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RUSVM Anesthesiology > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

How much total body water is in the ECF?

A

1/3

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2
Q

Extracellular fluid is made up of what two components and how much of total body water do they constitute ?

A

Intravascular fluid —> 1/12 TBW

Interstitial fluid —> 3/12 TBW

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3
Q

Intracellular fluid makes up ________ total body water

A

2/3

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4
Q

T/F: total body water is more in obese and old animals

A

False

Less

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5
Q

What influences fluid movement from the interstitium to venous system?

A

Capillary wall
—> permeable to water and ions
—> impermeable to protein

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6
Q

What influence fluid movement form the intracellular to intersitial?

A

Cell membrane
—> permeable to water
—> impermeable to ions

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7
Q

What is the main ion in the intracellular fluid?

A

K+

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8
Q

What is the main ion in the extracellular fluid?

A

Na+

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9
Q

What is the approximate osmolality in both ECT and ICF?

A

300 mOsm/kg

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10
Q

Plasma protein have a net ______ charge

A

Negative

-essential for driving fluid into the IVF

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11
Q

What protein is most important in determining colloid onctoic pressure

A

Albumin

—>edema can be cause by hypoalbuminemia

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12
Q

What is the physiological osmotic pressure ?

A

23mmHg

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13
Q

What are the three types of fluids?

A

Cyststalloids
Colloids
Blood and products

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14
Q

What are crystal lords?

A

Contain water, electrolytes, and non-electrolytes

Can enter all body fluid compartments

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15
Q

Crystalloids replace small blood losses at a __________ v/v ratio

A

3:1

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16
Q

What are the replacement (balanced) crystalloid solutions?

A

Ringers
Ringers lactate
Plasmalyte R (normosol R)

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17
Q

_____________ types of fluids are used to replace body water and electrolytes

A

Crystalloids - replacement solutions

Eg ringers/ plasmalyte R

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18
Q

T/F: replacement solutions cause no changes in electrolytes

A

True

  • electrolyte composition is similar to the ECF
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19
Q

Large volumes of crystalloids can cause rapid re-expansion of ECF, but approx ______ remains IVF after 30 minuteus, and ______ will remain IVF after 1 hour

A

1/3; 1/4

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20
Q

Besides electrotyes, replacement solutions normally contain what type of agents?

A

Alkalinizing

Eg lactate, acetate, gluconate

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21
Q

What products are crystalloids maintenance solutions?

A

Plasmalyte M (Normosol M) in Dextrose 5%

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22
Q

When do we used a crystalloid maintenance solution?

A

Patients that have been stabilized by replacement fluids

Patients not taking in adequate amounts to meet daily requirements

Meant to replace daily fluid loss

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23
Q

What is the amount of maintenance fluid requirements?

A

40-60mL/kg/day

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24
Q

T/F: Plasmalyte M is used commonly for peri-anesthetic use

A

False

Maintenance solutions are not appropriate for peri-anesthetic use

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25
Q

Does Plasmalyte M contain more sodium or potassium

A

More K+ than Na because the body secretes K+ relatively quick than Na

26
Q

What is the maximum infusion rate of maintenance solutions?

A

0.5mEq/kg/hour

27
Q

What is the concentration of physiological saline?

A

0.9% NaCl

28
Q

When is use of physiological saline recommended?

A

Hyperkalemia patients

Hyperkalemia, hyponatremic patients with hypoadrenocorticism

29
Q

What would you be concerned about if you have high volumes of physiological saline?

A

Dilute other electrolytes

30
Q

What is the concentration of hypertonic saline?

A

7.5% NaCl

31
Q

What is the main use of hypertonic saline?

A

Rapid IVF compartment expansion
—> temporary cardiac function improvement (fast onset and short duration)

Can be used to treat cerebral edema if BBB is intact

32
Q

What is Dextrose 5% used for?

A

Not much use, glucose rapidly metabolized with water by-product

Essentially provides water —> component of maintenance fluids

33
Q

What are colloid fluids?

A

Large molecular weight, stay in vasculature a long time

34
Q

What is the main purpose of colloid fluids?

