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fluids, respiratory, muscles > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

What percent of body weight is water

A

60%
Pediatric: maybe 70%
Obese: use lean body weight for calculations (lean body weight is 70% of BW)

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2
Q

In dogs and cats, what percent of total body water is intracellular vs extracellular

A

Intracellular: 2/3 of TBW (40% BW)

Extracellular water: 1/3 of TBW (20% BW)
within this, interstitial water is 75% of ECF and intravascular water is 25% of ECF

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3
Q

Extracellular water is approx 1/3 of total body water (or 20% of body weight), what are its further subdivisions

A

Interstitial water: 75% of ECF
Intravascular water: 25% of ECF

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4
Q

2/3 of the total body water is _____________ (40% of body weight)

A

intracellular fluid

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5
Q

1/3 of the total body water is ____________ (20% of body weight)

A

extracellular fluid

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6
Q

If you have a 10kg dog. What is:
-TBW
-Intracellular fluid water
-Extracellular fluid water
-Interstitial Fluid Water
-Intravascular fluid

A

TBW: 0.6 x 10= 6kg

Intracellular: 2/3 of 6 L= 4L

Extracellular: 1/3 of 6L = 2L

Interstitial: 3/4 of ECF= 1.5L

Intravascular= 1/4 of ECF = 0.5L (1/12 of TBW)

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7
Q

About what percent of the body weight is blood volume

A

8-9% of BW in dogs
5-6% of BW in cats

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8
Q

Intravascular fluid water volume is about 5% of the body weight, why is the blood volume 8-9% of TBW and 5-6% of the body weight in cats?

A

Because blood contains both a liquid phase (plasma) and a cellular phase (RBC)

-IV water volume takes only the liquid phase into acocunt

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9
Q

If you have a 30kg dog. What is:
-TBW
-Intracellular fluid water
-Extracellular fluid water
-Interstitial Fluid Water
-Intravascular fluid

A

TBW= 0.6xBW= 18L

ICF: 0.67xTBW= 12L

ECF: 0.33xTBW= 6L

Intravenous Water (plasma) volume= 0.25xECF = 0.25x 6= 1.5L

Interstitial fluid volume= 0.75xECF= 0.75x6=4.5L

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10
Q

If you have a 5kg cat. What is:
-TBW
-Intracellular fluid water
-Extracellular fluid water
-Interstitial Fluid Water
-Intravascular fluid

A

TBW= 0.6xBW= 3L

ICF: 0.67xTBW= 2L

ECF: 0.33xTBW= 1L

Intravenous Water (plasma) volume= 0.25xECF = 0.25x 1= 0.250L

Interstitial fluid volume= 0.75xECF= 0.75x1=0.750L

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11
Q

Barrier between ICF and ECF compartments

A

Semi-permeable cell membrane
Freely permeable to water based on concentration gradients
Impermeable to electrolytes and proteins unless by transport

*Fluid move because of osmotic forces

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12
Q

How is fluid moved between ICF and ECF

A

Fluid move because of osmotic forces
Semi-permeable cell membrane
Freely permeable to water based on concentration gradients
Impermeable to electrolytes and proteins unless by transport

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13
Q

How is fluid moved within the ECF- between Int and IV

A

*Fluid moved because of Starling forces

-Endothelium
-freely permeable to electrolytes based on concentration gradients- water will follow
-relatively impermeable to proteins, larger molecules

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14
Q

Osmolality is proportional to

A

the number of non dissociable ions in a given solution

-not a function of the size or the molecular weight of the ion, just the number
expressed as mOsm/kg

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15
Q

How do you calculate osmolarity

A

2(NA +K) + BUN (mg/dL)/2.8 + Glucose (mg/dL)/18

Normal values are 280-305mOsm/L for dogs and 95-320 mOsm/L for cats

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16
Q

Is potassium higher ICF or ECF

A

ICF

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17
Q

Is Na+ higher ICF or ECF

A

ECF

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18
Q

Is Mg2++ higher ICF or ECF

A

ICF

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19
Q

Is Cl- higher ICF or ECF

A

ECF

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20
Q

What allows for movement of K+ out of cell and Na+ into the cell

A

Na/K ATPase

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21
Q

Effective osmoles

A

generate osmotic pressure across a semi-permeable membrane that is not permeable to that particle
*will result in movement of water
*Determines the tonicity of that compartment
ex: Sodium, Potassium

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22
Q

Why does albumin have minimal effect on osmolality

A

because its molecular weight is very high (66,000 Da) which makes the particle number relatively low
*We use colloid osmotic pressure, also known as oncotic pressure, refers to the osmolality due to proteins

