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SA Emergency > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

Tell me about the fluid compartments of the body

A

Body is about 65% water

2/3 of that is found in the intracellular space

1/3 is in the extracellular space

The extracellular space is broken down into interstitial fluid and intravascular fluid

75% of the extracellular fluid is in the interstitial space and 25% is intravascular

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2
Q

Equation for total body water

A

BW x 0.65

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3
Q

Blood volume is about _____ml/kg water

A

90

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4
Q

How can you figure out how much plasma is in the body?

A

Find total blood volume (BW in kg x 90mL/kg)

Blood is made up of about 45% RBCs and 55% plasma

Multiply total blood volume by 0.55

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5
Q

T/F: the concentration of electrolytes varies based on the fluid compartment

A

True

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6
Q

Discuss electrolyte concentration in the extracellular space

A

High sodium (~140 mEq/L)
Low potassium (~4mEq/L)

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7
Q

Discuss electrolyte concentration in the intracellular space

A

High potassium (~140mEq/L)
Low sodium (~30mEq/L)

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8
Q

Water is to ________ as Bailey is to Paul Mescal

A

Sodium

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9
Q

What determine intravascular volume?

A

Sodium concentration

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10
Q

Total body sodium determines _______

A

Hydration

Ex. Whenever I eat a large quantity of ramen noodles, my fingers swell b/c I’ve got a lot of extra sodium for water to hang out with

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11
Q

What is an osmole?

A

The number of moles in a solution that contribute to its hold on water

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12
Q

What is osmolality?

A

Number of moles dissolved in a mass of solvent

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13
Q

What electrolyte has the greatest impact on osmolality?

A

Sodium

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14
Q

What does serum sodium concentration actually mean?

A

A reflection of total body water NOT total body sodium

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15
Q

Hyponatremia =

A

Water excess
Serum sodium concentration is low likely due to free water excess

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16
Q

Hypernatremia =

A

Water deficit
Severe dehydration

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17
Q

There are three types of fluids that can be lost - what are they

A

Hypotonic
Hypertonic
Isotonic

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18
Q

What type of fluid loss am I: more water loss than solute loss

A

Hypotonic

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19
Q

Give an example of hypotonic fluid loss

A

Diarrhea, vomit, sweat

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20
Q

What type of fluid loss am I: isotonic to ECF

A

Isotonic - sodium concentration likely unchanged

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21
Q

What could hypotonic fluid loss lead to?

A

Hypernatremia

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22
Q

What is the least common type of fluid loss?

A

Hypertonic

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23
Q

What kind of fluid loss am I: more solute loss than water loss

A

Hypertonic

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24
Q

Give an example of how hypertonic fluid loss could occur

A

Replacing losses with only water and not the solutes

Could lead to hyponatremia

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25
Q

T/F: Dehydration and hypovolemia are the same thing, one is just more severe.

A

False - differ in where the fluid is lost from, how quickly it is lost, and how quickly it needs to be replaced

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26
Q

What is dehydration?

A

Fluid losses from the interstitial space

Usually occurs over longer period of time

Can be replaced more slowly

27
Q

What is hypovolemia?

A

Loss of fluid form intravascular space

Usually occurs more rapidly than with dehydration

Requires rapid restoration of blood volume

28
Q

What is the one similarity between hypovolemia and dehydration?

A

Both should be replaced with fluids that are higher in sodium

29
Q

What are some good reasons to give fluids?

A

Dehydration
Hypovolemia
Anorexia (>12-24)
Severe losses
General anesthesia
As a vehicle to get other stuff in the patients

30
Q

Name some characteristics of a crystalloid fluid

A

Salt water
Freely moves within the EC space
Redistributes into interstitium rapidly

31
Q

Name some characteristic about colloids

A

Contains molecules that don’t readily leave the IV space
Theoretically stays in IV space longer
Synthetic and natural available

32
Q

What determines the immediate effect of a fluid on blood volume?

A

Volume delivered

Greatest absolute increase in blood volume seen with crystalloids

33
Q

What determines the later effect of a fluid on the blood volume?

A

Type of fluid given

Most sustained increase in blood volume seen with colloids

34
Q

What are the cons to crystalloids?

A

Large volume
Transient effect b/c rapidly redistributes to interstitium
Might potentiate edema

35
Q

What are some cons to colloids?

A

Potential interstitial leak may lead to edema formation
Changes in coagulation
Kidney injury
Cost

36
Q

What is tonicity?

