

A

hyperlactatemia d/t tissue hypoxia

**hypoxemia, hypoperfusion, anemia

42
Q

Define type B lactic acidosis

A

hyperlactatemia in the absence to tissue hypoxia

–sepsis, inflammation, thiamine deficiency, catabolism, beta2 adrenergic stimulation, inc mm activity (esp with seizures)

43
Q

lactate clearance is performed by what organs (primary, secondary, tertiary)?

A

primary: liver

secondary: kidney (metabolism, not excretion)

tertiary: heart, skeletal mm

44
Q

sodium bicarbonate should not be administered with what conditions?

A

-lactic acidosis (will serve no purpose to correct the acidemia)
-pulmonary disease (unable to “blow off” to bicarbonate)
-unmeasured anion acidosis

45
Q

To replace blood loss with crystalloid solution, what volume is required?

A

3 to 4 times the volume of blood lost needs to be replaced

46
Q

What are pathologic changes that lead to changes in hydrostatic pressure?

A

heart failure (R or L)
thromboses
IVF
diuretic administration
acute blood loss
degeneration of interstitial collagen
inflammatory cytokines
severe burns

47
Q

Tonicity of extracellular fluid volume is regulated by?

A

antidiuretic hormone

48
Q

Rapid correction of hypovolemia occurs with reversal of the 7 perfusion parameters. what are these?

A

-tachycardia
-pale mm
-prolonged CRT
-cold extremities
-poor pulse quality
-depressed mentation
-reduced jugular fill

49
Q

What are signs of intravascular volume overload?

A

-INC CVP (>10-20 cmH20 neonates- 15 cmH20 adults)
-DEC PaO2 likely secondary to pulmonary edema
-DEC spO2 consistent with pulmonary edema development

-CS: SQ edema, tachypnea, edema large airways-nostrils

50
Q

If there is no improvement in hypoperfusion, it is not only due to hypovolemia , what treatments are recommended?

A

-requires inotropes +/- vasopressors

51
Q

central venous pressure is determined by

A

blood volume
venous tone
cardiac contractility

52
Q

What are values for fluid therapy monitoring techniques?

A

CVP
MAP
lactate concen
CO
glucose
urina anlytes

53
Q

foals direct and indirect MAP should be

A

direct MAP ~85 mmHg

indirect MAP ~ 144 mmHg

54
Q

adults direct MAP normal

A

110-133 mmHG

55
Q

at what MAP does end organ perfusion occur

A

60 mmHg

56
Q

What is the rate of dextrose supplementation in the cases of liver dysfunction/failure

A

0.5 mg/kg/min

**up to 1-2 mg/kg/min

57
Q

Why is it recommended to supplement dextrose in liver cases?

A

even if normoglycemic– will limit gluconeogenesis, catabolism of tissues & risk of hyperammoniogenesis

58
Q

Isotonic fluids are preferred in renal failure, what are best choices?

A

-normosol & plasmalyte excellent (potassium)
-isotonic sodium bicarb
-LRS preferred over saline but hyperchloremic acidosis

59
Q

calves with 2 to 4 % dehydration

A

– <2 mm eye ball recession (mm)
– 3 to 4 seconds skin tent

60
Q

calves with 6-8% dehydration

A

3-4 mm eye ball recession
5 to 6 seconds skin tent

61
Q

calves with 10 -14% dehydration

A

6-8 mm eye ball recession
7 to 9 second skin tent

62
Q

Most sick cattle have which acid base abnormality

A

alkalotic

63
Q

Most sick cattle are alkalotic, however what are conditions in cattle where acidosis are more common?

A

-urinary tract disease
-grain overload
-small intestinal strangulation/ obstruction
-enteritis/diarrhea

64
Q

In cattle, the hypertonic saline when administered with what, is effective in rehydrating cattle ?

A

combined with oral electrolyte solutions

65
Q

What diseases in cattle, is dextrose administration recommended?

A

early lactation with severe ketosis, hepatic lipidosis, hypoglycemia

66
Q

A positive base excess , is what abnormality?

A

alkalosis

67
Q

A negative base excess (base deficit), is what abnormality

A

acidosis

68
Q

When correcting a metabolic acidosis, how much of the deficit should you replace?

A

replace half of deficit, then re-evaluate
–inc renal perfusion
–inc tissue perfusion

69
Q

How many mEq of HCO3 are in baking soda?

A

12 mEq per gram of baking soda

70
Q

what is isotonic bicarb

A

1.3% bicarb
154 mEq/L

71
Q

How to make isotonic bicarb?

A

isotonic bicarb= 1.3% bicarb, 154 mEq/L

12 mEq baking soda / 1 gram

154 mEq/12 mE/gram baking soda= 13 grams baking soda per liter

72
Q

for treatment of hypernatremia, the sodium concentration should drop at what rate?

A

1 mEq/hour drop in Na concentration

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