Ch.32: Fluid Therapy (Pablo) Flashcards by Sara Prent

body fluids consist of:

water (solvent) and dissolved particles (solutes)

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electrolyte

compound which dissociates in water to form electrically charged particles (ions). Ex: NaCl and KCl

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osmotic pressure

pressure which tends to pull water into the compartment containing the solutes

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oncotic pressure

total osmotic effect of a non-diffusible colloid (proteins)

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hydrostatic pressure

pressure which tends to push water into the compartment containing less solute

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osmolarity

number of osmoles per liter of water; depended upon the number of particles in solution

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osmolality

number of osmoles per kilogram of water. The difference is usually negligible to osmolarity because of the low solute concentrations in the body fluids

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effective osmolality

osmolality that tends to maintain an effective osmotic pressure because the solute cannot easily diffuse across the membrane

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tonicity

refers to effective osmolality

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colloid sollution**

solution that contain large particles that don’t readily leave the vascular space

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crystalloid solution**

solution that contain electrolytes or solutions of glucose in water. doesn’t stay in IV space for a long time

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body weight is what percent water at maturity

60%

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BW is what percent water in newborns

80%

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BW is what % water in intracellular space?

40%

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BW is what % water in extracellular space?

20% (15% interstitial and 5% IV)

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capillary walls are permeable to:

water, solutes; only slightly permeable to proteins

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Factors that affect water distr. and movement in body

Electrolytes
Hydrostatic and oncotic P
Lymphatic drainage

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Hydrostatic P tends to push water/solutes where?

into interstitial space

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Oncotic P tends to push water/solutes where?

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plasma water loss –> water movement?

from intracellular/interstitium to IV

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protein loss –> water movement?

IV to interstitial/intracellular space

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what does lymphatic drainage do?

remove excess fluid in the interstitial space

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Abnormal processes affecting water distribution

vascular injury –> edema
changes in electrolyte conc.
lymphatic injury
altered intravascular osmolality –> inc. plasma osmolality
hypoproteinemia –> dec. plasma oncotic P

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3 Indications for fluid therapy

1) restore normal circulation in patients with hypovolemia or shock
2) correct fluid deficits in dehydrated patients
3) maintain fluid balance in patients with decreased fluid intake/increased fluid loss

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name 3 replacement solutions

LRS --> most commonly used in SA! Normosol --> most commonly used in LA! Normal Saline

chars. of replacement solutions

isotonic sodium-based used for replacement of fluid deficits similar composition as plasma water can be given rapidly

"sensible" fluid loss

via kidneys/bladder. We are aware of it

"insensible" fluid loss

via LI, lungs, skin. We are unaware of it

If ECF and ECF are the same, movement of H2O is at ____

homeostasis

Is LRS a colloid or crystalloid?

crystalloid

which fluid stays in interstitial fluid the longest?

LRS

Which stays IV longer: colloids or crystalloids?

colloids

2 types of crystalloid solutions. How do they differ in composition?

replacement (conc. electrolytes similar to body) | maintenance (lower Na and Cl, higher K than replacement fluids)***

Basic components of LRS. alkylizing or acidifying solution?

``` ALKYLIZING AGENT Na K Ca** Cl lactate ```

lactate is precursor for:

bicarbonate (converted in liver)

Basic components of Plasma-Lyte A. alkylizing or acidifying solution?

``` ALKYLIZING AGENT Na K Mg** Cl Gluconate Acetate ```

acetate and gluconate converted to:

bicarbonate (converted in lungs)

Basic components of Normosol. alkylizing or acidifying solution?

Same as Plasma-Lyte A

can you add bicarbonate to LRS/Normosol?

LRS: No (interacts with Ca) Normosol: Yes

disadvantage of giving normosol alone?

can develop hypocalcemia. Add Ca glutamate to counteract.

Basic components of Ringer's Solution. alkylizing or acidifying solution?

``` ACIDIFYING SOLUTION: Na K Ca Cl** NO BUFFER BASE ```

use of Ringer's solution

tx for metabolic alkalosis

use of 0.9% saline solution. Alkylizing or acidifying solution?

Acidifying solution. tx for hyperkalemic animals, metabolic alkalosis -not ideal replacement solution

use of 7.5% saline solution

short-lived increase in IV volume in severely hypovolemic animals; used in emergencies only

use of 5% dextrose solution

free water source** NO electrolytes, buffer base Tx for hyperkalemia, hypernatremia, hypoglycemia (as in liver dz, sick neonates, hepatic shunts)

contraindication for dextrose solution

brain trauma; results in additional brain swelling

a true maintenance fluid has low ___

1/2 strength LRS and 2.5% dextrose can be used as:

maintenance fluid if given slowly

Choose solution based on:

hydration status history PE lab data

What is lost in vomiting dogs?

H and Cl. Use acidifying solution to help

What is lost in diarrhea dogs?

Na and bicarb. Use alkylizing solution to help restore water and electrolytes

T/F: horses lose less fluid per kg of body weight lost than small animals?

What should be included in a lab workup when assessing fluid status?

``` Plasma protein** PCV** blood gas electrolytes osmolality urinalysis ```

Dehydration --> PCV, plasma protein?**

both increase

Dehydration + anemia --> PCV, plasma protein?**

PCV unchanged, plasma protein increases

dehydration + hypoproteinemia --> PCV, plasma protein?**

PCV increases, plasma protein unchanged or decreases

When developing a fluid therapy plan, must calculate:

- existing deficit - maintenance requirement - contemporary loss

Deficit in L =

% Dehydration x bw (kg)

total maintenance requirement = **

``` sensible loss (urine) + insensible losses **usually 40-60ml/kg/day** ```

big dogs have higher/lower fluid requirements than small dogs

lower!

contemporary loss

loss of fluids via v/d, internal bleeding, etc. | -hard to keep track of

Total fluid volume to administer over 24 hrs =

deficit + maintenance + ongoing loss

How quickly should you restore blood volume in case of severe dehydration?

within 1 hr

Ways to monitor fluid therapy

PE** lab work** urine output central venous pressure

specific gravity is higher/lower when animal is dehydrated?

higher

signs of improvement

``` more elastic skin turgor moister MM animal looks brighter inc. BW PCV, TP, specific gravity dec. HR dec. eyes less sunken in ```

Which fluid therapy should you NOT give SC?

dextrose

T/F: fluids are only a supportive therapy

<5% of dehydration CS

not detectable

9-12% of dehydration CS

``` tented skin stands in place prolonged CRT sunken eyes dry MM possible signs of shock ```

When normal saline given IV, where does most of it go?

most stays in ECF

contraindication of using normal saline

animal with CHF

Ch.32: Fluid Therapy (Pablo) Flashcards

(72 cards)