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VM 580 - Vet Surgery & Anesthesia > Mod 1 - Fluid Therapy (8/14) > Flashcards

Mod 1 - Fluid Therapy (8/14) Flashcards

Quiz 1

1
Q

Water makes up 1% of an animal’s body weight. 2% is intracellular fluid and 3% is extracellular. Extracellular fluid is made up of 4, 5, 6, & 7.

A
  1. 50-60%
  2. 40%
  3. 20-30%
  4. plasma (5%)
  5. interstitium (15%)
  6. lymph (2%)
  7. transcellular (1-3%)
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2
Q

What 5 signalments can alter total body water?

A
  1. age (young = more, old = less)
  2. sex (M > F)
  3. species
  4. level of exercise
  5. body condition
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3
Q

ICF contains a higher concentration of 1.
ECF contains a higher concentration of 2 & 3.

A
  1. K+
  2. Na+, Cl-
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4
Q

How much fluid does a patient intake per day?

A

40-60 mL/kg/day

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5
Q

How much fluid from a patient is lost per day?

A

24-48 mL/kg/day

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6
Q

What 2 things can cause an abnormal fluid balance?

A
  1. decreased fluid intake - fasting, anorexia, NPO
  2. increased fluid losses - V+, D+
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7
Q

What 5 things can cause an isotonic fluid loss?

A
  1. V+
  2. D+
  3. hemorrhage
  4. 3rd space
  5. sweat
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8
Q

What 2 things can cause a hypertonic fluid loss?

A
  1. Loop diuretics (K+)
  2. Addison’s disease
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9
Q

What 3 things can cause a hypotonic fluid loss?

A
  1. renal failure
  2. respiratory loss
  3. burns
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10
Q

What are the 4 steps to developing a fluid therapy plan?

A
  1. assess patient’s need for fluids
  2. determine dose
  3. select type and route
  4. select rate of administration
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11
Q

What are 3 reasons to administer fluids to a patient?

A
  1. maintain euhydration
  2. restore circulating volume (dehydration, hypovolemia)
  3. treat a specific disease process
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12
Q

What is hypovolemia?
Emergency Y/N?

A

a decrease in effective circulating volume, resulting in circulatory shock
EMERGENCY

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13
Q

What are the 2 causes of hypovolemia, with examples of each?

A
  1. absolute - fluid loss, hemorrhage
  2. relative or distributive - vasodilation (sepsis, SIRS, iatrogenic)
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14
Q

What is dehydration?

A

Usually a chronic loss of total body water

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15
Q

Dehydration vs. hypovolemia
1. which should be replaced rapidly (minutes to hours)?
2. which should be replaced slowly (days)?

A
  1. hypovolemia
  2. dehydration
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16
Q

How do you calculate a fluid dose?

A

deficit/dehydration + maintenance + losses

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17
Q

What is the maintenance rate for a patient?

A

40-60 mL/kg/day (this will vary from patient to patient!)

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18
Q

Regarding dehydration, what compartment is the total body water typically pulled from?

What about in large animals?

A

extracellular fluid (vasculature)

ECF & colon or rumen

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19
Q

What happens when we “guess-timate” loss of fluids due to dehydration?

A

we often overestimate the losses - important to reassess frequently!

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20
Q

How do we get the amount of fluids we need to replace a deficit/dehydration?

A

% dehydration x weight (kg) = fluid amount (L)

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21
Q

List 4 objective ways to measure dehydration.

A
  1. HR
  2. CRT
  3. PCV/TS
  4. creatinine
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22
Q

List 5 subjective ways to measure dehydration.

A
  1. skin elasticity
  2. sunken eyes
  3. MM moisture
  4. MM color
  5. mentation
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23
Q

T/F - we can tell if a patient is 5% or less dehydrated on physical exam.

A

False - we can’t!

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24
Q

T/F - a patient over 15% dehydrated will be dead.

A

True

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25
Q

T/F - fluid therapy should be tailored to the patient.

A

True

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26
Q

What 2 things can affect PCV?

A
  1. anemia (dec. RBCs)
  2. splenic contraction (inc. RBCs)
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27
Q

What 3 things can affect TS?

A
  1. inflammation (inc. fibrinogen in LA)
  2. renal disease (dec. protein)
  3. gastrointestinal disease (dec. protein)
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28
Q

What are 4 sensible losses that are included in the estimation of fluid losses?

A
  1. V+
  2. nasogastric reflux
  3. D+
  4. hemorrhage
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29
Q

Calculate the fluid dose:

500 kg horse estimated at 6% dehydration with 4 L of reflux every 6 hours (Q4).

