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1

Body fluid composition

Water makes up 60% of weightIntracellular water--40% of weight, 2/3 of total body water, high K +Extra cellular water--20% of weight, 1/3 of total body water, high Na +EC water is1. Intravascular/plasma 25%2. Extravascular/interstitial 75%

2

Movement of fluid within the body depends on.....

... The balance btwn 1. Filtration (incr hydrostatic P, decr oncotic P)2. Resorption (decr hydrostatic P, incr oncotic P)occurs at the level of the capillary

3

Define dehydration

Hypohydration= loss of bodily fluidsCauses: GI, renal, burns/skin, respiratory tract, saliva, third spacing, hemorrhage

4

Dehydration and PE chart

<5% non-detectable5-8% decr skin turgor, dry MM8-10% + eyes sunken, prolong CRT10-12% + severe skin tent, eyes sunken, prolong CRT, dry MM, +/- shock12% life threatening

5

Shock dose dog vs cat

Dog 90ml/kgCat 50 ml/kg= to one blood volume

6

hyper vs hypotonic fluid losses

hypotonic fluid losses (loss of water >solutes)-->tonicity of extracellular fluid incr-->water shifts from intracellular to extracellular-->intracellular dehydrationhypertonic fluid losses (loss of solutes >water)-->tonicity of intracellular fluid will be higher or hypertonic and fluid to shift from extracellular to intracellular-->extracellular dehydration

7

guidelines for calculating rehydration for patient

KG x % dehyd (replacement) +estimated losses + maintanence

8

osmolarity of plasma

290-310 mOsm/L

9

isotonic fluids contain which types of bicarbonate precursors

alkalinizing effect1. lactate--metabolized by liver (D-lactate is not mx)2. acetate--metabolized by muscle (more profound effect)3. gluconate--metabolized by many cells

10

Fluid choice for patients with hypoNa, hypoCl, metabolic alkalosis

0.9% NaCl

11

T/FLarge quantities of acetate containing fluids can cause vasodilation and decr in BP

trueLarge quantities of acetate containing fluids can cause vasodilation and decr in BPsecondary to adenosine release (potent vasodilator) from muscle

12

fluid choice for head trauma patients

0.9% NaClbecause of high Na content (154 mEq/L) and is least likely to cause decr in osmolarity and subsequent water movement into brain interstitium

13

replacement vs maintenance fluids

replacement---isotonic (hi NaCl)maintenance--hypotonic (low NaCl, hi K)

14

option to treat free water deficit

hypotonic fluid252 mOsm/L (slightly lower than plasma)5% dextrose with sterile water

15

fluid choice for patients with diabetes insipidus or hypernatremia

sterile water with 5% dextrose

16

T/FD5W can be given as a bolus

FALSEhypotonicif given as a bolus will distribute to all body fluid compartments, cause acute decreases in osmolarity and lead to cerebral edema.

17

Why administer hypertonic fluids slowly

if hypertonic fluids are given too fast (> 1 ml/kg/min) osmotic stimulation of pulmonary C fibers results in vagal mediated bradycardia, bronchoconstriction, hypotensionbc monocyte dehydration and subsequent friction btwn monocytes

18

goal of hypertonic saline solutions

draw extravascular water into the intravascular spaceosmotic diuresis

19

contraindications of HTS use

do not given in already dehydrated animalsphlebitis/hemolysisavoid right atrium (leads to arrhythmias)

20

How are synthetic colloids described

by their weight average (Mw) or number average (Mn) molecular weightpolydispersity index Mw/Mn ratiohigher molecular weight molecules are not metabolized or excreted as quickly as smaller particlespersist longer

21

side effects of colloid administration

disrupt normal coagulationdecr factor VIII, vWFimpair platelet fxinterfer w fibrin clot stability-->increased finbrinolysis

22

hydroxyethyl starch colloids are characterized by what?

contain highly branched starch, amylopectinweight average (Mw)--low, med, hiconcentration %# substitutions (more substitutions last longer)

23

T/F Total protein refractometer readings are a valid way of monitoring colloidal therapy

FALSEcolloids do NOT increase TP

24

Characteristics of oxyglobin

Hb based oxygen carrying fluidsterile, ultrapure, bovine Hb solutionnonantigenic40 mm Hg oncotic P13 ml/dL Hb concentration

