Test 1: Fluids Therapy, Shock, and Sepsis Flashcards by Preeti Gulve

The foundation of

The Problem Oriented Approach to Medicine

involves the systematic collection of information assembled in a database that is the same for each patient. What is included in this database?

Signalment

Owner’s Complaint

History

Physical Exam

Working Problem List

Differential Diagnosis List

Diagnostic Testing Plan for each problem on DDx

Treatment Plan and Prognosis

Therapeutic Plan and monitoring of efficacy

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What does SOAP stand for?

Subjective, Objective, Assessment, Plan

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What is used to monitor the efficacy of a therapeutic plan in the problem oriented approach to medicine?

SOAP

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What are the steps of a general physical exam?

Inspection

Palpation

Auscultation

Percussion

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Your body weight is ____% water

60%

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40% of your body weight is water stored in the

_______ space

intracellular space

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_______ space contains 1/3 of body water

extracellular space

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What are the 3 compartments of extracellular space?

Interstitial (ECF)

Intravascular (plasma)

Transcellular (CSF, Synovial fluid)

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What are the 2 basic non-blood fluids used in

fluid therapy?

Crystalloids

Colloids

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This fluid ends up in

interstitial spaces

Crystalloids

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This fluid remains in

intravascular spaces

(in the plasma)

Colloids

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Hypotonic Crystalloid fluids

draws fluid into cells

because it has a

_____ osmolality than intravascular fluid

lower

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Hypertonic Crystalloid fluids

draw water out of cells and into the intravascular space because it has a

_____ osmolality than blood cells and plasma

higher

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Ringer’s Solution is an example of

a crystalloid ______ fluid

isotonic

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Normosol M is an example of a

crystalloid ______ fluid

hypertonic

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What is the most commonly used synthetic colloid fluid used?

Hetastarch

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If you want to correct dehydration, shock, or diarrhea, what type of fluid would you use?

Crystalloids

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What disorders or diseases can cause a patient to

have a low serum albumin level?

(Less than 3 or about 4.5)

Vasculitis

PLN (protein losing nephropathy)

PLE (protein losing enteropathy)

Liver Failure

Sepsis

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In a patient with a low albumin level, what

type of fluid would you choose to treat it?

Colloids

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What could happen if you give a

large amount of crystalloid?

Peripheral edema

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When would you give a patient

a crystalloid and a colloid together?

Combine maintenance fluids with colloids in patients with low albumin

To decrease the amount of crystalloid used

To restore a fluid deficit of the intravascular space more rapidly

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What type of fluid is used to replace fluid loss?

Replacement fluid

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What type of fluid is used to replace daily sodium loss?

Maintenance fluid

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What type of fluid can you give rapidly?

Replacement fluid

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If you use a replacement fluid as a maintenance fluid, what could happen?

Patient could become ***hypernatremic*** and their brain could swell causing CNS signs

What disease is contraindicated in Colloid usage

Heart failure

Human albumin, a colloid, causes what serious potential side effect in dogs?

Anaphylaxis

What are the 2 indications for use of ***hypertonic saline*** (a crystalloid)?

***Hypo****volemic shock* (in cases withOUT dehydration or hypernatremia) *Head trauma*

What are potential side effects of rapid administration of hypertonic saline?

Bronchoconstriction Bradycardia HYPOtension

How many mLs of hypertonic saline can you administer over **20 minutes** to a dog? To a cat?

Dog: **4-7 mL/kg** Cat: **2-3.5 mL/kg**

What is the Sliding Scale of Scott used to determine?

The amount of **potassium** to be added to fluids based on the patient's *existing K level*

Why would you add potassium to fluids?

Because patients that aren't eating become hypokalemic in a few days

**Kmax** is *how rapidly you can give fluids with potassium added to it.* What is the Kmax dose?

**0.5 mEq/kg/hr**

What is the best method of fluid administration in a patient experiencing Dehydration or Shock?

IV administration

What is the best method of fluid administration for a pediatric animal?

