Fluid Balance and Acid Base (MR) Flashcards Preview

Clinical Medicine Master > Fluid Balance and Acid Base (MR) > Flashcards

Flashcards in Fluid Balance and Acid Base (MR) Deck (120):
1

Total Body Water is what % of body weight?

60.00%

2

ICF is what % of Total Body Water? ECF?

66% 33%

3

What % of ECF is Intravascular? What fluids are Intravascular?

25% Plasma – proteins Blood What % of TBW is Blood Volume? 8% What % of ECF is Interstitial? What is in Interstitial fluid?

4

What is basically the same between intravascular fluid (Plasma) and interstitial fluid?

Solutes

5

What % of ECF is Transcellular? What is in transcellular fluid?

25% Synovial Peritoneal CSF Intraocular

6

Hydration is a physiological balance between?

Interstitial and intravascular fluid

7

2 organs with big spaces in the vasculature?

Spleen Liver

8

2 organs where there are there are no spaces in the vasculature?

Brain (BBB) Prostate (BPB)

9

What are the 4 main forces of Starlings forces?

Interstitial Oncotic (∏i) - pulling fluid out Capillary Oncotic (∏c) - pulling fluid in Interstitial Hydrostatic (Pi) - pushing fluid in Capillary Hydrostatic (Pc) - pushing fluid out P = Hydrostatic Pressure - water thru your garden hose. C = Capillary I - Interstitial ∏ = Oncotic

10

What is the sum of all the forces?

Net Fluid Movement

11

When can it be a more influential component? Why is there water in the abdomen?

∏I , Dz State

12

A 10 yo female spayed Shitzu presents to you with grade 4/6 tricuspid systolic murmur and a belly full of fluid. You stick a needle in it and its a transudate. Why is the water in the belly?

Pc is ↑ due to backup of blood back into body from right side of heart

13

You have a 6yo Sharpei with chronic dxa and he's got limb edema and mild ascites. Why is the fluid where it is?

↓ ∏c due to ↓ in TP - shitting it out - PLE

14

Normal dog, nothing wrong with it. Doing a study on Hetastarch which is an Oncotically (∏) active fluid. If you give him Hetastartch, what is going to happen to his interstitial fluid compartment?

↑ in ∏c - pull fluid from interstitium into capillaries

15

K factor in the equation is related to? What does it affect?

Leakiness of vasculature Fluid will move more easily in areas that are leakier like the spleen and liver

16

The role of lymphatics: You have a dog with limb edema and a very enlarged inguinal LN, why is there leg edema?

Pi - backup of lymphatics will cause a backup of interstitial fluid and an ↑ in Pi

17

What do lymphatics drain?

Interstitium

18

Effective Osmols: ECF?

Na+ Cl- HCO3-

19

Effective Osmols: ICF?

K+ PO4- ICF Proteins (too big to get out)

20

How much Na+ is there in ECF? ICF?

142 mEq/L 10 mEq/L

21

How similair is plasma to interstitial fluid? They are both ______?

Very Similar Extracellular

22

How much K+ is there in ECF? ICF?

4 mEq/L 140 mEq/L

23

How much Ca2+ is there is ECF? ICF? Then, where the hell is all this "oh so important" Ca2+?

5 mEq/L <1 mEq/L Hidden away in lil compartments inside the cell. Like Binladen.

24

Where can fluid move freely between for the most part? Where can it not?

Interstitium & Plasma ECF & ICF

25

Tonicity is regulated by? Where/how is it restricted?

Effective Osmols (EOs) ICF by membrane

26

Isotonic?

same concentration of EOs inside and out of cell

27

Hypotonic?

Less EOs outside/More Eos inside of cell and fluid enters cell

28

Hypertonic?

Less Eos inside/More EOs outside of cell and fluid exits cell

29

What is the Osmosis Cheer?

Water follows solute hey!

30

What is dehydration? Who bears the brunt of the fluid loss?

Loss of bodywater due to hypertonic ECF ICF

31

What is the hallmark of dehydration? Why?

Hypernatremia It is the 1º ECF so if it is ↑, you know dehydration! What does body care about more, water in cells or water in vasculature? When ECF becomes hypertonic and water exits cells. Volume in vasculature to stay alive, even to detriment of cells

32

What behaviors/situations lead to thirst?

Fever Panting lack of water

33

What are the two types of thirst?

Hypovolemic Osmotic

34

Ostmotic Thirst: what signals to brain that you need to drink?

Na+

35

What is the pathway of signaling that leads to water conservation?

Osmosensory neurons to preoptic area = ↑ Vasopressin release to ↑ water conservation and to hypothalmus to ↑ thirst and make you drink

36

Hypovolemic Thirst: what is the difference and where are the signals involved in correction?