25

Side effect of oxyglobin administration

NO scavenging affectsvasoconstriction

26

How much blood can most animals lose prior to blood transfusion

most can lose 10-15%acute hemorrhage > 20% often requires blood transfusion

27

dose of pRBC, FFP, or whole blood

pRBC 10-15 ml/kgFFP 10-15 ml/kgwhole blood 20-25 ml/kg

28

blood volume in dog vs cat

90 ml/kg dog50 ml/kg cat

29

calculation of volume of pRBC to be deliveredShort et al JVECCS 2012

volume of RBC to be delivered = blood volume x kg x (PCV goal-PCV current)/PCV donor blood1.5 x %PCV rise x kg (both gave accurate predictions in PCV post pRBC transfusion)

30

What does whole blood contain

clotting factors (no longer present if stored >24hr)plateletsRBCplasmause within 8 hr

31

pRBC characteristics

PCV ~ 80%shelf life 20 daysONLY RBCreadily available, low risk overload, reduced exposure to plasma antigens

32

What does plasma contain?

Protein (alb, globulins)Clotting factorsFFP within 6 hr-1yrFP >1yr--no longer has clotting factors

33

What does cryoprecipitate contain

vWf VIIIfibrinogenfibronectin

34

sequele of administering citrate containing blood products too quickly

chelation of Ca and clinical hypoCa

35

optional good products for vWF patients

cryoprecipitate (most effective)FFPplasma donors from dogs treated with desmopressin (DDAVP)

36

dose of DDAVP

1 mcg/kg SQ once before surgeryMOA: induces release of vWF

37

how many dog blood antigens

8 know canine blood antigens

38

how many dogs can tolerate a first blood transfusion

15% have reaction first time85% tolerate first transfusion fine

39

MOA of EACA

epsilon aminocaproic acidEACA binds lysine residues on fibrin-->BLOCKS activation of plasminogen to plasmin-->keeps clot longerantifibrinolytic used to treat greyhound bleeders

40

EACA and amputation in GHMarin 2012

5.7x more likely to bleed without EACA28% delayed post op bleeding GH

41

EACA and gonadectomy in GHMarin 2012

30% bleeding in placebo group/ 10% EACA groupEACA sign decr bleeding post op by increasing clot strength (TEG--MA)

42

feline blood typing

A--DSHB--persian, british, himalayanType A cats rarely have large quantities of antiB antibodiesType B cats OFTEN have STRONG antiA antibodies

43

Why is auto transfused blood not a dependable source of clotting factors

with hemorrhage into a body cavity, all clotting factors and fibrin are rapidly depleted

44

how to perform autotransfusion

mix aspirated blood with 10 ml of CPDA-1 or 3.8% citrate with 90 ml blood

45

anticoagulant used in blood transfusions

CPDA-1citrate phosphate dextrose adenine-1

46

potential risks of human albumin transfusion

fatal acute or delayed hypersensitivityvolume overloadcoagulopathyantibody formation (avoid repeat exposures)

47

regulation of Na and serum osmolarity

Osmoreceptors/Baroreceptors sense incr osmolarity or hypovolemiastimulate ADH/Vasopressin releaseJG apparatus RAASincreases aldosteronerenal Na/water retention

48

causes of hypoNa

-hypervolemia (CHF, Nephrotic synd, severe liver dz, kidney failure-normovolemia (psychogenic PD, inappropriate ADH, ADH drugs, myxedema, hypotonic fluid admin-hypovolemia (GI loss--V,d, Third spacing, burns, renal loss--addisons, ADH)

49

correcting low Na too quickly leads to

demyelination and central pontine myelinolysisDO NOT EXCEED 0.5 mEq/L/hr

50

correcting hi Na too quickly

cerebral edemaDO NOT EXCEED 1 mEq/L/hr

51

causes of hyperNa

usually from free water losses--hypovol (GI loss--V,d, Third spacing, burns, renal loss, diuresis)--normovol (Diabetes insipidus, inadequate H2O, incr insensible losses)--hypervol (excessive salt ingestion, HTS, Cushings, hyperaldosterone)

52

calculation of a free water deficit

free water deficit (L) = 0.6 x KG x (Na present/Na normal-1)

53

normal resting membrane potential and cation in charge

intracellular K+--90mV inside the cell relative to outside the cell

54

regulation of body K

GIKidneyTranscellular shifts

55

list two fluids that contain acetate

Plasmalyte-148Norm-R

56

What are side effects of low oncotic pressure

negative effect on wound healingpredispose to bacterial translocationinterstitial edemadecrease tissue perfusionincrease distance for oxygen and nutrients to travel