A

Basically osmolality but just looking at the effect of salts

37
Q

____________ fluids have similar tonicity to ECF

A

Isotonic fluids

38
Q

LRS, 0.9% NaCl (normal saline), Normosol R, and Plasmalyte A are examples of _______

A

Isotonic fluids

39
Q

T/F: hypotonic fluids are the best choice for patients presenting in hypovolemic shock

A

False - hypotonic fluids should never be bolused as this will lead to cell lysis

40
Q

How does hypertonic saline work?

A

Pulls free water from interstitial and intracellular spaces to increase IV volume

41
Q

What are the positive physiologic and immunomodulatory effects of hypertonic saline?

A

Increased tissue oxygen delivery
Vagally mediated reflex to sustain HR and CO
Decreased cellular edema (great for cerebral edema)

42
Q

When is hypertonic saline contraindicated?

A

Hypernatremia

Dehydration - minimal fluids in interstitium to pull from

43
Q

What is mean by balanced versus unbalanced fluids?

A

Referring to overall electrolyte make up of the fluid

Balanced = major electrolytes are in similar proportion to ECF (lower chloride)

Unbalanced = electrolytes are not in proportion with ECF though often are isotonic

44
Q

Name some isotonic and balanced fluids

A

LRS
Normosol R
Plasmalyte A

45
Q

Name some isotonic and unbalanced fluids

A

Normal saline (0.9%)
5% dextrose in water (D5W)

46
Q

Maintenance fluids are ________ in sodium and chloride, but ______ in potassium

A

Lower; higher

47
Q

Replacement fluids mimic ________, so they are higher in sodium.

A

ECF

48
Q

Name some replacement fluids

A

LRS
Normal saline
Normosol R
Plasmalyte 148

49
Q

Name some maintenance fluids

A

Normosol M
0.45% NaCL (half strength saline)
D5W
Plasmalyte 56

50
Q

T/F: Though oral fluids are best whenever possible, IV fluids are the best option when PO is not feasible.

A

True

51
Q

A dog in suspected hypovolemic shock is in the ER with a potential GDV. You want to give fluids for resuscitation. The vet student says, “since he’s not drinking, we should give them subcutaneously.” What do you say back?

A

SC fluids are only for stable patients. To best address the hypovolemia, we need to give and intravenous bolus of a replacement fluid like LRS, Normosol R, or 0.9 NaCl.

52
Q

The delivery rate for crystalloids for shock and hypotension is ________.

A

10-20mL/kg given as fast as possible or over about 10 minutes

Reassess and repeat as needed (up to 3 times?)

53
Q

What is the delivery rate for colloids for patients in shock or hypotension?

A

5-10mL/kg bolus then reassess

54
Q

What is the delivery rate for hypertonic saline in a shocky or hypotensive patient?

A

4-6mL/kg bolus

55
Q

A patient is assessed to be 7% dehydrated. How do we correct this?

A

% dehydration x BW (in kg) = fluid deficit in L

Replace the deficit over 6, 12, 24, 48 hours.

56
Q

When blousing fluids, use a _______ diameter and _______ catheter

A

Large; short

57
Q

Formulas for maintenance fluids

A

(BW x 30) + 70 = mL fluid per day

70 x BW^0.75 = mL fluid per day

58
Q

T/F: once you set a maintenance rate, you are good to go and can leave the patient to rehydrate.

A

False - should be reassessing hydration status frequently and adjusting fluid rate as needed

59
Q

T/F: in general, the smaller the dog, the smaller the fluid rate

A

False - the opposite.

Large/giant breeds - 40mL/kg/dag

Medium dogs and cats - 50mL/kg/day

Small dogs - 60mL/kg/day

60
Q

What is the maintenance fluid rate for neonates?

A

80-100mL/kg/day

61
Q

Complication of fluid therapy

A

Electrolyte imbalances
Fluid overload
Iatrogenic CHF
Phlebitis
Extra cost
Prolonged hospitalization

62
Q

When do we stop administering fluids?

A

Rehydration is complete

Patient is eating and drinking sufficiently to maintain daily losses

Ongoing losses are under control

63
Q

What are some ways we can monitor fluid therapy?

A

BW!!!!!
USG
PE
Ins and Outs
Central venous pressure
Left ventricular end-diastolic diameter
Electrolytes

SA Emergency (11 decks)

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