IV fluids Flashcards
1
Q
What is the major component of all body fluids?
A
Water
2
Q
When there is equilibration of water between compartments, what has been reached?
A
Homeostasis
3
Q
What is the approximate total body water value for adult dogs & cats?
Neonates?
A
- 60%
- 80%
4
Q
Do older patients have more or less total body water than adults?
A
Less
5
Q
What is the 60:40:20 rule?
A
60% BW is water, 40% ICF, 20% ECF
6
Q
Fluid needs are estimated based on what?
A
Lean body weight
7
Q
How do you calculate lean body mass with a normal body weight?
With an obese body weight?
With a thin body weight?
A
- Normal body weight x 0.8
- Obese body weight x 0.7
- Thin body weight x 1.0
8
Q
Is ICF composition similar to or different from ECF?
A
Very different from ECF
9
Q
Is it easy or difficult to change ICF?
A
Difficult
10
Q
ECF is composed of what?
A
Any fluid that is not inside a cell.
11
Q
Changes in hydration are markedly affected where?
A
ECF
12
Q
Where do we target when trying to change hydration status?
A
ECF
13
Q
How much of ECF is intravascular?
What is this portion mostly composed of?
A
- 1/4
- Plasma
14
Q
3/4 of ECF is composed of what?
A
Interstitial fluid
15
Q
What does blood volume equal?
A
Plasma + erythrocytes
16
Q
What is the blood volume of cattle?
A
60 mL/kg
17
Q
What is the blood volume of dogs?
A
90 mL/kg
18
Q
What is the blood volume of horses?
A
70 (TBs 100) mL/kg
19
Q
What is the blood volume of cats?
A
65 mL/kg
20
Q
What is the blood volume of sheep?
A
60 mL/kg
21
Q
What is the blood volume of pigs?
A
50 mL/kg
22
Q
What differs significantly between ECF and ICF?
A
Concentration of solutes
23
Q
When total number of anions and cations in all body fluids is equal, what is maintained?
A
Electroneutrality
24
Q
What are the 2 primary ECF cations?
Which is most abundant?
A
- Na+, K+
- Na+
25
Which ECF cation is present in small amounts but very physiologically important?
K+
26
What are the 2 primary ECF anions?
Cl-, HCO3-
27
What are the 2 primary ICF cations?
K+, Mg2+
28
What are the 2 primary ICF anions?
Organic phosphates, proteins
29
In diseased states, fluids are usually initially lost from where?
ECF
30
What are 3 types of fluid & solute loss?
- Loss of hypertonic fluids (solute in excess of water)
- Isotonic loss
- Loss of hypotonic fluids (water in excess of solute)
31
Which type of fluid/solute loss is the one most commonly seen under anesthesia?
Isotonic loss
32
Most of ECF is in what 2 areas?
- Interstitial compartment
| - Intravascular space
33
Fluid division between plasma and interstitium maintains what?
Effective circulating volume
34
What are 4 examples of forms of water loss?
- Urinary
- Fecal
- Respiratory (panting)
- Cutaneous evaporation
35
What are 2 examples of cutaneous evaporation?
- Salivary (cats)
| - Eccrine sweat glands (dog foot pads)
36
The function of renal solute load in diet and obligatory renal water losses for urinary solute excretion determine what?
Water requirements
37
What is the water requirement for small dogs?
Large dogs?
Cats?
- 60 mL/kg/d
- 40 mL/kg/d
- 50-80 mL/kg/d
38
Are maintenance fluids given in anesthesia?
No
39
How are maintenance fluid rates calculated in very large (> 50 kg) or very small (
- BWkg^0.75 x 70 = mL/day
| - (BWkg x 30) + 70 = mL/day
40
What are 4 factors a patient history can uncover?
- Duration of issue
- Estimate losses
- Eating/drinking
- Panting, febrile
41
What is the most common fluid given in anesthesia?
Crystalloids
42
Solutions with electrolyte and non-electrolyte solutes able to enter all body fluid compartments are known as what?
Crystalloids
43
Where do crystalloids primarily exert their effects?
Interstitium & ICF spaces
44
In a balanced crystalloid, the composition resembles what?
ECF
45
What type of crystalloid composition does not resemble ECF?
Non-balanced
46
What are 3 examples of balanced crystalloids?
- Lactated Ringers (LRS)
- Normosol-R
- Plasma-Lyte 148
47
What is an example of a non-balanced crystalloid?
Saline
48
Every 1 mL of blood loss should be replaced with how much crystalloid?
3 mL
49
Where do colloids primarily exert their effects?
Intravascular compartment
50
What are 2 indications for the use of colloids?
- Shock
| - Hypoproteinemia
51
What are 4 examples of colloids?
- Plasma
- Dextrans
- Hydroxyethyl starches
- Hemoglobin-based oxygen carrying fluid
52
What are 4 examples of parenteral route of administration for fluids?
- Subcutaneous
- Intraperitoneal
- Intraosseous
- IV
53
Subcutaneous fluid is only given in what type of patient?
Stable
54
What can prevent good uptake of fluids given SQ?
Vasoconstriction
55
What type of fluid is given SQ?
Isotonic
56
What are 4 things to be cautious about when giving fluids SQ?
- Thermal burns
- Infection
- Cellulitis
- Skin necrosis
57
Are there any advantages to giving fluids intraperitoneally?
No, can be potentially hazardous.
58
Capillary beds of medullary vascular system allow access to the vascular space for what route of administration?
Intraosseous
59
What is an alternative route of administration to IV in neonates?
Intraosseous
60
What is a form of administration that is used short-term in emergency situation?
Intraosseous
61
What is the preferred route of administration when blood volume expansion is needed?
IV
62
Which route of administration is better in a critically ill patient, IV or SQ?