57

when does K move from extracellular to intracellular

during presence of glucose, insulin, catecholamines, metabolic alkalosis

58

when does K move from IC to EC

during metabolic acidosis, hyperosmolarity

59

total body hypoK causes

decreased intake (insufficient diet, K depleted fluids)Increased losses (GI, Renal, drug induced diuretics, Penicillins, amino glycosides, hyperadrenocorticism/aldosteronism--mineralocorticoid excess)Translocation (alkalemia, insulin/glucose, TPN, catecholamines, hyperthyroid, HKPP)

60

define paradoxical aciduria

with GI loss of fluids with are K and Cl rich--> hypoK, hypoCl, hypoNa-->kidneys attempt to maintain Na and rid K,H-->worsens hypoK and metabolic alkalosis but H in urine (paradoxical aciduria)

61

what mineral should be checked with refractory hypoK and hypoCa

magnesium

62

EKG changes of hyperK

spiked T waveprolonged PR intervalbradycardiawidened QRSdisappearance of P wavesV fib/asystole

63

general clinical signs of hypoK

< 3 muscle weakness, arrythmias2 rhabdomyolysis<2 respiratory muscle paralysis

64

classical clinical signs of hypoK in cats

cervical ventroflexionstiff stilted gaithindlimb weaknessplantigrade stance

65

what effect does low K have on pancreatic islet cells

low K impairs insulin release from beta pancreatic cells

66

treatment of hypo K

K supplementationKCl or KPhosDO NOT EXCEED 0.5 mEq/kg/hr

67

causes of hyperK

decreased renal excretion (obstruction, uroab, oligo/anuric renal fail)GI dz--whipwormsChylothoraxdrugs (ACE inhibits, NSAIDS, K sparing diuretics, heparin)Translocation (acidosis, tumor lysis syndrome)increased intakePseudohyperKAddisons

68

define pseudo hyper K

occurs as a result of severely elevated WBC (>100,000)hemolysis ( ESS, Akitas--with hi IC K)thrombocytosis

69

most common cause of hyper K

impaired renal excretion

70

what syndrome occurs if serum Na increases too fast

central pontine myelinosis(demyelination)

71

T/F Boag JVIM 2005linear FB (not discrete FB) were associated with low Na, Low Cl and metabolic alkalosis

Truelinear FB (not discrete FB) were associated with low Na, Low Cl and metabolic alkalosis

72

most clinically relevant adverse effect of hyper K

decrease in RMP (makes it more negative)more negative (less than threshold potential)therefor cannot depolarize

73

tx hyper K

K deficient fluidsCa gluconate (0.5-1 ml/kg SLOWLY)Dextrose/InsulinCatecholamines --Beta2 agonist (albuterol)Na bicarbHemodialysis

74

Mx of calcium gluconate for treatment of hyperK

does not alter K levelsraises threshold membrane potential to restore cell excitability

75

where is 99% of Ca found

hydroxyapatite of bone

76

forms of calcium and which is most active

ionized, protein bound, chelatedionized is most active; doesn't always correlate w other forms

77

T/Fhypoalbuminemia affects total body Ca levels

true but NOT active ionized form

78

three hormones regulating Ca homeostasis

calcitonin--senses hi Ca, GOAL to lower Cavitamin D (cholecalciferol)--aims to incr Caparathyroid hormone--senses low Ca. GOAL to incr Ca

79

3 body systems involved in Ca homeostasis

boneGIkidney

80

PTH ROLE

senses low Caincr Ca from bone, incr resorption from kidneyactivates vit D from kidney (incr Ca absorption from gut)

81

Calcitonin role

senses hi Ca, GOAL to lower Cainhibits bone resorption and release of Ca

82

causes of hypoCa

decr PTH release ( hypoPTH, postopthyroidectomy/PTectomy, suppression from chronic hyperCa, hypoMg)decr vit D (renal failure, malabsorption, liver insufficiency)Chelation (eclampsia, UT obstruction, saponification-pancreatitis, anticoag in blood transfusions, ethylene glycol))Critical illnesshypoAlb (does not change ionized, only total)

83

mechanism of acute/chronic renal failure on bit D synthesis

renal failure decreases the ability of kidney to convert25-hydroxycholecalciferol to to vit D (cholecaciferol)

