SA MED - ECC Fluid Therapy

Question 1

Why do colloid fluids remain in the vascular space longer?

Answer 1

They contain large molecular substances

Question 2

How do colloid fluids draw water into the intravascular space?

Answer 2

Colloids pull fluid from interstitial space via oncotic properties

Question 3

What is the effect of colloids on total blood volume?

Answer 3

Total blood volume increases

Question 4

________ are more effective than crystalloids in increasing intravascular volume.

Answer 4

Colloids

Question 5

Synthetic colloids increase intravascular volume by _____ than the volume infused.

Answer 5

More

Question 6

Why use colloids?

To improve ______
To maintain ______

Answer 6

Improve intravascular volume - hypovolemia, hypotension tx

Maintain intravascular colloid osmotic pressure - minimizes tissue edema

Question 7

Three types of colloid fluid solutions

Answer 7

Synthetic - VetStarch, Hetastarch
Natural - plasma, albumin
O2 carrying solution - whole blood, PRBCs

Question 8

VetStarch and Hetastarch are also known as ____ starch solutions

Answer 8

Hydroxyethyl starch solutions

Question 9

Hydroxyethyl starch solutions have a structure similar to _____

Answer 9

Glycogen

Question 10

The elimination half-life of Hydroxyethyl starch solutions is determined by these three things:

Answer 10

Molar substitution
C2:C6 substitution ratio
Molecular weight

Question 11

Volume expansion of Hydroxyethyl starch solutions is determined by ___.

Answer 11

Solution concentration

Question 12

Coagulopathy of Hydroxyethyl starch solutions is determined by _____ and _____.

Answer 12

Molecular weight and molar substitution

Question 13

Duration of Hetastarch vs VetStarch

Answer 13

Hetastarch 24-36 hours
VetStarch 4-6 hours

Question 14

Hydroxyethyl starch solutions:

Recommended dosage for dogs vs cats

Answer 14

Dogs: 20 mL/kg/day
Cats: 10-20 mL/kg/day

Bolus
Dogs: 5 mL/kg
Cats: 2.5-5 mL/kg

24-hr CRI

Question 15

Hydroxyethyl starch solution side effects (3)

Answer 15

Allergic reactions
Induced coagulopathies
Acute kidney injury

Question 16

How is plasma obtained?

Answer 16

Plasma is obtained after removing RBCs from whole blood by centrifugation

Question 17

What does plasma provide?

Answer 17

Proteins - albumin, globulin, fibrinogen
Coagulation factors
Immunoglobulins

Question 18

What is the recommended dosage fro plasma?
What is the effect on total protein and coagulation factors?

Answer 18

20 mL/kg
TP increases by 1 g/dL
Coagulation factors increased by 40%

Question 19

Fill in the natural colloids chart

Answer 19

Question 20

When are packed red blood cells indicated?

Answer 20

Anemia with normal protein concentrations and normal coagulation status

Question 21

____ mL/kg packed red blood cells raises the PCV by 1%.

Answer 21

1.5 mL/kg

Question 22

How much will the PCV increase in a 30 kg dog given 1 unit of packed red blood cells (225 mL)?

Answer 22

5% (?)

Question 23

When is the use of fresh/stored whole blood indicated?

Answer 23

Anemia with hypoproteinemia AND/OR coagulopathy (factor or platelet deficiency)

Question 24

What dosage of whole blood raises the PCV by 1%?

Answer 24

2.2 mL/kg

Question 25

How much will the PCV increase in a 5kg cat given 1 unit of whole blood (60 mL)?

Answer 25

5.5% ?????

Question 26

Considerations when choosing fluids to treat shock

Answer 26

Pathophysiology Type of fluid defecit Microvascular integrity Colloid oncotic pressure Properties of the fluid

Question 27

Four types of shock

Answer 27

Hypovolemic - inadequate circulating blood volume Distributive - maldistribution of blood flow and volume Obstructive - extracardiac obstruction of blood flow Cardiogenic - primary pump failure

Question 28

Complete the algorithm

Answer 28

Question 29

Chip, a 3YO MN Lab has a history of four days of vomiting and diarrhea. On physical exam, he is quiet, depressed, and 12% dehydrated. Temp is 98.3 F, Pulse 200 bpm, Respiration 48 bpm, blood pressure 60 mmHG. He has pale mucous membranes with CRT 3 seconds. PCV 57% TS 8.4 Blood glucose 89 Lactate 5.6 What type of shock is most likely?

