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LAM 1 > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

What is the calculation for correcting fluid loss?

A

Deficit (dehydration) + Ongoing Losses + Maintenance over 24hr

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2
Q

What are the characteristics of a 5% dehydrated horse?

A

Skin Tent: 1-3 sec
MM/CRT: Moist to slightly tacky, normal
HR: Normal
Other: Decreased Urine output

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3
Q

What are the characteristics of an 8% dehydrated horse?

A

Skin Tent: 3-5 sed
MM/CRT: Tacky, often 2-3 sec
HR: 40-6 bpm
Other: Decreased arterial BP

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4
Q

What are the characteristics of a 10-12% dehydrated horse?

A

Skin Tent: 5 or more sec
MM/CRT: Dry, often >4 sec
HR: 60 bpm or more
Other: Reduced jugular fill, barely detectable peripheral pulse, sunken eyes

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5
Q

What are the characteristics of a 12-15% dehydrated horse?

A
  • Obvious sunken eyes

- Obvious shock

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6
Q

At what percent dehydration is the horse closet death or dead?

A

15%

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7
Q

T/F: Sunken eyes are more obvious in food animals and may not be very apparent in horses.

A

True

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8
Q

What is the best way to administer fluids to an animal with an intestinal obstruction?

A

PO- helps to break up the blockage and return mobility to GIT

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9
Q

What instances would we want to over-hydrate a horse?

A
  • Impaction
  • Pneumonia or dried respiratory secretions in airways
  • Renal failure to provide diuresis
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10
Q

What are the advantages of oral administration of fluids?

A
  • Most physiologic
  • Least expensive/invasive/ complication
  • Can give large volumes
  • Useful for GI impaction
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11
Q

Horses with what issue would be best to administer fluids PO rather than IV?

A

Horses with decreased jugular filling

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12
Q

What are the disadvantages to oral administration of fluids?

A

Contraindicated in gastric distension and ileus

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13
Q

What kind of needles/catheters are typically used to administer IV fluids?

A

14g 5.5” needles

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14
Q

What veins can be used to administer IV fluids?

A
  • Jugular vein (first choice)
  • Lateral thoracic vein (dysfunctional jugular)
  • Cephalic Vein
  • Saphenous vein
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15
Q

What direction should jugular catheters be placed in order to administer fluids?

A

Tip towards the heart

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16
Q

What is the disadvantage to lateral thoracic catheters in recumbent animals?

A

Dislodge easily; typically only placed for low volume of fluids or for medication administration

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17
Q

What is the first choice for limb vein catheters?

A

Cephalic vein- may clot easily

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18
Q

What is a disadvantage of saphenous catheter placement?

A

Easily bent by limb motion and poorly tolerated

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19
Q

When is a saphenous catheter going to be beneficial?

A

Severely depressed horses when other places have been overused/can’t be accessed

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20
Q

What are the advantages of IV fluid administration?

A
  • Easy access
  • Nearly unlimited fluid volume limit
  • Allows for easy changes in fluid plan
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21
Q

What are the disadvantages of IV fluid administration?

A
  • Dangerous in compromised veins
  • Sepsis- requires sterility
  • Expensive
  • Requires monitoring and hospitalization
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22
Q

Why is SQ fluid administration nearly never used in adult horses?

A

Skin is not very elastic

Can sometimes be used in foals

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23
Q

What kind of needles/catheters are used for IP fluid administration?

A

Same as for jugular- 14g 5.5”

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24
Q

Where are IP fluid administered?

A

Dorsal aspect of the left flank at the paralumbar fossa on the left

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25
Q

Why are IP fluids ONLY administered on the left?

A

The cecum lives on the right and you don’t want to poke it

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26
Q

What are the disadvantages to IP fluid administration?

A

You cannot give large volumes of fluid (can lead to colic) and risk of septic peritonitis if not done sterile

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27
Q

What position should the horse be in for rectal administration of fluids?

A

Hind end on an incline above the head

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28
Q

What are the advantages of rectal fluid administration?

A
  • Allows for absorption across rectum mucosa
  • Large volumes at rapid rates
  • Easy for severely dehydrated animals to increase circulating volume
  • Good choice when PO would be ideal but is contraindicated (reflex)
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29
Q

What are the disadvantages of rectal fluid administration?

A
  • Unlikely to help in moderate to severe ileus

- Contraindicated in severe colitis and diarrhea

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30
Q

What are the flow rates for a 14Gx 5.25” catheter?

A

219 mL/min or 13.1 L/hr

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31
Q

What are the flow rates for a 12Gx 5.25” catheter?

A

449 mL/min or 26.9 L/hr

32
Q

What are the flow rates for a 10Gx 5.25” catheter?

A

609 mL/min or 36.5 L/hr

33
Q

What are the characteristics of a long term catheter?

A

Can be left in for several weeks
More expensive
Typically made of polyurethane or silicone

34
Q

What are the characteristics of a short term catheter?

A

Should be removed or replaced with relative frequency

Typically made of teflon or polyethylene

35
Q

What is the limiting factor for flow rate in the Stat IV set up with 14g, 12g, and 10g catheter?