84

clinical signs of hypoCa

muscle tremors, hyperexcitability, restless, facial rubbing, stiff, seizures, hyperthermia, vomiting

85

tx hypoCa

calcium gluconate 0.5-1.0 ml/kg slowly 10-20 minwatch ECG for bradyarrythmias

86

causes of hyper Ca

G (granulomatous dz)O (osteoclastic dz/osteomyelitis/osteoporosis)S (spurious)H (hyperPTH--primary or secondary)D (vit D toxicosis--cholecalciferol toxicosis)A (Addisons)R (renal failure)N (neoplasia--AGAC, lymphoma, MM, mets--carcinomas; nurtritional secondary renal hyperPTH)I (iatrogenic, idiopathic)T (toxins)

87

how does malignancy lead to hyper Ca

paraneoplastic syndromelymphoma, anal sac adenocarcinomaPTH-related peptide synthesismost common cause of hyper Ca in DOGS

88

most common cause of hyper Ca in cats

IDIOPATHIC

89

tx of hyperCa

Ca free fluids---NaCl diuresisloop diuretic--promotes calciuresis furosemideGCCBisphosphonatesCalcitoninCa channel blockersNabicarbdecr calcium in diet

90

Magnesium plays an important role in what homeostatic mechanism

PTH and vitamin D maintenance of Ca levelsif low Mg PTH does not work normally

91

Phosphorous less that < 1 mg/dl leads to what

hemolysis, rhabdomyolysisMost dogs (other than Japanese or Koren--Akita, Shiba Inu, Kindo) have phosphorous independent RBC regulation and may NOT develop hemolysis

92

when does soft tissue mineralization occur with hyperP

Ca x P >> 60-70= soft tissue dystrophic mineralization

93

What is pseudo hyperchloridemia

automated analytical assays measure halides all under Cl(ex. KBr patient)

94

how are brain cells unique when it comes to glucose utilization

brain cells are permeable to glucosedo NOT require insulin to bring into cellsneuronal cells also don't synthesize their own glucose

95

hormones involved in glucose homeostasis

insulin--pancreatic B islet cellsglucagon--pancreatic alpha islet cellscortisolepinephrinegrowth hormone

96

liver role in glucose homeostasis

hypogly conditions:liver is stimulated via glucagon to make glucose (glycogenolysis, gluconeogensis)

97

How do glucometers work

need normal patient (not anemic)whole bloodAnemic patients or serum samples will read erroneously high

98

what is Whipple's triad

low BGclinical signs corresponding to low BGresolution of signs with glucose therapy

99

causes of hypoglycemia

1. excess insulin (iatrogenic, insulinoma, paraneoplastic, toxins-xylitol)2. increased glucose utilization (infection, exercise induced, paraneoplastic, pregnancy, polycythemia)3. decreased glucose production (liver fail, pediatric, toy breed, PSS, counter regulatory hormone deficiency, Addison

100

paraneoplastic hypoglycemia

hepatomashepatocellular carcinomas leimyomas/myosarcomas

101

Drugs/toxins that cause hypoglycemia

sulfonylureasbeta blockersinsulin overdosexylitol

102

tx hypoglycemia

dextrose bolus (0.5-1.0 g/kg) diluted 1:1 to prevent phlebitis(can worsen insulinomas)GCC, frequent meals

103

how common is stress induced hyperglycemia

16% critically ill dogs54% critically ill cats

104

discuss the mechanisms by which hyperglycemia has adverse effects on the body

1. osmotic force--can pull IC fluids out2. increased glucose goes into urine and osmotic diuresis occurs dehydrating patients 3. tissue damage (retinopathies, heart attacks, renal dz)

105

T/Fprogesterone causes hyperglycemia

TRUEP causes hyperglycemia during diestrus

106

in insulinoma patients ________administration may be more harmful and instead __________administration is used

dextrose is harmful because stimulates more insulinconsider glucagon CRI

107

what is the molecular weight of albumin and its half life

69,000 daltons16 hours

108

what is colloid oncotic pressure of plasma vs HES

plasma 25 mm HgHES 30 mm Hg

109

Aarnes et al AJVR 2009 administration of HES rather than LRS is recommended for treatment of isoflurane induced hypotension in dogs

TRUE

110

Gebhardt et al JVECCS 2009T/F there is a sign difference btwn non septic SIRS and sepsis survival rates in dogs base on initial C reactive protein concentrations

FALSE