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ACVECC prep 2022 > Terms, definitions and nomenclature of fluid administration 2021 seminal > Flashcards

Terms, definitions and nomenclature of fluid administration 2021 seminal Flashcards

1
Q

Absolute Hypovolemia

A

Reduction in total circulating volumee. Can be caused by dehydration, or the loss of blood

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2
Q

Acid

A

substance capable of increasing the concentration of hydrogen ions when dissolved in water (aqueous solution)

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3
Q

Acidosis

A

A process in which there is a net accumulation of acid in the body

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4
Q

acidemia

A

blood pH in which there is a net accumulation of acid in the body

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5
Q

Acute normovolemic hemodilution

A

blood conservation strategy where a specific volume of whole blood is removed from the patient and stored, and replaced by crystalloid or colloid solutions to restore volume prior to surgery. The rationale is to reduce the loss of RBC from surgical bleeding. The blood is given back after surgery.

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6
Q

Albumin

A

circulating blood protein weighing 69 kDa, synthetised by the liver and is the major determinant of plasma oncotic pressure

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7
Q

Alkalemia

A

blood pH that is the above the normal physiologic range for the species in questions

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8
Q

Alkalosis

A

A process in which there is a net accumulation of alkali in the body

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9
Q

Anion

A

negatively charged atom or molecule, such as chloride (Cl-) and bicarbonate

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10
Q

Anion gap

A

Calculated difference between the principle cations and anions in plasma. Formula:
AG= (Na + K) - (Cl + HCO) Anion gap is useful to narrow down the causes of metabolic acidosis

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11
Q

Autotransfusion

A

blood conservation strategy used during hemorrhage or surgery where shed blood is collected, typically mixed with anticoagulant, filtered and reinfused to the patient. If there is a RBC wash prior to readministration is called cell salvage

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12
Q

Balanced component resuscitation = balanced resuscitation

A

fluid resuscitation strategy in severe trauma management where blood products are transfused in proportions similar to blood (1:1:1 for RBC, PLT and Plasma)

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13
Q

Balanced crystalloid solution (= Balanced isotonic electrolyte solution, polyonic crystalloid solution or balanced salt solution)

A

FLuid that contains and electrolyte composition (particularly Na, K and Cl ) similar to found in plasma. It should maintain or normalize acid base balance and be isotonic and isosmotic with normal plasma

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14
Q

Base

A

substance that is capable of accepting a hydrogen ion when dissolved in water

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15
Q

Base deficit

A

amount of a strong base that must be added in vitro to 1 L of oxygenated blood to return the pH to 7.4 at a partial pressure of CO2 of 40mmHg and temp of 37C in presence of metabolic acidosis.
* represents a deficiency of base, or the negative form of base excess, where a BD of +1 mmol/L is equivalent to a BE of -1mmol/L

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16
Q

Base excess

A

the amount of strong acid that must be added in vitro to 1 L of oxygenated blood to return the pH to 7.40

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17
Q

Blood volume

A

total volume of blood contained within the circulatory system
Same as: vascular volume or intravascular volume

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18
Q

buffered crystalloid solution

A

intravenous fluid containing an acid-base buffer in order to help maintain or restore physiologic pH. This consist of an aqueous solution containing a mixture of electrolytes and weak acid and its conjugate base. The most common buffers are bicarbonate or organic anions ( e.g.

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19
Q

Cation

A

Positively charged atom or molecule

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20
Q

Central venous pressure

A
  • Measurement of venous blood pressure within a large central vein, or more specifically, the cranial or caudal vena cava.
  • It is a controversial method of assessing right ventricular preload: its not correlated with total blood volume.
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21
Q

Colligative properties

A

Alterations in the properties of a solvent due to the addition of solutes.
* Depend on the concentration of molecules in solution, rather than the type of chemical species present.
*E.g. Vapor pressure, boiling point, freezing point, osmotic pressure

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22
Q

Colloid

A

Large molecular weight molecule (>30 kDa) that are preferentially retained in the intravascular space following intravenous administration.
* Natural colloids: plasma and albumin
* synthetic Hydroxyethyl starches, dextrans and gelatins

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23
Q

Colloid osmotic pressure

A

Osmotic force generated by large molecules (colloids) in solution when separated by a semipermeable membrane from a region with a different colloid concentration.
* Same as oncotic pressure

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24
Q

Colloid solution

A

Intravenous fluid containing macromolecules dispersed in a crystalloid solution. It is administered to support intravascular volume or raise plasma colloid osmotic pressure.
* colloid fluid therapy is also called biophysical therapy.

