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Anesthesiology > IV fluids > Flashcards

IV fluids Flashcards

1
Q

What is the major component of all body fluids?

A

Water

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2
Q

When there is equilibration of water between compartments, what has been reached?

A

Homeostasis

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3
Q

What is the approximate total body water value for adult dogs & cats?
Neonates?

A
  • 60%

- 80%

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4
Q

Do older patients have more or less total body water than adults?

A

Less

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5
Q

What is the 60:40:20 rule?

A

60% BW is water, 40% ICF, 20% ECF

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6
Q

Fluid needs are estimated based on what?

A

Lean body weight

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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
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8
Q

Is ICF composition similar to or different from ECF?

A

Very different from ECF

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9
Q

Is it easy or difficult to change ICF?

A

Difficult

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10
Q

ECF is composed of what?

A

Any fluid that is not inside a cell.

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11
Q

Changes in hydration are markedly affected where?

A

ECF

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12
Q

Where do we target when trying to change hydration status?

A

ECF

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13
Q

How much of ECF is intravascular?

What is this portion mostly composed of?

A
  • 1/4

- Plasma

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14
Q

3/4 of ECF is composed of what?

A

Interstitial fluid

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15
Q

What does blood volume equal?

A

Plasma + erythrocytes

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16
Q

What is the blood volume of cattle?

A

60 mL/kg

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17
Q

What is the blood volume of dogs?

A

90 mL/kg

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18
Q

What is the blood volume of horses?

A

70 (TBs 100) mL/kg

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19
Q

What is the blood volume of cats?

A

65 mL/kg

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20
Q

What is the blood volume of sheep?

A

60 mL/kg

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21
Q

What is the blood volume of pigs?

A

50 mL/kg

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22
Q

What differs significantly between ECF and ICF?

A

Concentration of solutes

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23
Q

When total number of anions and cations in all body fluids is equal, what is maintained?

A

Electroneutrality

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24
Q

What are the 2 primary ECF cations?

Which is most abundant?

A
  • Na+, K+

- Na+

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25
Q

Which ECF cation is present in small amounts but very physiologically important?

A

K+

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26
Q

What are the 2 primary ECF anions?

A

Cl-, HCO3-

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27
Q

What are the 2 primary ICF cations?

A

K+, Mg2+

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28
Q

What are the 2 primary ICF anions?

A

Organic phosphates, proteins

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29
Q

In diseased states, fluids are usually initially lost from where?

A

ECF

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30
Q

What are 3 types of fluid & solute loss?

A
  • Loss of hypertonic fluids (solute in excess of water)
  • Isotonic loss
  • Loss of hypotonic fluids (water in excess of solute)
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31
Q

Which type of fluid/solute loss is the one most commonly seen under anesthesia?

A

Isotonic loss

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32
Q

Most of ECF is in what 2 areas?

A
  • Interstitial compartment

- Intravascular space

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33
Q

Fluid division between plasma and interstitium maintains what?

A

Effective circulating volume

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34
Q

What are 4 examples of forms of water loss?

A
  • Urinary
  • Fecal
  • Respiratory (panting)
  • Cutaneous evaporation
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35
Q

What are 2 examples of cutaneous evaporation?

A
  • Salivary (cats)

- Eccrine sweat glands (dog foot pads)

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36
Q

The function of renal solute load in diet and obligatory renal water losses for urinary solute excretion determine what?

A

Water requirements

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37
Q

What is the water requirement for small dogs?
Large dogs?
Cats?

A
  • 60 mL/kg/d
  • 40 mL/kg/d
  • 50-80 mL/kg/d
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38
Q

Are maintenance fluids given in anesthesia?

A

No

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39
Q

How are maintenance fluid rates calculated in very large (> 50 kg) or very small (

A
  • BWkg^0.75 x 70 = mL/day

- (BWkg x 30) + 70 = mL/day

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40
Q

What are 4 factors a patient history can uncover?

A
  • Duration of issue
  • Estimate losses
  • Eating/drinking
  • Panting, febrile
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41
Q

What is the most common fluid given in anesthesia?

A

Crystalloids

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42
Q

Solutions with electrolyte and non-electrolyte solutes able to enter all body fluid compartments are known as what?

