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MODULE 16 - Alimentary Tract Disease > PATIENT SUPPORT - Advanced Fluid Therapy > Flashcards

PATIENT SUPPORT - Advanced Fluid Therapy Flashcards

1
Q

What are the indicators for fluid therapy?

A

Dehydration
Shock
Correct electrolyte abnormalities
Maintain oncotic pressure
Provide maintenance fluida
Diuresis

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2
Q

What is dehydration?

A

Dehydration is a deficit of total body water

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3
Q

What are the general causes of dehydration?

A

Decreased fluid consumption
Increased fluid loss

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4
Q

What can cause decreased fluid consumption?

A

Anorexia

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5
Q

What can cause increased fluid loss?

A

Sensible fluid loss
Insensible fluid loss
Pathological fluid loss

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6
Q

What is sensible fluid loss?

A

Sensible fluid loss is normal fluid loss that can be measured by clinicians

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7
Q

What is insensible fluid loss?

A

Insensible fluid loss is normal fluid loss than cannot be measured by clinicians

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8
Q

What are some of the causes of pathological fluid loss?

A

Vomiting
Diarrhoea
Renal disease
Panting (i.e. secondary to pyrexia)
Hypersalivation
Wound exudation
Third space fluid loss

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9
Q

What are the clinical signs of dehydration?

A

Skin tenting
Dry mucous membranes
Sunken eyes

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10
Q

What are the clinical signs of a patient less than 5% dehydrated?

A

Not clinically detectable

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11
Q

What are the clinical signs of a patient 5 - 6% dehydrated?

A

Subtle skin tent

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12
Q

What are the clinical signs of a patient 6 - 10% dehydrated?

A

Moderate skin tent
Tacky mucous membranes
Possibly sunken eyes

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13
Q

What are the clinical signs of a patient 10 -12% dehydrated?

A

Marked skin tent
Dry mucous membranes
Sunken eyes

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14
Q

What are the clinical signs of a patient 12 - 15% dehydrated?

A

Marked skin tent
Dry mucous membranes
Sunken eyes
Clinical signs of hypovolaemia

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15
Q

What are some other indicators of dehydration other than clinical signs?

A

Increased PCV/TS
Weight loss

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16
Q

What are your aims when treating dehydration?

A

When treating dehydration your aims are to replace the fluid deficit over 24 hours as well as provide maintainence fluids and accound for ongoing losses. It is also important to recheck your patient to assess if treatment is working

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17
Q

How do you treat dehydration?

A

Fluid therapy with isotonic crystalloid fluids

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18
Q

What are isotonic crystalloid fluids?

A

Isotonic crystalloid fluids are fluids containing water and electrolytes in a similar composition of extracellular fluid (ECF)

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19
Q

What are four examples of isotonic crystalloid fluids?

A

0.9% NaCl
Ringer’s solution
Hartmann’s (also known as lactated ringers)
Plasmalyte 148

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20
Q

What is the composition of 0.9% NaCL?

A

Water
Sodium
Chloride

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21
Q

What is the composition of Ringer’s solution?

A

Water
Sodium
Chloride
Potassium
Calcium

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22
Q

What is the composition of Hartmann’s?

A

Water
Sodium
Chloride
Potassium
Calcium
Lactate

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23
Q

What is lactate?

A

Lactate is a bicarbonate precursor which is metabolised by the liver into bicarbonate

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24
Q

What is the composition of plasmalyte 148?

A

Water
Sodium
Chloride
Potassium
Calcium
Acetate

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25
Q

What is acetate?

A

Acetate is a bicarbonate precursor which is metabolised by the muscle into bicarbonate

26
Q

What is the most common route of administration for fluid therapy?

A

Intravenous fluid administration

27
Q

When is oral and subcutaneous fluid administration indicated?

A

Oral and subcutaneous fluid administration is indicated for mild dehydration

28
Q

What can cause patients to remain clinically dehydrated even with fluid therapy?

A

Technical issues with fluid administration
Incorrect estimation of dehydration
Ongoing fluid losses

29
Q

How do you estimate ongoing fluid losses?

A

You have to reassess your patient every 4 hours and if possible measure the ongoing losses and account for these losses when calculating/altering your fluid rate

30
Q

What are some of the clinical signs of hypokalaemia?

A

Asymptomatic
Muscle weakness
Polyuria, polydipsia (PUPD)

31
Q

What are the general causes of hypokalaemia?

A

Decreased intake of potassium
Translocation of potassium
Increased loss of potassium

32
Q

What are some of the gastrointestinal causes of hypokalaemia?

A

Vomiting
Diarrhoea

33
Q

How do you correct hypokalaemia?

A

Fluid therapy using an isotonic crystalloid fluid spiked with potassium

34
Q

What are some of the main causes of hypernatraemia?

A

Diabetes insipidus
Neurological disease

35
Q

How do you correct hypernatraemia?

A

Fluid therapy using an isotonic crystalloid fluid at a rate of less than 5mmol/l/hr

36
Q

Why should you correct hypernatraemia with a fluid rate of less than 5mmol/l/hr?