Volume is the concern Cardiac Baroreceptors signal to brainstem Kidney Baroreceptors to trigger Angiotensin II signal to subfornical Then, both brainstem and sf organ signal Preoptic Area

37

Explain the common portion of the thirst and water conservation mechanism?

Water Conservation: Preoptic Area to Supraoptic nucleas & paraventricular nucleas to release Vasopressin and inact water conservation

38

What is hypovolemia?

Water & Electrolyte Loss

39

What is the change in water balance with Isotonic water loss?

None

40

Which compartment is primarially affected with hypovolemia? Causes?

Intravascular Hemorrhage GI loss Burns Tissue Injury

41

With hypovolemia, what is the cascase of events?

↓ Blood Volume - ↓ Venus Return - ↓ Stroke Volume - ↓ Cardiac Output ↓ Tissue Perfusion

42

What can you test to see if you have a ↓ in tissue perfusion?

Lactate

43

What do baroreceptors respond to?

Blood Pressure and Volume

44

What 2 mechanisms do Baroreceptors turn on to correct pressure and volume?

Neuro Mechanisms Endocrine Mechanisms

45

What are the neuro mechanisms turned on by baroreceptors?

Baroreceptors Chemo receptors Cardiovascular centers Sympathetic Activation to release Epi and NE leading to ↑ Cardiac CO

46

What is the result of the neural mechanism?

↑ CO Peripheral Vasoconstriction ↓ BP ↓ Venous Reserve

47

What are the Endocrine mechanisms turned on by baroreceptors? What is the combined effect?

ADH Angiotensis II Aldosterone EPO ↑ Blood Volume

48

What does Angiotensin II do?

↑ Sympathetic System Tubular reabsorption of Na+, Cl-, & Water follows (& K+ excretion) Powerful Vasoconstrictor - ↑ BP
ADH Secretion from Posterior Pituitary - Collecting duct H2O absorption

49

Progressive Hypovolemia: why is it progressive?

bc cells keep metabolizing til they die

50

What is Dysoxia? Does this occur when animal is breathing normally?

Lack of O2 or ability to utilize O2 at the cellular level Sure can!

51

What happens when you have Dysoxia? What type occur due to inadequate O2? What type inhibit mitochondrial function (oxidative phosphorylation)?

SHOCK Hypovolemic & Cardiogenic Endotoxic & Septic

52

When cell doesnt have O2 to make energy what happens? Producting?

Anaerobic Metabolism Lactate

53

CX of Hypovolemia?

Tachycardia ↓ Pulse Pressure ↑ CRT, ↓ Jugular Fill Tachypnea Cold Extremities ↓ Urine Output Obtunded/Ataxic

54

CX of Dehydration - %5?

Tachy MM Prolonged Skin tent - not sensitive Sunken Eyes ↑ USG Snarky Muscle Cramping

55

Why does Hypovolemia cause tachycardia?

Body tries to correct volume SV * HR = CO SV ↓ so to maintain CO, HR ↑

56

What happen together?

Severe Dehydration & Hypovolemia!

57

When does volume status need to be corrected? When does hydration status need to be corrected?

NOW – EMERGENCY Over 12 - 24 hrs

58

TQ!!! Dx Testing: What is the easiest and best way to evaluate hydration status over time in the hospital?

Body Weight Monitoring!!!

59

How much does a L of water weigh?

1kg

60

What other test are used to determine water balance situation?

PCV/TS USG Creatinine/BUN Lactate CVP - Central Venus Pressure (meh) Venous O2 Saturation

61

What does Lactate measure? RR?

Anaerobic Metabolism Marker < 1.0 mmol/L

62

How is a CVP performed?

Catheter(at level of Rt Atrium) and monometer outside Right Jugular Vein

63

What % is mild dehydration? CX?

5 - 7% Skin Tent Mildly tachy mm

64

What % is moderate dehydration? CX?

8 - 10% Depressed Tacky MM CRT > 2 sec Correlated Hypovolemia

65

What % dehydration is Severe? CX?

>10% Cool extremeties Poor Perfusion

66

TQ!!! How much does 1L of fluid weigh?

1 kg

67

What info do you need to calculate fluids?

Deficits Ongoing Losses Maintenance

68

What is the maintenance does for Dogs & Cats? Horses?

40 - 60 ml/kg/day Dogs Higher end/Cats lower end 50 ml/kg/day

69

How do you calculate deficit?

kg * % dehydrated remember 1kg = 1 L

70

How do you figure out losses ongoing?

Estimate or measure and add it in in mL or L

71

What should you estimate for mild horse dxa?

1L / hr

72

What happens if you are hypovolemia?

Shock Dose!

73

Can you kill something with fluids?

YES

74

What is blood volume of body weight?

8-9%

75

What is the Shock Dose for fluids? Except for?