A

Crystalloids

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43
Q

Where do crystalloids primarily exert their effects?

A

Interstitium & ICF spaces

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44
Q

In a balanced crystalloid, the composition resembles what?

A

ECF

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45
Q

What type of crystalloid composition does not resemble ECF?

A

Non-balanced

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46
Q

What are 3 examples of balanced crystalloids?

A
  • Lactated Ringers (LRS)
  • Normosol-R
  • Plasma-Lyte 148
47
Q

What is an example of a non-balanced crystalloid?

A

Saline

48
Q

Every 1 mL of blood loss should be replaced with how much crystalloid?

A

3 mL

49
Q

Where do colloids primarily exert their effects?

A

Intravascular compartment

50
Q

What are 2 indications for the use of colloids?

A
  • Shock

- Hypoproteinemia

51
Q

What are 4 examples of colloids?

A
  • Plasma
  • Dextrans
  • Hydroxyethyl starches
  • Hemoglobin-based oxygen carrying fluid
52
Q

What are 4 examples of parenteral route of administration for fluids?

A
  • Subcutaneous
  • Intraperitoneal
  • Intraosseous
  • IV
53
Q

Subcutaneous fluid is only given in what type of patient?

A

Stable

54
Q

What can prevent good uptake of fluids given SQ?

A

Vasoconstriction

55
Q

What type of fluid is given SQ?

A

Isotonic

56
Q

What are 4 things to be cautious about when giving fluids SQ?

A
  • Thermal burns
  • Infection
  • Cellulitis
  • Skin necrosis
57
Q

Are there any advantages to giving fluids intraperitoneally?

A

No, can be potentially hazardous.

58
Q

Capillary beds of medullary vascular system allow access to the vascular space for what route of administration?

A

Intraosseous

59
Q

What is an alternative route of administration to IV in neonates?

A

Intraosseous

60
Q

What is a form of administration that is used short-term in emergency situation?

A

Intraosseous

61
Q

What is the preferred route of administration when blood volume expansion is needed?

A

IV

62
Q

Which route of administration is better in a critically ill patient, IV or SQ?

A

IV

63
Q

What are 6 potential complications of IV fluid therapy?

A
  • Extravasation
  • Thrombosis/thrombophlebitis
  • Volume overload
  • Infection
  • Embolism
  • Exsanguination
64
Q

What are 2 examples of drugs that can cause extravasation?

A
  • Thiopental

- NSAIDs

65
Q

What are 7 basic things that are monitored during fluid therapy?

A
  • HR
  • RR
  • CRT
  • MM color
  • Temperature
  • Mentation
  • Urine production
66
Q

What are 4 other measurements taken during fluid therapy?

A
  • Central Venous Pressure (CVP)
  • Systemic Arterial Blood Pressure (ABP)
  • Pulmonary Capillary Wedge Pressure (PCWP)
  • Cardiac output (CO)
67
Q

Anesthesia and surgery disrupt what?

A

Homeostasis

68
Q

What is the goal of peri-anesthetic fluid management?

A

Correct abnormalities as much as possible before anesthetic event.

69
Q

Most anesthetic drugs negatively effect what?

A

Cardiovascular and renal function

70
Q

What are 4 reasons to administer IV fluids?

A
  • Maintain patent IVC
  • Counteract effects of anesthetic drugs
  • Replace insensible losses
  • Replace procedural losses
71
Q

What are 6 concerns with peri-anesthetic fluid management?

A
  • Hypovolemia
  • Hypervolemia
  • Anemia
  • Hypoproteinemia
  • Acid base and electrolyte abnormalities
  • Abnormal glucose
72
Q

What are 4 reasons hypoproteinemia is significant with anesthesia?

A
  • 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
Q

What species is more prone to over-hydration?

A

Cats

74
Q

What is the peri-anesthetic fluid rate for most dogs?

For cats?

A
  • 10 mL/kg/hr

- 5 mL/kg/hr

75
Q

Does redistribution of crystalloids happen quickly or slowly?

A

Quickly

76
Q

How much crystalloid remains intravascular 15 minutes after infusion?

A

20-30%

77
Q

Blood loss should be replaced with how much fluid?

A

3-4 times the volume of blood lost

78
Q

Where do crystalloids get redistributed?