A

Expand and maintain IVF space volume

  • oncotic pull
  • volume administered
  • volume retained
35
Q

Colloids replace low volume blood loss at a _____ v/v ratio

A

1: 1

36
Q

Colloids can be co-administered with what to minimize ISF deficits

A

2-3x crystalloids

37
Q

What are the synthetic colloids ?

A

Hydroxyl-ethyl starch (HES)
Dextran
Gelatin

38
Q

What are the natural colloids?

A

Whole blood plasma

Albumin

39
Q

What re the Hb-based oxygen carrying solution colloids ?

A

Oxyglobin

40
Q

What is the most commonly used colloid?

A

Hetastarch

Molecular weight 420kDa

41
Q

What affect does hetastarch have on hemostatis?

A

Saves oncotic pressure

Decrease factor VIII and von willebrands factor concentrations

42
Q

Where is hetastarch metabolized and eliminated//

A

Metabolized by serum amylase

Eliminated by kidneys (associated with osmotic nephropathy - avoid in septic patients)

43
Q

T/F: dextrans are colloids with a similar weight to hetastarch

A

True

Polymer of glucose
More hyper-oncotic than plasma

44
Q

What is the main contributor to oncotic pull of plasma

A

Albumin

45
Q

T/F: plasma contains clotting factors

A

True

-can be used to treat coagulopathies

46
Q

Why are fluid and electrolyte/ acid-base disturbances common during anesthesia ?

A 
Open body cavities 
High fresh gas flow driven fluid loss
Bleeding 
Drug induced polyuria 
Effects from drug-induced respiratory and cardiovascular depression
47
Q

Why should we give peri-anesthetic fluids?

A

Maintaining IV catheter patency

Correction of deficits (fasting) and ongoing normal fluid losses

Maintenance of whole body fluid during procedure

Support cardiovascular function (BP)

  • > maintain preload and SV
  • > compensate for peripheral vasodilation from drugs
48
Q

T/F: all anesthetized patients should ideally be on fluid therapy

A

True

49
Q

What vein do we commonly use in pigs and ruminants for IV fluid therapy?

A

Auricular

50
Q

When do we use the intraosseous route for fluid therapy?

A

Very dehydrated or difficult to catheterize (young or small)

51
Q

T/F: Subcutaneous fluid therapy can be used for shock therapy

A

False

Only use for mild deficits

52
Q

What is the best catheter size for fluids?

A

Largest, and longest

53
Q

For adult horses and cattle, what side of catheter is appropriate?

A

14g or 12g

54
Q

For dogs, what catheter sizes are generally used?

A

Large dog - 18g

Med- 20g

Small-22g

55
Q

In cats, what catheter size is used

A

22g (adult)

24g ( kitten)

56
Q

In calves, sheep and goats, what catheter size is used?/

A

16 or 14g

57
Q

What is the standard fluid type used peri-anesthetically, and the rate used?

A

Replacement crystalloids eg ringers

10ml/kg/hour

58
Q

In what cases is the standard rate for peri-anesthetic fluid too high?

A

Young animals
Long procedures
Heart failure
Renal disease

59
Q

What should you do if you have acute hypotension during anesthesia ?

A

Decrease anesthetic depth

Extra fluid over standard rate
-crystalloid 10ml/kg/hour over 15mins

If no change with crystalloid, turn to colloids

60
Q

What should you do if your patient is still acutely hypotensive after decreasing anesthetic depth, and administering 2 blouses of fluid?

A

Cardio active drugs

  • ephedrine
  • phenylephedrine
  • atropine
61
Q

How would you address acute hemorrhage with fluid therapy?

A

Minimal (less than 10% blood vol)

  • crystalloids (3x volume lost)
  • colloids (exact volume lost)
Excessive loss (more than 20% blood vol) 
-consider blood transfusion
62
Q

What are potential complications of fluid therapy

A

Fluid overload (cats high risk)

Hypothermia (cold fluids)

Coagulation deficits

Reduced tissue oxygenation (low PCV)
-> reducing TP and PCV

Electrolyte disturbances

Acid base imbalances

RUSVM Anesthesiology (32 decks)

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