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25
Q

Constant rate infusion (CRI)

A

continuous intravenous administration of a medication in order to maintain a steady delivery or plasma concentration

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26
Q

Critical hematocrit

A

minimum hematocrit that supports adequate tissue oxygenation and below which organ hypoxemia will develop

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27
Q

Crystalloid

A

Solution that contains electrolytes and other small water soluble molecules and/or dextrose.
* Organized by tonicity: hypotonic, isotonic and hypertonic

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28
Q

Cumulative fluid balance (vs Daily fluid balance)

A

Difference between all fluid inputs and outputs over a defined period of time. (over 24h is referred to as daily fluid balance)

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29
Q

Damage control resuscitation

A

Resuscitation strategy used to treat severely traumatized patients in order to reduce the development of the “lethal triad” of hypothermia, acidosis and coagulopathy. Key principles are the early use of blood products, avoidance of excessive crystalloid infusions which can cause dilutional coagulopathy, and permissive hypotension

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30
Q

Deescalation

A

Reduction of fluid administration due to clinical improvement of the patient

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31
Q

Dehydration

A

Loss of body water, with or without salt , at a rate greater than the body can replace it

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32
Q

Deresuscitation

A

Correcting fluid overload by using dialysis or diuretics to remove excess fluid

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33
Q

Early goal-directed therapy

A

Protocol- driven treatment algorithm that aims to guide fluid, vasoppressor and other resuscitation therapy toward specific hemodynamic end-points, with the goal of optimizing oxygen delivery.

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34
Q

Edema

A

Clinical manifestation of fluid accumulation within the interstitial tissue space (interstitial edema) or within cells (cellular edema)

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35
Q

Effective osmole

A

Electrolyte (ion) that exerts an osmotic force (i.e. pull) across a semi-permeable membrane. Effective osmoles determine a solution’s tonicity. Sodium ion is the predominant effective osmole in the body.

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36
Q

Electrolyte

A

Dissolved ions in solution that carry a positive or negative electric charge (sodium, K, Cl, Ca)

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37
Q

Endothelial glycocalyx

A

*Negatively charged, mesh-like layer on the luminal surface of vascular endothelial cells, composed of membrane-bound glycoproteins and proteoglycans, which have an important role in regulating vascular permeability, endothelial anticoagulation and modulating interactions between the endothelium and the vascular enviroment .
*EG damage and breakdown are particularly susceptible to fluid overload, catecholamine-induced damage and shock.

38
Q

Fluid balance

A

Net difference between bodily fluid gains or inputs ( including IV fluids,meds and blood products) and fluid losses or outputs (UOP, GI, blood). insensible losses are usually omitted.
*Positive fluid balance: ins exceed the losses
* Can be expressed as a volume or as a percentage body weight.

39
Q

Fluid bolus

A

Rapid IV administration of small or large volume of fluid for the purpose of restoring tissue perfusion, such as during the treatment of hypovolemic shock

40
Q

Fluid challenge

A

Rapid IV administration of a modest volume of fluid, usually a crystalloid, ir order to assess the likelihood of volume-responsiveness in a patient with hemodynamic instability, while minimizing the risk of fluid overload. A fluid challenge is typically followed by a fluid bolus in patients that exhibit a positive response to the fluid challenge.

41
Q

Fluid compartments

A

Describes the distribution pattern of total body fluid within several well-defined spaces separated from each other by cell membranes. Together, the intravascular and interstitial fluid compartments comprise the extracellular fluid space and cointains about 1/3 of the total body water.

42
Q

Fluid Creep

A

two different meanings:
1: administration of IV fluid to burn patients in excess of fluid requirements calculated by the Parkland formula. (improve perfusion but might increase risk of oedema )
2: unintentional and unmeasured fluid volumes administered in the process of delivering medication and nutrition through enteral and parenteral routes.

43
Q

Fluid overload

A

Increase in total body fluid (typically both water and lytes) in excess of physiologic requirements.
* some publications: 10% or more increase in total body weight due to fluid adm. which represents the threshold for an increased risk of adverse clinical effects.
* more specific terms: volume overload (excessive fluid in the intravascular compartment) , overhydration (excessive pure water gain)

44
Q

Fluid responsiveness

A

The ability for hemodynamic parameters to improve in response to a fluid challenge or bolus .
* Increase in CO, or SV, by at least 10-15% from baseline following administration of a fluid bolus that is delivered over <15min or 30min.
* Others: significant change in one or more of: Increase MAP>10mmHg, decrease HR >10bpm, increase CVP >2cm H2O, or increase in UOP.