A

Interstitial space

79
Q

Fluid has to be administered cautiously with what 3 conditions?
What is the dose lowered to?

A
  • Cardiac disease
  • Anuric renal failure
  • Geriatric
  • 2-5 mL/kg/hr
80
Q

What can be used to treat anesthetic induced hypotension?

A

Fluid bolus

81
Q

How much crystalloid can be given as a rapid bolus in addition to the continued hourly rate?

A

5-10 mL/kg over 15 minutes (or less)

The same amount as an hourly rate, but all given within 15 minutes.

82
Q

How much is a shock rate fluid bolus?

A

1 blood volume/hour

83
Q

What are 4 examples of fluid delivery set sizes?

A
  • 10 drops/mL
  • 15 drops/mL
  • 20 drops/mL
  • 60 drops/mL
84
Q

Which size fluid delivery set is used in larger patients?

Smaller?

A
  • Larger: 10 drops/mL

- Smaller: 60 drops/mL

85
Q

Is it ok to bolus supplemented bags of fluids?

A

No

86
Q

How much K+ can safely be given in an hour?

A

0.5 meq/kg/hr

87
Q

What can be given in large volumes to expand ECF volume without changes in electrolyte composition?
What is the exception? Why?

A
  • Crystalloids

- Saline: saline is not balanced

88
Q

Which type of crystalloid is acidifying?

A

Normal saline (0.9% NaCl)

89
Q

What type of cases may normal saline be a good choice for management in?

A

Chronic renal cases

90
Q

What is an example of a balanced electrolyte solution (BES)?

A

Lactated Ringers Solution

91
Q

What is the alkalinizing agent in LRS?

A

Lactate

92
Q

What does LRS contain that one needs to be aware of if transfusing blood?

A

Calcium

93
Q

Caution with LRS use should be used in what condition and in what species?

A
  • Lactic acidosis

- Reptiles

94
Q

What is a common choice for anesthetized patients?

A

LRS

95
Q

What is the alkalinizing agent for Normosol-R and Plasmalyte 148?

A

Acetate

96
Q

Normosol-R and Plasmalyte 148 may cause what with very rapid administration?

A

Vasodilation

97
Q

Caution needs to be used with Normosol-R and Plasmalyte 148 in what type of patient?
Why?

A
  • Diabetic ketoacidosis patients

- These fluids increase blood ketone concentrations

98
Q

What is an example of a resuscitation crystalloid?

A

Hypertonic saline (7.5% NaCl)

99
Q

Where does hypertonic saline draw fluid?

A

Into intravascular space

100
Q

Hypertonic saline always has to be followed up with what?

A

Replacement crystalloid

101
Q

What is the administration dose of hypertonic saline?

A

4 mL/kg IV

102
Q

What is hypertonic saline used to increase?

A

ICP

103
Q

The component of total osmotic pressure in plasma contributed by colloids is known as what?

A

Colloid osmotic pressure (oncotic pressure)

104
Q

What are 3 uses for colloids?

A
  • Correct hypovolemia
  • Support colloid osmotic pressure
  • Hypoproteinemic patients (TP
105
Q

Oncotic pressure provided by colloids depends on what?

A

Number of particles

106
Q

Duration of action of colloids depends on what?

A

Size of particles

107
Q

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

A

Vetstarch (hetastarch)

108
Q

Hetastarch is metabolized by what?

What will this cause in the patient?

A
  • Amylase

- Increase in amylase levels

109
Q

What is the infusion rate of hetastarch?

A

2-5 mL/kg/hr

110
Q

What is the maximum amount hetastarch that can be given per day?
Vetstarch?

A
  • 20 mL/kg/day

- 40-50 mL/kg/day

111
Q

What can too much start lead to?

A

Coagulopathies

112
Q

What are 6 examples of negative effects that can be seen with hetastarch?

A
  • Volume overload
  • Coagulation
  • Renal failure
  • Hepatic failure
  • Anaphylaxis
  • Pruritus
113
Q

What are 2 examples of colloid blood products?

A
  • Plasma protein (FFP, whole blood)

- Lyophilized albumin

114
Q

Plasma protein is used primarily for what?

A

Clotting factors

Anesthesiology (19 decks)

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