A

14g- Catheter
12g- Catheter
10g- Stat IV set

36
Q

What is the max flow rate of the Stat IV set?

A

27-28 L/hr for a standard 10ft ceiling (8ft bag height)

37
Q

What is the flow rate from a free flow system determined by?

A
  1. Height from the base of the heart
  2. Size of the tubing in the entire system
  3. Length of the system
  4. Fluid viscosity
  5. Catheter gauge and length
38
Q

How many bags are hooked up to the system in a Stat IV set?

A

4x 5L bags

39
Q

What are some common catheter complications?

A
  • Perivascular leakage
  • Thrombosis
  • Phlebitis
  • Thrombophlebitis (can be septic)
  • Breakage
40
Q

What is perivascular leakage from a catheter typically caused by?

A

Cracks at the edges of the catheter and hub

41
Q

What are some consequences of perivascular leakage?

A

Local abscessation, neurological dysfunction, sloughing of tissue (especially if medications are cytotoxic)

42
Q

What is the most concerning complication of catheter placement?

A

Septic thrombophlebitis- may necessitate the removal of the jugular vein

43
Q

T/F: Catheter breakage is not too big of a deal.

A

Yes and no- not the worst thing in the world but you do want to go find the broken catheter within 24 hours or risk it moving into the lungs

44
Q

What is typically the maximum amount of fluids you want to administer in one hour?

A

One blood volume or 8% BW in kg

45
Q

What is the maximum shock dosage in a horse?

A

60-90 mL/kg/hr (can be up to 9% of bw)

46
Q

Is it appropriate to administer more than one blood volume if indicated clinically?

A

Depends on the case

47
Q

What strength is isotonic saline?

A

0.9%

48
Q

What strength is hypotonic saline and what horses do we use it most in?

A

0.45%

Typically used in foals

49
Q

What strength is hypertonic saline?

A

1.8% or tup to 7-7.4%

50
Q

What does hypertonic saline do?

A

Rapid increase in circulating volume and decrease in peripheral resistance

51
Q

What are the advantages of hypertonic saline?

A
  • Requires small volumes which makes transport easier
  • Does not support bacterial growth
  • Inexpensive
  • No special management
52
Q

What are the local effects of hypertonic saline?

A

Draws fluid from extravascular areas, 3rd space, and intracellular environment

53
Q

What are the central effects of hypertonic saline?

A

Stimulates a CNS response favoring CV stability

54
Q

What are the adverse effects of hypertonic saline?

A

Hemolysis and cardiovascular alterations

55
Q

When is hemolysis most likely when administering hypertonic saline?

A

When it is given in a small vessel

Counteract with 25% HS and 24% Dextran

56
Q

What cardiovascular alterations can occur with hypertonic saline administration?

A

Arrhythmias and VPCs

57
Q

What are the contraindications of hypertonic saline administration?

A

Uncontrolled hemorrhage, severe hypernatremia, sever hypokalemia

58
Q

What condition of horses do you particularly want to avoid hypertonic saline administration in?

A

Ruptured uterine artery prior to foaling (unless the foal is more important than the mare via owner)

59
Q

T/F: Dehydration is a contraindication of hypertonic saline administration.

A

False- dehydration alone is fine

Dehydration with hypernatremia is not fine

60
Q

What are other fluids that can be administered to horses?

A

LRS, Normosol, Plasmalyte, Dextrose

61
Q

Why is PCV labile in the horse?

A

Splenocontraction can alter PCV dramatically very quickly

62
Q

Why would chloride be retained while sodium is lost?

A

In an attempt to balance electroneutrality if bicarb is being lost

63
Q

What can sodium and chloride losses be used to predict?

A

Likelihood of metabolic acidosis (anion gap)

64
Q

What kind of acidosis should you NOT administer bicarb in?

A

Respiratory acidosis- can make it worse

65
Q

What is the calculation for bicarb dosages in metabolic acidosis cases?

A

Deficit (normal is 25) x distribution (0.3, 0.4 or 0.5)

Administer 1/2 dose over 1 hr and re-evaluate need

66
Q

What should bicarb be administered in?

A

Isotonic fluid- typically LRS if bicarb is around 17-18

67
Q

Why might an animal with normal potassium suddenly become hypokalemic once fluids are administered?

A

Potassium uptake back into the cells

68
Q

When should you always supplement potassium?

A

In cases of decreased feed intake

69
Q

T/F: Calcium should always be supplemented more conservatively than potassium.

A

Yes- horses have massive calcium stores in their bones

70
Q

What is the maximum potassium supplementation rate?

A

0.5 mEq/kg/hr

71
Q

What is the typically guideline?

A

10-20 mEq/L per horse

72
Q

What kind of fluids should you NOT administer potassium in?

A

Replacement fluids- rate is too high and can lead to over dose

73
Q

T/F: Horses will typically have isotonic sodium losses if related to GI disease

A

True

74
Q

T/F: Both hyper- and hyponatremia will result in CNS dysfunction due to fluid shifts in the cells.

A

True

75
Q

What may hyponatremia be due to?

A

Chronic dehydration- triggers thirst centers and will drink massive amounts which increases renal excretion

LAM 1 (10 decks)

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