A

In response to hypernatraemia the brain cells produce idiogenic osmoles as a protective mechanism from the high osmolality in the plasma which could draw fluid from the brain cells causing the brain to become dehydrated. Idiogenic osmoles increase the intracellular osmolality to minimise the loss of intracellular water in the brain. However, becaused of these idiopathic osmoles, rapid correction of hypernateaemia can be fatal as a rapid decreased in serum sodium levels will rapidly decrease the osmolality of the blood relative to the cells, causing fluid to move into the brain cells and cause swelling of the brain

37
Q

How do you correct hyponatraemia?

A

Fluid therapy using an isotonic crystalloid fluid at a rate of less than 5mmol/l/hr

38
Q

Why should you correct hyponatraemia with a fluid rate of less than 5mmol/l/hr?

A

There is a risk of myelinolysis

39
Q

What is one of the main functions of albumin?

A

Albumin is a plasma protein which generates oncotic pressure which is a pressure gradient that pulls fluid into the vasculature

40
Q

What are the general causes of hypoalbuminaemia?

A

Decreased production of albumin
Increased loss of albumin

41
Q

What can cause decreased production of albumin?

A

Hepatic disease

42
Q

What can cause an increased loss of albumin?

A

Protein-losing enteropathy
Protein-losing nephropathy
Inflammation

43
Q

When are serum albumin levels classified as critically low?

A

Serum albumin levels of less than 15g/l is classified as critically low

44
Q

How do you correct hypoalbuminaemia?

A

Correcting hypoalbuminaemia is challenging and often requires treatment of the underlying disease which is causing the hypoalbuminaemia, however, synthetic colloids can be used to try and help maintain oncotic pressure

45
Q

What are synthetic colloids?

A

Synthetic colloids are fluids containing large molecular weight particles (such as starch or gelatin) which cause rapid expansion of the intravascular volume and cannot easily diffuse out of the intravascular space

46
Q

What are the potential side effects of synthetic colloids?

A

Dilutional coagulopathy
Renal failure
Anaphylaxis

47
Q

What is the most common synthetic colloid available for use in the UK?

A

Haemaccel (gelatin based colloid)

48
Q

Other than synthetic colloids, what else can be used to correct hypoalbuminaemia?

A

Fresh frozen plasma
Human serum albumin

49
Q

What are the limitations of fresh frozen plasma for correcting hypoalbuminaemia?

A

Fresh frozen plasma is expensive and not very effective at correcting hypoalbuminaemia

50
Q

What are the benefits and limitations of human serum plasma for correcting hypoalbuminaemia?

A

Human serum plasma is very effective at correcting hypoalbuminaemia however there is a risk of anaphylaxis due to an autoimmune response against the human plasma

51
Q

Which electrolyte and acid base imbalances can be seen with diarrhoea and vomiting?

A

Hypokalaemia
Metabolic acidosis

52
Q

How do you correct the electrolyte and acid base imbalanced seen in patients with diarrhoea and vomiting?

A

Hartmann’s spiked with potassium. The hartmann’s spiked with potassium will correct the fluid deficit and hypokalaemia as well as provide lactate which will be converted into bicarbonate and correct the metabolic acidosis

53
Q

What is pre-pyloric vomiting?

A

Pre-pyloric vomiting is the evacuation of gastric contents before the pylorus

54
Q

Which electrolyte and acid base imbalances can be seen with pre-pyloric vomiting?

A

Hypokalaemia
Hyponatraemia
Hypochloraemia
Hypochloraemic metabolic alkalosis

55
Q

How does the body self-perpetuate states of metabolic alkalosis?

A

The body will prioritise correcting volume loss over correcting the metabolic alkalosis through increasing renal reabsorption of water and bicarbonate into the blood and secreting chloride into the urine which will help to correct volume loss however will exacerbate the metabolic alkalosis. A chloride (Cl-) depletion stimulates the kidneys to resorb bicarbonate ions (HCO3-) to maintain electroneutrality. The HCO3- ions would bind to H+ in the blood, further increasing the pH and maintaining the alkalosis. This will also result in paradoxical aciduria due to the increased secretion of chloride into the urine

56
Q

How do you correct the electrolyte and acid base imbalanced seen in patients with pre-pyloric vomiting?

A

Fluid therapy with chloride containing fluids such as Ringer’s to correct the alkalosis. You may also have to spike these fluids with potassium

57
Q

How can you use fluids in the management of intestinal obstructions?

A

Fluid therapy can be used to correct any dehydration, electrolyte and acid base imbalances seen with intestinal obstructions, especially as these cases are often surgical and these factors need to be corrected prior to anaesthesia

58
Q

Which consequences of hepatic disease can be corrected using fluid therapy?

A

Hypoalbuminaemia
Hypoglycaemia
Hypokalaemia
Acid/base imbalances

59
Q

Why should hartmann’s ideally not be used in patients with severe hepatic dysfunction?

A

Hartmann’s contains lactate which needs to be metabolised into bicarbonate by the liver

60
Q

What are the potential complications of fluid therapy?

A

Iatrogenic electrolyte disturbances
Catheter complications
Volume overload

61
Q

What are the clinical signs of volume overload?

A

Chemosis
Serous nasal discharge
Increased respiratory, rate and effort
Restlessness
Peripheral oedema
Polyuria

62
Q

What is chemosis?

A

Chemosis is swelling of the conjunctiva

MODULE 16 - Alimentary Tract Disease (23 decks)

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