Fluid therapy

Question 1

Crystalloid

Answer 1

Contains small molecules

Question 2

isotonic crystalloid purpose

Answer 2

To manage dehydration and hypovolaemia

Question 3

isotonic crystalloid examples

Answer 3

Hartmanns, 0.9% NaCl

Question 4

Colloid

Answer 4

contains large molecules that can’t cross semi-perm membranes

Question 5

5 routes of fluid admin

Answer 5

Per os (mouth)
sub cut
IV
central venous access
IO

Question 6

Volume overload symptoms (hypervolaemia)

Answer 6

dyspnoea, tachypnoea, crackles

Question 7

Venous engorgement symptoms

Answer 7

jugular distension, peripheral oedema, cavitary effusions

Question 8

fluid distribution

Answer 8

60% is water- 55% extravascular- 40% inside cells, 15% outside cells

Question 9

hypovolaemia vs dehydration

Answer 9

hypovolaemia is fluid lost quickly from the intravascular space, dehydration is fluid lost slowly from extravascular space

Question 10

consequences of hypovolaemia

Answer 10

blood loss-> reduced preload-> reduced stroke volume-> decreased CO-> vasoconstriction and tachycardia-> BP drop

Question 11

patient assessment of IV volume

Answer 11

HR
pulse quality
MM colour
CRT (>2secs)
BP
mentation (mental status)
temp

Question 12

patient assessment of extravascular volume

Answer 12

moistness of MM
skin turgor
weight
globe position
urine output

Question 13

clinicopathological parameters

Answer 13

PCV, TS
urea, creatinine
USG

Question 14

shock

Answer 14

an imbalance between oxygen delivery to the tissues and oxygen consumption by the tissues

Question 15

4 types of shock

Answer 15

hypovolaemia
cardiogenic
obstructive (tension pneumothorax, thromboembolism)
distributive (uncontrolled inflammatory response)

Question 16

physiological response to hypovolaemic shock

Answer 16

neurohormonal response:
- catecholamine release (increases HR, vasoconstriction)
- activation of renin-angiotension-aldosterone system (increases Na + water retention
- ADH release
- spleen contraction (releases more RBC)

Question 17

steps for use of isotonic crystalloids

Answer 17

1. bolus of fluid 10-20ml/kg for dogs, 5-15ml/kg for cats over 15-20mins
2. reassess
3. admin 45-50ml/kg max for dogs, 30-35ml/kg max for cats
4. if no change, reassess diagnosis and ongoing blood loss

Question 18

shock dose (total blood vol of patient)

Answer 18

80-90ml/kg in dogs
50-55ml/kg in cats

Question 19

determining efficacy of fluid therapy treatment

Answer 19

1. reassess every 12-30mins
2. bp (could be compensatory)
3. lactate levels
4. ECG (monitor arrythmias)

Question 20

hypertonic fluid uses

Answer 20

• common in large animals
• lowers initial vol reqiured for vol resus
• reduces cerebral oedema

Question 21

large animal fluid resus

Answer 21

1L hypertonic fluid followed with 10L isotonic fluid
- stomach tube/IV

Question 22

indications for colloid fluid therapy

Answer 22

tissue oedema, hypovolaemia, low oncotic pressure

Question 23

signs of dehydration

Answer 23

tachy MM, slow CRT, sunken eyes, bradycardia

Question 24

osmotic pressure

Answer 24

the minimum pressure which needs to be applied to a solution to prevent the inward flow of its pure solvent across a semipermeable membrane

Question 25

oncotic pressure

Answer 25

a form of osmotic pressure induced by the proteins in a blood vessel's plasma which causes a pull on fluid back into the capillary

Question 26

indications for blood testing in patients recieving fluid therapy

Answer 26

for all animals sick enough to warrant hospitalisation and fluid therapy - every 24-48hrs - sooner if signs of complications

Question 27

blood tests that should be considered using in dogs and cats recieving fluid therapy

Answer 27

- PCV and TS - blood urea nitrogen and creatinine - urine specific gravity (USG) - lactate - glucose - electrolytes - acid-base status

Question 28

3 electrolytes

Answer 28

- sodium - potassium - chloride

Question 29

causes of hyperkalaemia

Answer 29

- urethral obstruction - uroabdomen - hypoadrenocorticism - renal failure

Question 30

managing hyperkalaemia

Answer 30

- IVFT (dilutes K+ in blood) - calcium gluconate (stabilises myocardium) - glucose +/- soluble insulin (potassium -> intracellular spaces) - treat underlying cause

Question 31

causes of hypokalaemia

Answer 31

- GI tract losses (vomiting, diarrhoea) - urinary tract losses, diuretics

Question 32

managing hypokalaemia

Answer 32

- address underlying cause - K+ supplementation - KCl can be added to fluid therapy

Question 33

metabolic acidosis causes

Answer 33

- loss of base from the body - failure to excrete acid - accumulation of acid

Question 34

metabolic acidosis body compensation

Answer 34

body counteracts this by blowing off CO2 through hyperventilation - will have low pH and pCO2

Question 35

metabolic alkalosis causes

Answer 35

- increase in hydrogen bicarbonate loevels - loss of acid from body

Question 36

metabolic alkalosis body compensation

Answer 36

hypoventilation which lowers pH

Question 37

respiratory acidosis causes

Answer 37

a rise in blood CO2 - upper airway obstruction - pulmonary effusion (fluid on the lungs) - pulmonary disease - CNS depression

Question 38

respiratory acidosis body compensation

Answer 38

- kidneys retain more bicarbonate and excrete H+ ions to increase pH

Question 39

respiratory alkalosis causes

Answer 39

a fall in blood CO2 - fear, pain, excitement, pyrexia - hyperventilation

Question 40

respiratory alkalosis body compensation

Answer 40

- eliminate bicarbonate via kidneys to lower pH

Question 41

fluid therapy preferrable for acidotic patients

Answer 41

hartmann's - contains lactate as a buffer

Question 42

fluid therapy preferrable for alkalotic patients

Answer 42

0.9% NaCl - slightly acidic