Intraosseous administration

What is the best method of fluid administration in a patient in chronic renal failure?

SubQ administration

How do you calculate the maintenance dose of fluids for a dog? For a cat?

Dogs need **60 mL/kg/day** Cats need **40 mL/kg/day**

If a patient has decreased fluid in *intracellular or interstitial* spaces, it is suffering from what?

Dehydration

If a patient has decreased fluid in *intravascular spaces* it is suffering from what?

Shock!

What is the most common fluid used in vet med?

Isotonic crystalloid

Replacement fluids and Maintenance fluids are both \_\_\_\_\_\_\_ fluids

_isotonic_ fluids

The sodium concentration of this type of fluid is close to the *normal plasma sodium concentration* which is **[140 mmol/L]**

Replacement fluids

The sodium concentration for this type of fluid is *close to normal TOTAL body sodium concentration* which is **[70 mmol/L]**

Maintenance fluids

What is the most commonly used Replacement Fluid?

**LRS**

Uh oh! You are a vet and only have replacement fluids on hand, but you have a patient that needs maintenance fluids STAT! What do you do?

Give it the replacement fluids BUT: Add POTASSIUM and Monitor Serum Sodium level

If you want to restore clotting factors, antithrombin III or albumin, what type of fluid would you use?

Colloid, Plasma specifically

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

Hetastarch

What is the max daily dose of Hetastarch in a CRI which is formulated as a 6% solution in saline?

**10-20** mL/kg/day

A bolus dose of Hetastarch, which is **5 - 10** ml/kg over **5 - 10 minutes** is given in what case?

Hypovolemia

Some cats get restless or salivate when given this fluid

Hetastarch

You should NEVER give hetastarch to a patient with

heart failure

**Cardiac patients** should be given THIS formulation of fluids because the high sodium load in the other fluids can *unmask preclinical congestive heart* *failure due to volume overload **because water follows sodium***

**0.45%** NaCl **+** **2.5%** dextrose

If a patient has a prolonged capillary refill time (CRT) but its eyes do not appear to be sunken, what would you estimate its dehydration status to be?

**10%** With sunken eyes would be **13%**

What are the signs of *hypovolemic shock*?

Tachycardia Bradycardia-in cats Prolonged CRT Poor pulses Decreased urine output

How do you calculate the **fluid deficit** in a dog or cat?

**%**dehydrated **x** body weight in **(kg)**

In a dehydration case, how much of the calculated fluid deficit needs to be replaced within the first **4 - 6 hours**?

**HALF the deficit**

**One circulating blood volume** is equal to what?

The shock dose fluid volume

How do you calculate the shock dose, which is equal to one circulating blood volume, for a dog? For a cat?

Dog Shock Dose= **90** mL/kg/**hour** Cat Shock Dose= **45** mL/kg/**hour**

After calculating the shock dose volume, you want to give **1/4 of that as a BOLUS** immediately. How do you calculate the BOLUS of the shock dose?

**Weight in lbs and add a 0**

If an animal has a fever, how does this change your fluid calculations for **maintenance fluids**?

You give an additional **15 - 20 mL/kg/day** in cases of fever

What is the most common type of shock?

Hypovolemic circulatory shock

What MAP is considered a STRONG pulse?

MAP **\>** **80** mmHg is strong

SIRS (Systemic Inflammatory Response Syndrome) is associated with this type of shock

Vasodilatory/Distributive circulatory shock

What are the 5 classifications of circulatory shock?

Hypovolemic Cardiogenic Vasodilatory/Distributive Obstructive A combination of the above

Which disease is associated with obstructive circulatory shock, and it obstruction of venous return?

GDV gastric dilation volvulus

Sepsis, anaphylaxis, and emboli are all associated with this type of shock

Vasodilatory/ Distributive circulatory shock

What kind of shock is caused by an anesthetic overdose?

Cardiogenic circulatory shock

What is hypoperfusion?

Decreased blood flow through an organ

Septic shock results in _____ perfusion, and severely altered hemodynamics

_decreased_

What are the two phases of septic shock?