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23
Q

Ineffective osmoles

A

have osmotic potential but they are unable to diffuse across the barrier
No osmotic pressure is generated, no movement of water
contributes to total osmolality but not tonicity
ex: Urea (diffusible), glucose (metabolized)
Note: D5W is iso-osmolar AND hypotonic

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24
Q

What are Starling’s forces

A

determine the movement of water between the interstitial fluid compartment and the intravascular fluid compartment, within the ECF
1) Oncotic pressure
2) Hydrostatic pressure
3) Vascular permeability
4) Lymphatic drainage

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25
Q

The movement of fluid within the ECF depends on

A

1) Oncotic pressure
2) Hydrostatic pressure
3) Vascular permeability

(Starling forces)

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26
Q

What does hydrostatic pressure fluid movement depend on

A

The pressure difference between the capillary and the interstitial
causes fluid leakage out of the vessel

Capillary Hydrostatic pressure: primarily the venous pressure (Arterial pressure is not translated across the precapillary sphincter)
venous stasis will increase the capillary pressure

Intersitium hydrostatic pressure: characteristic of the tissue, tightness of the interstitial matrix

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27
Q

Venous stasis will ______________ the capillary pressure

A

increase

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28
Q

Changes in hydrostatic pressure causes

A

fluid leakage out of the vessel

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29
Q

What does oncotic pressure fluid movement depend on

A

the oncotic pressure difference between the capillaries and interstitisal
*Causes fluid to go into the vessels (Keeps fluids into the vessels)

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30
Q

Oncotic pressure depends on

A

proteins- number of particles = concentration/molecular weight

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31
Q

Differences in oncotic pressure causes fluid to ____________

A

go into the vessels

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32
Q

What is the normal capillary oncotic pressure

A

Dog: 21-25 mmHg
Cat: 23-28 mmHg

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33
Q

What does the filtration coefficient (Kfc) depend on

A

1) Capillary surface area: larger surface area will increase Kfc
2) Hydraulic conductivity (leakiness of the vessels)- characteristics of endothelium and endothelial continuity

*Liver and kidney have leaky vessels: large net movement of fluid out of blood vessels

*Brain and muscle have relatively tight vessels

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34
Q

What is the reflection coefficient

A

relatively permeability of the capillary bed to protein (reflection = bouncing back of the protein)
depends on tissue (low in liver, high in kidney)

Lungs have low Kfc and high reflection coefficient (non leaky)

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35
Q

Lungs have low Kfc and high reflection coefficient. What does that mean

A

they are relatively non-leaky

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36
Q

Changes in osmolality moves water between

A

ECF and ICF

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37
Q

glycocalynx

A

dense, gel-like meshwork that surrounds the cell, constituting a physical barrier for any object to enter the cell

difference in the oncotic pressures on each sides is what drives the movement of fluids

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38
Q

What are the different kinds of crystalloids

A

1) Hypotonic :D5W, 0.45% NaCl
2) Isotonic: LRS, 0.9% NaCl
3) Hypertonic (7.2% NaCl)

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39
Q

What are the different kinds of colloids

A

1) Synthetic (Hetastarch, Vetstarch)
2) Natural (e.g Plasma)

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40
Q

What are the different kinds of blood products

A

1) Fresh Whole Blood
2) Packed Red Blood Cells
3) Plasma Products
4) Platelet Products

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41
Q

Fluid shifts between the intersititium and IV compartments because of

A

Starling’s forces

1) Oncotic pressure
2) Hydrostatic pressure
3) Vascular permeability
4) Lymphatic drainage

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42
Q

What is the osmolality of hypotonic crystalloids

A

0.45% NaCl = 154 mOsm/L

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43
Q

What is the osmolality of isotonic crystalloids

A

0.9% NaCl = 310 mOsm/L

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44
Q

What is the osmolality of hypertonic crystalloids

A

7.5% NaCl = 1300 mOsm/L

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45
Q

Crystalloids can be classified on osmolality but how else can they be divided?

