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Renal > Therapy of shock > Flashcards

Therapy of shock Flashcards

1
Q

Why can fluid therapy be dangerous?

A
  • starling’s equation determines fluid movement in healthy animals but this can be altered if an animal is ill
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2
Q

Which patients are at risk of fluid overload?

A
  • cardiac dz
  • pulmonary dz
  • oliguric/anuric renal failure
  • geriatric cats (undetected dz)
  • hypoalbuminaemia
  • sepsis/ SIRS
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3
Q

What happens when we give too much fluid?

A
  • pulmonary oedema
  • interstitial oedema (SC oedema, oedema of organs –> decreased function)
  • 3rd space loss
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4
Q

CS -fluid overload

A
  • pulmonary crackles (generalised)
  • RR and RE
  • peripheral oedema
  • chemosis of eyes
  • bilateral serous nasal discharge
  • jugular distension/pulsation
  • increase in body weight
  • large L atrium on US
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5
Q

Where are you wanting fluids to disperse in a. shock and b. dehydration?

A

a. intravascular space

b. interstitial space

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6
Q

When should you tx for shock?

A

tx until 6 perfusion parameters are normal

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7
Q

How much is too much to give?

A

no more than one blood volume:
dog 80ml/kg
cat 50ml/kg

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8
Q

Components - fluid prescription

A
  • fluid type
  • dose rate (dose - shock, rate - dehydration)
  • additives
  • how to deliver
  • when to stop
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9
Q

Name 3 types of crystalloid

A
  • ISOTONIC (hartmann’s, CSL, LRS, 0.9% NaCl)
  • HYPERTONIC (7.5% NaCl)
  • HYPOTONIC (0.45% NaCl, 5% dextrose)
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10
Q

Name 2 types of colloid

A
  • SYNTHETIC (Volulyte)

- NATURAL (blood products, albumin)

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11
Q

Which fluids aren’t used to tx shock?

A

hypotonic

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12
Q

What are balanced crystalloids

A

contain Na, K and lactate

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13
Q

Why is there lactate in isotonic crystalloids?

A

metabolised to bicarbonate –> neutralises blood so treats metabolic acidosis (which occurs in shock)

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14
Q

Why do Isotonic crystalloids contain K+?

A

doesn’t usually cause hyperkalaemia (so can be used even if K+ in blood is slightly high), because diuresis causes increased renal excretion

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15
Q

Why do isotonic crystalloids contain Ca?

A

calcium chelates with sodium citrate preservative in blood products so DON’T give in same IV line unless you flush line through first with saline`

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16
Q

Indication - isotonic crystalloid

A
  • hypovolaemic shock (all causes
  • obstructive shock
  • vasodilatory shock
  • dehydration/ maintenance
  • diuresis (azotaemia, toxicity)
  • tx metabolic acidosis (hartmann’s, CSL, LRS)
  • tx metabolic alkalosis (0.9% NaCl)
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17
Q

What crystalloid dose for dogs and cats?

A
  • DOG: 10-20ml/kg IV
  • CAT: 5-10ml/kg IV
  • deliver over 15 minutes
  • repeat up to 4 times (monitor 6 perfusion parameters/ fluid overload).
18
Q

How many times should you repeat an isotonic crystalloid therapy?

A

If no improvement after 2 doses –> STOP!

19
Q

Indications - hypertonic saline

A
  • traumatic brain injury
  • cerebral oedema
  • large breed dog
  • CPR
20
Q

Contraindications - hypertonic saline

A
  • if patient is originally hyper or hyponatraemic

- dehydration

21
Q

Dose - hypertonic saline - 7.5% NaCl

A
  • 2-4ml/kg over 10 mins
  • bolus or CRI
  • only once
  • follow with isotonic crystalloids
22
Q

Indications - artificial colloids

A
  • severe hyperproteinaemia

- large dog

23
Q

Adverse effects - artificial colloids

A
  • kidney injury
  • coagulopathy
  • increased risk of fluid overload
24
Q

Contraindications - artificial colloids

A
  • coagulopathy
  • renal failure
  • sepsis (as animals are more prone to kidney injury)
25
Q

Dose - artificial colloids

A
  • DOG 5-10ml/kg over 15 minutes
  • CAT 2.5-5ml/kg over 15 minutes
  • repeat up to 4 times
26
Q

How do we deliver IVFT?

A
  • medium-large dogs: pressure bag
  • small-medium dog: fluid pump
  • cats: careful of fluid overload, 50ml syringe by hand, syringe driver, fluid pump with paediatric burette
27
Q

Components of continuous fluid therapy

A
  • maintenance
  • dehydration
  • ongoing losses
28
Q

Maintenance - define

A
  • normal daily fluid requirement
  • isotonic crystalloids: Hartmann’s, LRS, CSL, 0.9% NaCl
  • rate 2ml/kg/hr
29
Q

CS - dehydration

A

not detectable

30
Q

CS - dehydration 5-8%

A

slight increase in skin tent

possible tacky MM

31
Q

CS - dehydration 8-10%

A
  • definite increase skin tent
  • tacky MM
  • dry tear film
32
Q

CS - dehydration 10-12%

A
  • greater skin tenting
  • tacky MM
  • sunken eyes
  • shock
33
Q

What is the equation for dehydration replacement?

A

Total replacement amount (ml) = % dehydration/100 * BW * 1000
- administer over 8-24 hours

34
Q

What are ongoing losses?

A
  • V/ D
  • 3rd space loss (cavity effusions)
  • wounds
  • PU
35
Q

What rate for fluids is given for ongoing losses?

A
  • measure/weigh: vomit, diarrhoea, urine

- estimate 0.5-1.5* maintenance (low - for mild losses, higher end - more severe cases)

36
Q

Indications - hypotonic crystalloids

A

hypernatraemia only (NOT for maintenance of shock)

37
Q

Why add potassium chloride?

A
  • hypokalaemia (V, D, PU)

- don’t exceed >0.5mmol/l/kg/hr as high K can be toxic

38
Q

When add potassium phosphate to fluids?

A

hypophosphataemia (e.g. DKA)

39
Q

Why add dextrose to fluids?

A

hypoglycaemia

40
Q

Other than IV, how can fluids be given?

A
  • oral
  • SC
  • intraosseous
41
Q

What happens to fluid given to the intravascular space?

A

3/4 redistributes in the interstitial space (sometimes this is not what you want)

Renal (30 decks)

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