A

M: 500 kg x 50 mL/kg/day = 25,000 mL/day = 25 L

D: 500 kg x 0.06 = 30 L

L: 4 L x 6 hr = 24 L/day

25 L + 30 L + 24 L = 79 L/day = ~3 L/hr

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30
Q

T/F - it’s best to calculate a fluid plan for 24-48 hours and reassess after.

A

False - every 12 hours or sooner

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31
Q

What are 7 considerations we need to think about when deciding the route of fluid administration?

A
  1. species
  2. patient compliance
  3. owner finances
  4. disease treated
  5. volumes required
  6. facilities available
  7. monitoring
32
Q

Water available for oral consumption is a good choice for patients that…? (2)

A
  1. only need maintenance
  2. are able to consume it on their own
33
Q

Enteric or intragastic fluid intake
1. name 3 pros
2. name 4 cons

A

PROS:
1. low cost
2. fewer side effects
3. for maintenance & replacement

CONS:
1. volume limitations
2. can’t give if refluxing
3. not for >8% dehydration
4. possible trauma/pneumonia

34
Q

IV fluid intake
1. name 3 pros
2. name 4 cons

A

PROS:
1. allows for resuscitation & faster administration
2. fluids go directly into vasculature
3. good if PO/IG is not an option

CONS:
1. non-physiological route (may cause dehydration when stopped, can quickly affect electrolyte balance)
2. caution with certain diseases
3. catheter complications
4. more costly

35
Q

What 4 diseases should you take caution with when administering IV fluids?

A
  1. heart failure
  2. anuria
  3. urinary obstruction
  4. pulmonary edema
36
Q

Intraosseous fluid intake
1. when would this route be beneficial?
2. what species is this route great for?
3. what 4 locations can this be done?
4. what is 1 risk?

A
  1. difficult to get venous access
  2. pigs
  3. 1) tibia, 2) radius, 3) femur, 4) humerus
  4. osteomyelitis
37
Q

SQ fluid intake
1. name 1 pro
2. name 3 cons

A

PRO:
1. many administration sites

CONS:
1. limited volume given
2. slow absorption
3. must be isotonic

38
Q

Rectal fluid intake
1. name 3 pros
2. name 4 cons

A

PROS:
1. low cost
2. good to use if no venous access
3. absorption similar to PO

CONS:
1. inaccurate due to losses
2. less accepted by owner/patient
3. rectal injury
4. can’t use with severe D+

39
Q

Intraperitoneal fluid intake
1. which is the fastest: SQ, IP, or IV?
2. which is the slowest?
3. name 2 risks

A

1 & 2. SQ < IP < IV
3. 1) peritonitis, 2) organ puncture

40
Q

What are crystalloid fluids?

What are colloid fluids?

A

salt solutions

fluids with large molecules that stay within the vasculature to inc. oncotic pressure

41
Q

T/F - colloids are used for small volume resuscitation and maintenance fluids.

A

False - small volume resus. only!

42
Q

Crystalloids
When are:
1. isotonic fluids appropriate?
2. hypotonic fluids appropriate?
3. hypertonic fluids appropriate?

A
  1. replacement fluids for hypovolemia & dehydration
  2. maintenance fluids for normal losses
  3. resuscitation
43
Q

Isotonic crystalloids have high 1 (electrolyte).
Hypotonic crystalloids have lower 2 and higher 3, 4, and 5.

A
  1. Na+
  2. Na+
  3. K+
  4. Ca++
  5. Mg++
44
Q

How much crystalloid fluids remains in the vasculature 1 hour post-infusion?

A

25%
(75% gets redistributed to the interstitium)

45
Q

Large volumes of Na+ cause 1 diuresis.

A
  1. K+
46
Q

What is the IV dose of K+?

What rate of K+ should be given, and if it’s any higher than that, toxicity may occur?

A

20-40 mEq/L

<5 mEq/kg/hr

47
Q

What 2 things can occur with hypocalcemia?

A
  1. anorexia
  2. dystocia/lactation
48
Q

What is the small animal dose of Ca++?

A

50-150 mg/kg

49
Q

Mg++ is often depleted in (acute/chronic) illness. It is important in 1 function. With Mg++ toxicity, you will often see 2, 3, and, if given orally, 4.

A

chronic
1. neuromuscular
2. depression
3. neurological signs
4. diarrhea

50
Q

What is the dose for Mg++?

A

4-16 mg/kg/day

51
Q

Hypoglycemia is common in 1 & 2.