A

Based on electrolyte composition and acid base effects
-NaCl based vs balanced electrolyte (LRS or Plasmalyte)
-The amount and type of bicarbonate precursors
ex: 0.9% NaCl has none and is therefore an acidifying solution
ex: LactaTe (LRS) or lguconate/acetate (Plasmalyte) are alkalinizing solutions

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46
Q

What are examples of alkalizing solutions

A

LRS (Lactate is the bicarb precursor)
Plasmalyte/ Normosol R both have Acetate gluconate as their bicarb precursors

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47
Q

What is D5W

A

it behaves like water
No electrolytes or bicarb precursors
same osm of water (~287)

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48
Q

What do hypotonic crystalloids behave

A

it is distributed in both the ICF and ECF compartments
volume of distribution depends on the amount of Na in the solution

sometimes easier to consider hypotonic cyrstalloids as isontonic + water
-Isotonic fluid distribute 100% in ECF compartment
Water distributes 67% ICF and 33% ECF

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49
Q

How does isotonic fluid distribute when given

A

100% in the ECF compartment

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50
Q

You have 1000mL of Dextrose 5% in water. How is it distributed

A

D5W is iso-isomolar and hypotonic solution as dextrose is not an effective osmole (metabolized readilyy)
Should be consider equal to 1000mL of free water
so
ICF: 67% of 1000mL = 670mL
ECF: 33% of 1000mL = 330mL

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51
Q

You have 1000mL of 0.45% NaCl. How is it distributed?

A

is equal to 500mL of water + 500mL 0.9% NaCl
so
ECF distribution= 500mL + 33% of 500= 500+ 165= 665mL
ICF distribution= 67% of 500mL= 335mL

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52
Q

When should you use hypotonic crystalloids

A

1) True “maintenance” fluids
2) Free water deficit (ie. hypernatremia)
3) Maintenance fluid when Na restricted is needed (e.g heart and renal disease)

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53
Q

When are hypotonic crystalloids indicated

A

1) IV compartment volume expansion (ie shock treatment) - not good at going to the vasculature
2) Free water gain (hyponatremia)

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54
Q

What are the side effects of giving hypotonic crystalloids

A

1) Hyponatremia
2) If administered rapidly causes acute changes in blood osmolarity and fluid shifts
3) Resulting in neurological sequels and RBC damage

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55
Q

What are the most commonly used IV solutions

A

Isotonic crystalloids
-LRS
-Plasmayte 148, Plasmalyte A, Normosol R
-Normal/physiologic saline (0.9% NaCl)

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56
Q

What is the fluid behavior of isotonic crystalloids

A

*Stays within the ECF (3/4 intersititium space, 1/4 in intravascular space)
*Doesnt go into ICF

Redistribution to interstitial within 20-30 minutes according to Starling’s forces

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57
Q

T/F: isotonic crystalloids do not go into the ICF

A

true

*Stays within the ECF (3/4 intersititium space, 1/4 in intravascular space)

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58
Q

What are the indications for using Isotonic crystalloids

A

1) IV volume expansion (ie. treatment of shock)
2) ECF volume expansion (ie. rehydration, treatment of dehydration)
3) Replacement of ongoing loses

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59
Q

What are the contra-indications to using isotonic crystalloids

A

1) Low oncotic pressure
2) Severe cardiac or renal disease
3) Severe, active bleeding (large volume contraindicated)
4) Free water loss or gain (sodium disturbances)

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60
Q

What are the side effects of giving isotonic crystalloids

A

-Possible tissue edema (if aggressive/large volume) bc it goes into interstitial
-Possible worsening or creation of acid-base disorders
-Pro-inflammatory effects

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61
Q

How do hypertonic crystalloids behave

A

causes a shift of fluid from ICF/interstitium into the IV compartment
*Rapid volume expansion (5-7x the volume given)
But rapidly redistribute across all compartments (10-30min) - only transient impact on IV volume expansion
Also have microcirculation effects and improved cardiac contractility
horses: give smaller volumes

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62
Q

What are the indications for using hypertonic crystalloids

A

1) IV volume resuscitation (ie. shock treatment)
2) Traumatic brain injury- sucks water out of the brain
3) Correction of acute hyponatremia (usually use 3% NaCl)

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63
Q

What are the contra-indications for using hypertonic crystalloids

A

1) Chronic hyponatremia
2) Severe dehydration

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64
Q

What are the side effects of hypertonic crystalloids

A

1) Only transient volume expansion for 20-30 min
2) Cannot be re-dosed
3) Causes transient hypernatremia
4) Reflect vasodilation and bradycardia if bolused too fast

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65
Q

How do colloids behave

A

they contain larger molecules which do not readily cross capillary membranes
volume stays in the vascular space
contribute to oncotic pressure

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66
Q

How does hydroxyethyl starch (HES) behave

A

it is a synthetic colloid, modified polymers of amylopectin

volume of distribution is vascular space
volume expansion power of 80-120%
prolonged vascular expansion time compared to crystalloids

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67
Q

When should you give synthetic colloids like (HES, VES, Dextrans, Gelatin, HBOC)

A

1) IV fluid resuscitation (ie shock)- especially in cases with low albumin or transient response to isotonic crystalloids
2) Oncotic support for hypoproteinemia