45
Q

Fluid resuscitation

A

Administration of intravenous fluids to reverse life-threatening tissue hypoperfusion.
*volume resuscitation

46
Q

Fluid retention

A

Increase in net fluid balance resulting from excess fluids in body tissues and weight gain and in some cases peripheral oedema.
* Due to physiological or pathological processes promoting renal reabsorption and fluid conservation (pregnancy, dehydration, anesthesia, AKI and CHF)

47
Q

Hemodynamic coherence

A

Coherence between macrocirculatory and microcirculatory hemodynamics such that regional and microcirculatory perfusion and tissue oxygen delivery permits normal cellular function in support of organ function

48
Q

Hemoglobin-based oxygen carrier (HBOC)

A

Cell-free hemoglobin solution used in veterinary medicine iin the 90s and 2000s as a blood transfusion substitute to improve oxygen carrying capacity. * not available in US.

49
Q

Hyperchloremic metabolic acidosis

A

Hyperchloremia accompanied by hypobicarbonatemia and metabolic acidosis. Two different mechanistic explanations are bicarbonate loss or dilution (henderson-hasselbach approach) or a decrease in SID caused by an increase in chloride. * same as normal anion gap acidosis.

50
Q

Hyperoncotic colloid

A

Colloid solution with an oncotic pressure above that of plasma (e.g. 10% hydroxyethyl starch, 20% human albumin )

51
Q

Hyperperfusion

A

Supraphysiologic (increased) blood flow to the tissues

52
Q

Hypertonic crystalloids

A

Crystalloid solution with a higher effective osmolality than plasma
* 7.2% NaCl = 2464 mOsm/L

53
Q

Hypertonic saline

A

Sterile hypertonic intravenous crystalloid composed of water, sodium and chloride

54
Q

Hypertonic- hyperoncotic solution

A

Resuscitation fluid containing a hypertonic crystalloid (>310mOsmol) and hyperoncotic (>5%) colloid, that is used as an alternavite small volume fluid resuscitation strategy to rapidly increase intravascular fluid volume in the treatment of hypovolemia e.g. 7.5% saline dextran70 HSD. *synonym turbostarch

55
Q

Hypervolemia

A

excessive circulating blood volume = fluid overload

56
Q

Hypooncotic colloid

A

Colloid solution with an oncotic pressure below that of plasma e.g. 4% human albumin

57
Q

Hypoperfusion

A

Insufficient blood flow to the tissues, resulting in decreased oxygen delivery. End-organ hypoperfusion can manifest as cool extremities, reduced pulse quality, oliguria and tachycardia

58
Q

Hypotonic crystalloid

A

Crystalloid solution with a lower effective osmolality than plasma (e.g. 0.45% NaCl: 154 mOsm)
5% dextrose in water (d5w) despite having 278mOsm/L since dextrose is rapidly taken up into the cells and metabolized leaving water behind.

59
Q

Hypovolemia

A

Insufficient intravascular fluid volume, which may be absolute such as from dehydration and hemorrhage, or relative such as with vasodilatory shock

60
Q

Ineffective osmoles

A

Small disolved particles in solution that contribute to total osmolality but do not exert an osmotic pressure because they freely cross and equilibrate across cell membranes ( urea, dextrose)

61
Q

Insensible water loss

A

Body fluid losses that cannot be easily measured, such as evaporative losses from the skin and respiratory tract and the water content of the stool.

62
Q

Interstitial fluid and % of the total BW

A

total volume of extracellular fluid contained within the interstitial tissues surrounding cells (12-15% of total body weight)

63
Q

Intracellular fluid and % of the total BW

A

total volume of fluid contained within cells (40% of the total BW)

64
Q

Intravascular fluid and % of the total BW

A

Total volume of extracellular fluid contained within arteries, veins and capillaries in the circulatory system ( 6-8% of total BW)

65
Q

Intravascular volume depletion

A

reduction in intravascular fluid volume, which is a type of extracellular fluid depletion

66
Q

Isooncotic fluid

A

Colloid solution with an oncotic pressure similar to that of plasma (6% hydroxyethlyl starch, 5% human albumin)

67
Q

Isotonic crystalloid

A

Crystalloid solution with an osmolality similar to plasma. Isotonic saline: 0.9% NaCl or balanced solutions: LRS , normosol-R

68
Q

Lactic acidosis

A

Hyperlactatemia with concurrent metabolic acidosis. Lactate is produced by skeletal muscle and other tissues in large amounts during anaerobic conditions and is commonly used as a marker of the adequacy of tissue perfusion (type A lactic acidosis). Increased production of L-lactic acid in the absence of hypoxia or increased demand for ATP is termed type B lactic acidosis. Notably, rapid intravenous administration of lactated Ringers solution increases plasma lactate concentration within 10 min but baseline values are reestablished within 60 min after cessation of administration.

69
Q

Lean body mass

A

total body weight minus the weight of fat. Calculated as 80% of ideal BW when 20% is the weight of fat.