Hyperdynamic (warm) Hypodynamic (cold)

Which phase of septic shock is rarely seen in cats?

Hyperdynamic (warm) phase is rarely seen in cats

Which stage is more severe in septic shock?

Hypodynamic (cold) stage which occurs after the warm stage has progressed

Hypodynamic (cold) stage of shock can progress to this syndrome

MODS Multiple Organ Dysfunction Syndrome

Describe the pathophysiology of the **compensated** stage of shock

decreased blood volume--\> decreased vessel filling--\> activation of stretch baroreceptors--\> increased sympathetic stimulation and vasoconstriction

What are a dog's shock organs, the organs which experience decreased blood flow during the compensated stage of shock?

GI tract and Liver

What are a Horse's shock organs, the organs which experience decreased blood flow during the compensated stage of shock?

GI tract and LUNGS

What are a Cat, Ruminant, or Pig's shock organs, the organs which experience decreased blood flow during the compensated stage of shock?

LUNGS only

What physiological change marks the progression from the compensated stage of shock to the decompensated stage of shock?

If the blood volume problem is not fixed, * the local tissue beds that were **vasoconstricted*** * start to **vasodilate***

The decompensated stage of shock can lead to maldistribution of blood to non-essential organs, as well as this syndrome

MODS multiple organ dysfunction syndrome

What is the difference in treatment of hemorrhagic hypovolemic shock and non-hemorrhagic hypovolemic shock?

For hemorrhagic shock, you need a blood transfusion because blood and fluid is being lost to the internal OR external environment. For non-hemorrhagic, fluid is being lost to the external environment, and it can be replaced with IV fluids

What is the purpose of heparin in treatment of septic shock?

To improve the efficacy of antithrombin III in neutralizing activated coagulation factors

Why would vasopressors be considered in treatment of septic shock?

If the jugular vein is distended, if crackles are heard on auscultation, or if the CVP is greater than 10 cm H20, you would consider vasopressors because the patient is at risk for **fluid overload**

What are 2 examples of vasopressors?

Dopamine Dobutamine

Vasopressors are given for _______ shock, Vasodilators are given for ______ shock

Vasopressors- Septic shock Vasodilators- Cardiogenic shock

What is the level at which CVP (central venous pressure) indicates fluid overload?

CVP **\>12 - 15** cm H20 is indicative of fluid overload

Describe the pathophysiology of SIRS

PAMPS expressed by the pathogen (LPS or Endotoxin in gram neg bacteria or Peptidoglycan in gram pos bacteria) stimulate PRRs on host immune cells (monocytes, macs, neutrophils) and the result is *intracellular signaling cascade that releases proinflammatory cytokines*

What are the 3 proinflammatory cytokines?

TNF IL1 IL6

What are the 3 anti-inflammatory cytokines?

IL4 IL10 IL13

Leukotrienes, prostaglandins, thromboxanes, nitric acid, platelet activating factors, and free radicals are all inflammatory \_\_\_-regulators

inflammatory _up_-regulators

What is it called when inflammation is NOT contained?

SIRS

When SIRS is due to infection, it is called \_\_\_\_\_\_\_

_SEPSIS_

What are 6 things that can cause SIRS that are non-infectious causes?

HYPOtension Trauma and hemorrhage Hypoxia and ischemia Pancreatitis Burns Neoplasia

Second Hit Theory occurs in what syndrome?

SIRS

If SIRS or Septic Shock progress, they can turn into this syndrome

MODS

Failure of the coagulation system resulting in widespread clotting but at the same time, bleeding is called

DIC Disseminated Intravascular Coagulopathy

What is the main trigger for DIC?

Release of **tissue factor**

What would you see on a lab panel that would indicate DIC?

Prolonged PT and PTT Thrombocytopenia Low fibrinogen Positive D-Dimer

What are the 3 mechanisms of diarrhea?

Secretory Malabsorptive/Maldigestive Osmotic