Answer 29

Nontraumatic hypovolemic shock

Question 30

Chip, a 3YO MN Lab has a history of four days of vomiting and diarrhea. On physical exam, he is quiet, depressed, and 12% dehydrated. Temp is 98.3 F, Pulse 200 bpm, Respiration 48 bpm, blood pressure 60 mmHG. He has pale mucous membranes with CRT 3 seconds. PCV 57% TS 8.4 Blood glucose 89 Lactate 5.6 Fluid defecit: intravascular Path: decreased blood volume with concurrent dehydration Microvascular perm: normal Plasma oncotic pressure: normal Which fluid are you going to use to treat Chip’s shock? Plasma-Lyte 7.5% NaCl VetStarch 0.45% NaCl

Answer 30

Dehydration —> interstitial loss Chronic dehydration —> + intracellular loss Plasma-Lyte - isotonic crystalloid - 25% stays in vascular space; 75% redistributes from vascular to interstitial space - OK to start with but may need to change at some point 7.5% NaCl - hypertonic saline - pulls fluid from interstitial and intracellular spaces - NO bc will deplete compartments already dehydrated VetStarch - synthetic colloid - pulls fluid from interstitial space - NO bc interstitial space already depleted 0.45% NaCl - hypotonic crystalloid - NOT used to treat shock - good for replenishing interstitial and intracellular dehydration LATER

Question 31

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds. PCV 35% TS 4.8 Blood glucose 176 Lactate 6.8 What type of shock is most likely?

Answer 31

Traumatic hypovolemic shock

Question 32

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds. PCV 35% TS 4.8 Blood glucose 176 Lactate 6.8 What are the properties of Tank’s traumatic hypovolemic shock? Fluid deficit: Pathophysiology: Microvascular permeability: Plasma oncotic pressure:

Answer 32

Fluid deficit: intravascular Pathophysiology: decreased blood volume Microvascular permeability: normal to increased Plasma oncotic pressure: normal to decreased

Question 33

Tank, a 5YO MN Pug HBC 3 hours ago presents with epistaxis and bruising over abdomen and thorax. On physical exam, Tank is dull and unresponsive with normal hydration. Temp 99.8 F, Pulse 220 bpm, Resp 56 bpm, BP 50 mmHg. Tank has pale MM and CRT > 3 seconds. PCV 35% TS 4.8 Blood glucose 176 Lactate 6.8 Which fluid are you INITIALLY going to use to treat Tank’s shock? Plasma-Lyte 7.5% NaCl VetStarch Packed RBCs

Answer 33

Not dealing with dehydration, so don’t have to worry about interstitial and intracellular spaces Plasma-Lyte - isotonic crystalloid - 25% stays in vascular space, 75% redistributes to interstitial space - Tank is bleeding, a little anemic, protein a little low so have to be mindful of how much Plasma-Lyte administered - OK if use a volume-limited approach until we know Tank is not still hemorrhaging - avoid BP > 100 mmHg to avoid promoting hemorrhage - recommend 1/4 shock dose over 30 minutes instead of full dose over 15 minutes 7.5% NaCl - hypertonic saline - pulls fluid from interstitial and intracellular spaces - OK since patient has normal hydration - can also be used to treat increased intracranial pressure if concerned about mentation (instead of or in addition to mannitol) VetStarch - synthetic colloid - pulls fluid from interstitial space - OKish because normal hydration and not in septic shock - can cause hypocoagulability Packed RBCs - NO for initial treatment as cannot administer quickly enough to resolve shock - must give slowly (over 2-4 hours) and monitor for signs of transfusion reaction - can use later if needed

Question 34

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds. PCV 40% TS 6.2 Blood glucose 46 Lactate 7.8 Parvo + with rare WBCs on blood smear What kind of shock is most likely?

Answer 34

Septic shock

Question 35

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds. PCV 40% TS 6.2 Blood glucose 46 Lactate 7.8 Parvo + with rare WBCs on blood smear Properties of Murphy’s septic shock - Fluid deficit: Pathophysiology: Microvascular permeability: Plasma Oncotic Pressure:

Answer 35

Fluid deficit: relative depletion Pathophysiology: maldistribution of blood flow Microvascular permeabiliity: increased Plasma oncotic pressure: decreased

Question 36

Murphy, a 6MO MI lab has a history of two days of vomiting and bloody diarrhea. On physical exam, Murphy is depressed and >12% dehydrated. Temp 97.2 F, Pulse 210 bpm, Resp 50 bpm, BP unobtainable. Murphy has pale MM and a CRT of 4 seconds. PCV 40% TS 6.2 Blood glucose 46 Lactate 7.8 Parvo + with rare WBCs on blood smear Which fluid are you INITIALLY going to use to treat Murphy’s shock? Plasma-Leyte 7.5% NaCl VetStarch 0.45% NaCl & 2.5% Dextrose

Answer 36

Plasma-lyte - isotonic crystalloid - 25% stays in vascular space, 75% redistributes to interstitial space - OK to start tx with this patient who is shocky and dehydrated 7.5% NaCl - Hypertonic saline - might help with septic shock, but have concurrent dehydration so contraindicated 0.45% NaCl + 2.5% dextrose - hypotonic saline and dextrose - bag says isotonic because dextrose adds tonicity, but dextrose metabolizes to CO2 and water (hypotonic) - NO bc in the body, this mix is hypotonic * 0.9% NaCl + dextrose would be ok to use (isotonic saline and dextrose)