70
Q

Liberal vs restrictive fluid therapy

A

term applied to randomized trials investigating the effect on morbidity and mortality of.a conservative (restrictive) fluid strategy, compared to a standard (liberal) fluid regimen. Many standard fluid regimens are more likely to result in a positive fluid balance

71
Q

Macrocirculation

A

Large and medium-sized arteries and veins that serve as conduit vessels, transporting blood to and from organs and tissues

72
Q

Maintenance fluid

A

type of crystalloid solution. that is designed to maintain hydration by meeting daily water and electrolyte requirements. Both hypotonic and isotonic fluids can fulfill these requirements

73
Q

Maintenance fluid therapy

A

fluid therapy plan designed to provide water and lytes in quantities that meet normal daily fluid needs and replace urinary, gastrointestinal and evaporative losses.

74
Q

Massive hemorrhage

A

Loss of more than 40-50% of total blood volume over 24 hours

75
Q

Microcirculation

A

Blood vessels < 200 - 300 micrometers in diameter, consisting of small arteries, arterioles, capillaries and venules

76
Q

Osmolality

A

Measure of the concentration of osmotically active particles per kg of solvent, measured in milliosmoles per kg (mOsm/kg). In clinical practice, osmolarity (mOsm/L) and osmolality (mOsm/kg) are similar enough to be used interchangeably.

77
Q

Osmolarity

A

Measure of the concentration of osmotically active particles per unit mass of solution, measured in milliosmoles per L of solvent (mOsm/L). In clinical practice, osmolarity and osmolality are similar enough to be used interchangeably.

78
Q

Osmosis

A

process by which the molecules of a solvent tend to pass through a semipermeable membrane from a less concentrated solution into a more concentrated solution, thus equalizing the concentrations on both sides of the membrane.

79
Q

Parenteral

A

Administration of food or medication through a non-enteral (e.g. non-oral) route, such as IV, SC, IM and Intradermal

80
Q

Parkland formula

A

FLuid resuscitation protocol for burn patients which calls for lactated ringer’s solution dosed at 4ml/kg/%TBSA, where %TBSA refers to the percentage of the total body surface area burned. Half of the volume is delivered over the first 8h. and the remainer over the next 16 hours

81
Q

Perfusion

A

passage of fluid through the circulatory system to organs and tissues

82
Q

Permissive hypotension

A

Fluid therapy technique that aims to provide enough resuscitation fluid to ensure adequate end-organ perfusion while maintaining mild hypotension ( systolic pressures 80-90mmHg) until definitive hemorrhage control can be achieved.

83
Q

Plasma

A

liquid portion of blood that remains after the cells are removed. Plasma is retrieved by centrifugation of an anticoagulated blood sample, and so unlike serum, it contains fibrinogen and clotting factors.

84
Q

Pleth variability index (PVI)

A

An automatic measure of the dynamic change in perfusion index (PI), as determined by a pulse oximeter, occuring during a complete respiratory cycle. The pulse oxymeter derived pulsatile signal is indexed against the non-pulsatile infrared signal and expressed as a percentage [PI = (AC/DC) x 100] reflecting the amplitude of the pulse oximeter wave form. The pulse variablity index is calculated as PVI = [(PImax - PImin)/PImax] x 100

85
Q

Proteid

A

A complex biomolecule predominantly made of polypeptides that is found in all living matter

86
Q

Pulse pressure (PP)

A

The difference between arterial systolic and diastolic blood pressure measured in millimeters of mercury (mmHg)

87
Q

Pulse pressure variation (PPV)

A

Difference between the maximum (PPmax) and minimum (PPmin) arterial pulse pressures during one respiratory cycle, divided by their mean (PPmax + PPmin / 2). The equation is [(PPmax + PPmin/PPmean) x 100] and expressed as a percentage. Pulse pressure variation is used as a predictor of fluid responsiveness in mechanically ventilated patients

88
Q

Pulse wave transit time (PWTT)

A

Time needed for a pulse wave to travel between two arterial sites. Due to its inverse relationship to stroke volume, it can be used to assess changes in cardiac output and to evaluate fluid responsiveness in dogs after a fluid challenge. It also serves as a marker of of arterial stiffness in human with coronary artery disease. PWTT can be calculated as the time from the peak of the R-wave on an electrocardiogram to the rise point of the pulse oximeter wave ( the point where it attains 30% of its maximal amplitude)

89
Q

Rebound hypovolemia

A

Hypovolemia produced by diuresis induced by rapid bolus fluid administration to conscious animals

90
Q

Relative hypovolemia

A

Reduction in the effective circulating blood volume due to venodilation and increased venous capacitance. Relative hypovolemia can be caused by drug toxicity (e.g. sensitivity to anesthetic drugs or anesthetic overdose), impairment or loss of compensatory mechanisms, coexisting or induced inflammation, sepsis, cardiogenic shock and hypothermia

ACVECC prep 2022 (19 decks)

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