80 - 90 ml/kg CATS!

76

What is a BOLUS?

Any amount that goes in all at once

77

What is delivery of Shock Dose?

1/4 Total Dose as Bolus √ √ √ - if hypovolemic - Administer another 1/4 Bolus √ √ √ - if still hypovolemic - repeat until CX improve.

78

What do you do once no longer hypovolemic?

Move to Maintenance dose

79

What are the 2 major types of fluids?

Crystalloids Colloids

80

What are Crystalloids? List?

Basic E-lyte Solutions, Buffers LRS Saline Plasmalyte Hypertonic Saline

81

What are colloids? List?

Large osmotically active particles (remain intravascular) Pull fluid into vasculature! Artificial - Hetastarch, Oxyglobin Natural - Blood/Plasma Products

82

If you give a colloid, what will you then need to fix? How?

Interstitial balance Crystalloid

83

What is the tonicity of most crystalloids?

Isotonic - flow like plasma

84

How quickly does crystalloid move from plasma to interstitium?

30 min

85

What are Colloids generally used for?

Hypovolemia Hypoproteinemic

86

CAVE of hetastarch?

+/- bleeding times on high doses

87

What is Oxyglobin?

Polymerized Bovine Hgb Product

88

What are Blood Products? CAVE?

Whole Blood, FFP, pRBCs, Platelet Concentrate Transfusion Rxns

89

TQ!!! Combination Therapy Rule of Thumb?

For every 1L of Hypertonic Saline replace with 10 L of Crystalloid

90

What % NaCl is Hypertonic Saline?

7.00%

91

What is Hypertonic Saline used for? What does it do? How much?

Resuscitation! - NOT MAINTENANCE Pulls water into vasculature! 2 - 3 X fluid expansion of what was infused

92

Hypertonic solution will have what effect on ICF/ECF? Causing?

ICF redistributes to ECF (Robbing Peter to pay Paul) Dehydration - Give a crystalloid (isotonic)!

93

What % NaCl are normal saline fluids?

0.90%

94

What does 1/2 strength saline consist of?

0.45 saline + dextrose

95

Can you fix hypovolemia with oral fluids? Why?

NO Blood flow to gut is ↓ with hypovolemia (Sympathetic) Only mild dehydration Oral/Enteral ROA? (2) Contraindications? (3) Free choice Nasogastric Tube – Horse Refluxing GI obstruction Hypovolemia

96

Subcutaneous ROA: who? Which fluids? Dose Contraindications?

SA Isotonic Only! 10 ml/kg/site hypovolemia

97

IV ROA: Who? When is it MOST appropriate? Where?

Everyone! Mod - Severe dehy/hypovolemia recuscitation Jugular, Cephalic, SaphenousWhat is Intraosseus good for?

98

What is Poiseuille's Law?

Q = Pie r4 P/ 8 η L

99

What is laminar foow along the tube proportional to?

4th power of tube radius

100

What size should you use pertaining to the job?

Smallest necessary

101

What size catheter should be used for resuscitation?

Biggest Possible

102

Typer of Cathethers? Which is for shorter-term?

Over the Needle - shorter term Over the Wire

103

Response to Fluid Therapy: Hypovolemia? HR? PP/Jug Fill? RR?

↓ HR ↑ PP/ ↑ Jug Fill ↓ RR

104

What % is mild dehydration? CX?

5 - 7% Skin Tent Mildly tachy mm

105

What % is moderate dehydration? CX?

8 - 10% Depressed Tacky MM CRT > 2 sec Correlated Hypovolemia

106

What % dehydration is Severe? CX?

>10% Cool extremities Poor Perfusion CRT > 3-4 %

107

What is the pH of the stomach?

1

108

What determines [H+]?

pCO2 & [HCO3- ]

109

What does pH =?

Negative log of [H+]

110

What is the main reason to do an arterial blood gas?

to evaluate respiratory system and O2 exchange

111

Which artery do you do an arterial blood gas in in SA?

Femoral Dorsal pedal

112

What is the arterial blood gas parameter for hypoxemia?

PaO2 < 80 mmHg

113

What is PCO2?

Partial Pressure of O2

114

What is TCO2?

An estimate of HCO3-

115

What are the two ways to become acidemic?

↑ PCO2 ↓ HCO3-

116

What are the 2 ways to become alkalotic?

↑ HCO3- ↓ PCO2

117

How do you know if there is compensation?

Identify primary disorder, if the other is out of RR in the same direction you have compensation.

118

Causes of Respiratory Alkalosis?

Hypoxemia due to Pulm/Card Dz CNS dz/hemorrhage Salicylate intoxication Sepsis Iatrogenic tachypnea

119

What is Anion Gap?

[Na+ + K+] + [Cl- + HCO3-]

120

What is normal Anion Gap?

16+/-4