IV
63
What are 6 potential complications of IV fluid therapy?
- Extravasation
- Thrombosis/thrombophlebitis
- Volume overload
- Infection
- Embolism
- Exsanguination
64
What are 2 examples of drugs that can cause extravasation?
- Thiopental
| - NSAIDs
65
What are 7 basic things that are monitored during fluid therapy?
- HR
- RR
- CRT
- MM color
- Temperature
- Mentation
- Urine production
66
What are 4 other measurements taken during fluid therapy?
- Central Venous Pressure (CVP)
- Systemic Arterial Blood Pressure (ABP)
- Pulmonary Capillary Wedge Pressure (PCWP)
- Cardiac output (CO)
67
Anesthesia and surgery disrupt what?
Homeostasis
68
What is the goal of peri-anesthetic fluid management?
Correct abnormalities as much as possible before anesthetic event.
69
Most anesthetic drugs negatively effect what?
Cardiovascular and renal function
70
What are 4 reasons to administer IV fluids?
- Maintain patent IVC
- Counteract effects of anesthetic drugs
- Replace insensible losses
- Replace procedural losses
71
What are 6 concerns with peri-anesthetic fluid management?
- Hypovolemia
- Hypervolemia
- Anemia
- Hypoproteinemia
- Acid base and electrolyte abnormalities
- Abnormal glucose
72
What are 4 reasons hypoproteinemia is significant with anesthesia?
- Many anesthetic drugs are highly protein bound
- More drug available when protein levels are low, leads to more profound effects
- Low protein leads to loss of fluids from intravascular space
- Hypotension & pulmonary edema likely
73
What species is more prone to over-hydration?
Cats
74
What is the peri-anesthetic fluid rate for most dogs?
| For cats?
- 10 mL/kg/hr
| - 5 mL/kg/hr
75
Does redistribution of crystalloids happen quickly or slowly?
Quickly
76
How much crystalloid remains intravascular 15 minutes after infusion?
20-30%
77
Blood loss should be replaced with how much fluid?
3-4 times the volume of blood lost
78
Where do crystalloids get redistributed?
Interstitial space
79
Fluid has to be administered cautiously with what 3 conditions?
What is the dose lowered to?
- Cardiac disease
- Anuric renal failure
- Geriatric
- 2-5 mL/kg/hr
80
What can be used to treat anesthetic induced hypotension?
Fluid bolus
81
How much crystalloid can be given as a rapid bolus in addition to the continued hourly rate?
5-10 mL/kg over 15 minutes (or less)
| The same amount as an hourly rate, but all given within 15 minutes.
82
How much is a shock rate fluid bolus?
1 blood volume/hour
83
What are 4 examples of fluid delivery set sizes?
- 10 drops/mL
- 15 drops/mL
- 20 drops/mL
- 60 drops/mL
84
Which size fluid delivery set is used in larger patients?
| Smaller?
- Larger: 10 drops/mL
| - Smaller: 60 drops/mL
85
Is it ok to bolus supplemented bags of fluids?
No
86
How much K+ can safely be given in an hour?
0.5 meq/kg/hr
87
What can be given in large volumes to expand ECF volume without changes in electrolyte composition?
What is the exception? Why?
- Crystalloids
| - Saline: saline is not balanced
88
Which type of crystalloid is acidifying?
Normal saline (0.9% NaCl)
89
What type of cases may normal saline be a good choice for management in?
Chronic renal cases
90
What is an example of a balanced electrolyte solution (BES)?
Lactated Ringers Solution
91
What is the alkalinizing agent in LRS?
Lactate
92
What does LRS contain that one needs to be aware of if transfusing blood?
Calcium
93
Caution with LRS use should be used in what condition and in what species?
- Lactic acidosis
| - Reptiles
94
What is a common choice for anesthetized patients?
LRS
95
What is the alkalinizing agent for Normosol-R and Plasmalyte 148?
Acetate
96
Normosol-R and Plasmalyte 148 may cause what with very rapid administration?
Vasodilation
97
Caution needs to be used with Normosol-R and Plasmalyte 148 in what type of patient?
Why?
- Diabetic ketoacidosis patients
| - These fluids increase blood ketone concentrations
98
What is an example of a resuscitation crystalloid?
Hypertonic saline (7.5% NaCl)
99
Where does hypertonic saline draw fluid?
Into intravascular space
100
Hypertonic saline always has to be followed up with what?
Replacement crystalloid
101
What is the administration dose of hypertonic saline?
4 mL/kg IV
102
What is hypertonic saline used to increase?
ICP
103
The component of total osmotic pressure in plasma contributed by colloids is known as what?
Colloid osmotic pressure (oncotic pressure)
104
What are 3 uses for colloids?
- Correct hypovolemia
- Support colloid osmotic pressure
- Hypoproteinemic patients (TP
105
Oncotic pressure provided by colloids depends on what?
Number of particles
106
Duration of action of colloids depends on what?
Size of particles
107
What is the most commonly used synthetic colloid in vet medicine?
Vetstarch (hetastarch)
108
Hetastarch is metabolized by what?
| What will this cause in the patient?
- Amylase
| - Increase in amylase levels
109
What is the infusion rate of hetastarch?
2-5 mL/kg/hr
110
What is the maximum amount hetastarch that can be given per day?
Vetstarch?
- 20 mL/kg/day
| - 40-50 mL/kg/day
111
What can too much start lead to?
Coagulopathies
112
What are 6 examples of negative effects that can be seen with hetastarch?
- Volume overload
- Coagulation
- Renal failure
- Hepatic failure
- Anaphylaxis
- Pruritus
113
What are 2 examples of colloid blood products?
- Plasma protein (FFP, whole blood)
| - Lyophilized albumin
114
Plasma protein is used primarily for what?
Clotting factors