A
  1. neonates
  2. toy breeds
52
Q

Why should you avoid Dextrose 5% in water?

A

The dextrose is rapidly metabolized and then you’re just giving water, which will cause further electrolyte imbalances & diuresis.

53
Q

What is the problem with replacement fluids?

A

They contain a lot of Na+, which can cause diuresis and rebound dehydration, depletes electrolytes, and any excess Na+ retained can cause edema.

54
Q

Saline is 1% 2 and causes 3 and 4 metabolic acidosis. This metabolic acidosis results in renal vaso_5_ and (increased/reduced) renal perfusion.

A
  1. 0.9%
  2. NaCl
  3. hypernatremia
  4. hyperchloremic
  5. vasoconstriction
    reduced
55
Q

When is 0.9% NaCl indicated? (2)

A
  1. hyperkalemia
  2. hypochloremia (or metabolic alkalosis)
56
Q

With 0.9% NaCl, what causes K+ to shift out of cells to be excreted?

A

Hyperchloremia, or metabolic acidosis

57
Q

What are the 2 things that can cause hypovolemic shock, with examples of each?

A
  1. dec. effective circulating volume - severe dehydration, hemorrhage, burns
  2. circulatory collapse - loss of vascular tone, inc. endothelial permeability (sepsis, anaphylaxis)
58
Q

How do you treat hypovolemic shock?

A

rapid fluid resuscitation

59
Q

What is the primary goal of treatment of hypovolemic shock?

A

preservation of organ function

60
Q

What is the shock dose of isotonic crystalloids?

Why should we give 25% of the shock dose?

A

60-80 mL/kg

Because the risk of overestimating how much fluids to give could be fatal!

61
Q

When should you reassess and repeat a shock dose of fluids?

A

when the animal has not improved

62
Q

How do you know when you can start maintenance fluids (& no longer give shock boluses)?

A

when the patient’s vitals stabilize

63
Q

How many times can you give a shock bolus consecutively?

A

up to 3x

64
Q

Hagen-Poiselle’s Law deals with 1 & 2 to maximize the fluid rate.

What should 1 & 2 be to give the max amount of fluids as fast as possible?

A
  1. diameter
  2. length

diameter = as large as possible
length = as short as possible

65
Q

What are 6 things that can increase fluid rates?

A
  1. inc. catheter or extension diameter
  2. dec. catheter or extension length
  3. use 2 catheters
  4. remove any extension sets
  5. use pumps
  6. use a slam bag or utilize gravity
66
Q

Hypertonic crystalloids are used for (small/large) volume resuscitation.

What happens when you use hypertonic crystalloids?

A

small

rapid fluid shift to intravascular space - interstitium first, then intracellular space

67
Q

How big is the expansion of the intravascular space when using hypertonic crystalloids?

A

~4x the amount given

68
Q

How long does the volume expansion last when using hypertonic crystalloids?

A

45min

69
Q

What are 4 effects of giving hypertonic crystalloids?

A
  1. improves CO, stroke volume, MAP, & cardiac contractility (+ inotrope)
  2. dec. ICP
  3. anti-inflammatory
  4. anti-edema
70
Q

What are 2 contraindications for using hypertonic crystalloids?

A
  1. hypernatremia
  2. uncontrolled blood loss
71
Q

T/F - natural colloids (blood, plasma, albumin) can be used for resuscitation.

A

False - worry about possible anaphylactic reactions

72
Q

What are 2 indications to use colloids?

A
  1. dec. oncotic pressure
  2. rapid expansion of intravascular volume
73
Q

What is a side effect in cats/dogs that can occur when using colloids?

A

coagulation problems - inhibition of factor VIII and von Willibrand factor

74
Q

What are 5 safety considerations you should think about when considering fluid therapy?

A
  1. fluids are a DRUG
  2. electrolyte imbalances can occur (esp. with IV)
  3. be cautious with K supplementation
  4. overdose may result in pulmonary edema, volume overload, hemodilution
  5. may inc. mortality in septic & post-op patients
75
Q

T/F - we don’t need to rush when giving fluids - they can be discontinued whenever the DVM is ready.

A

False - work to discontinue fluids ASAP

76
Q

What are 4 ways to monitor fluid therapy?

A
  1. PE
  2. PCV/TS Q6-12hrs
  3. VBG (electrolytes, lactate, creatinine)
  4. USG
77
Q

The patient should be stable for 1 hours before you should discontinue fluids. Weaning should be (gradual/immediate).

A

12-24hrs
gradual

VM 580 - Vet Surgery & Anesthesia (11 decks)

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