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68
Q

What are the side effects or contraindications behind using synthetic colloids like (HES, VES, Dextrans, Gelatin, HBOC)

A

1) Coagulopathy: dose dependent (more than 20ml/kg/day with HES) but lower MW colloids like VetStarch is less concerning
mostly due to impaired platelet function
2) Renal injury: concern for increased risk of AKI and kidney failure in critically ill patients (lack of evidence in pets , just humans)

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69
Q

How might synthetic colloids like (HES, VES, Dextrans, Gelatin, HBOC) cause coagulopathies

A

mostly due to impaired platelet function

*VetStarch is less concerning than HES

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70
Q

What is the fluid behavior when giving natural colloids (plasma)

A

usually thought to expand vascular volume equivalent to the amount given (100%)

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71
Q

What are the indications for using natural colloids, like plasma

A

1) Acute blood loss
2) Coagulopathy
3) Hypoalbuminemia

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72
Q

What are the adverse effects of natural colloids

A

1) Cost
2) Low Availability
3) Transfusion reactions (less than 1%)

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73
Q

What is the fluid behavior of human serum albumin

A

stays in the vasculature AND pulls fluids from intersitium and ICF (VEP >100%)

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74
Q

What are the side effects of Human Serum Albumin

A

1) Acute (type I) and delayed (type III) hypersensitivity
2)redosing is absolutely contra-indicated and will trigger anaphylactic shock
3) In people, no documented benefit, except maybe in septic shock

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75
Q

What are the indications for human serum albumin

A

There really arent, it is a strong debate but possible severe sepsis and septic shock (hypoalbuminemia with severe side effects)

most patients it is contra-indicated, if previously received HSA especially

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76
Q

What are the pros/ cons of the oral/enteral route

A

Pros:
Most natural way, low cost and risks, can also provide nutritional/calric support, either spontanteous drinking or through feeding tube, much less risk of volume overload

Cons: usually patients needed fluid therapy were not able to maintain volume status to begin with because of sickness, need functional GI tract, volume and speed of administration is usually too high for correction of dehydration and/or hypovolemia

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77
Q

What are the complications of the oral/ enteral route

A

low effeciveness for fluid expansion
Risk of aspiration pneumonia if vomitting and/or low LOC

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78
Q

What are the advantages of IV route

A

1) Direct vascular access for volume expansion
2) Rapid administration is possible- cut down placement if needed
3) Multiple types of fluid can be given (all types of cyrstalloids, colloids, blood products)

used for IV fluid resuscitation, significant dehydration (especially with expected ongoing losses), critically ill patients

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79
Q

What are the indications for using IV route for fluids

A

used for IV fluid resuscitation, significant dehydration (especially with expected ongoing losses), critically ill patients

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80
Q

What are the peripheral IV locations that you can use

A

Cephalic
Medial saphenous in dogs
Lateral saphenous in cats

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81
Q

What are the central IV locations that you can use

A

Usually on the jugular vein
usually longer and with multi-lumen
can be peripherally inserted central catheter (PICC) in the lateral or medial spahenous

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82
Q

What are the differences between administering peripheral vs central vein IV

A

Peripheral: fast, easy cheap and the bigger and shorter catheters allows for a faster administration because the flow of the fluid is proportional to the radius of the tube but only for relatively isotonic fluid and is easy to dislodge and cant be used for sampling

Central: Safer admin of hypo- and hypertonic fluids, serial blood sampling but requires more expertise and shouldnt be used for TBI or high risk bleeding patients

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83
Q

Can peripheral or central venous be used for serial sampling

A

Central venous

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84
Q

Can peripheral or central venous be used for isotonic solutions

A

peripheral venous

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85
Q

When might the intraosseus route be used

A

1) Smaller patients (ie neonates_
2) Exotics such as birds or others
3) rapid access if IV access is not possible or challenging (ie shick, CPR)
4) Various sites: proximal humerus, femur or tibia; birds: distal ulnar and proximal tibia

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85
Q

What are possible complications of IV catherization

A

1) Infection/Inflammation- thrombophlebitis or catheter side inflammation/ infection
2) Thrombosis/ thromboembolism- clot formation with potential migration
3) Extravasation of fluids from catheter can cause severe necrosis
4) Blood loss if disconnected
5) Blood stream related infection (BSRI)
6) Cathetic fragment foregin body

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86
Q

What are the pros and cons of the intraosseus route?

A

Pros: rapid access to vascular space when IV not possible or challenging, drugs and fluids can be given equivalent to IV, relatively easy placement

Cons: often short-lived access, complications are not uncommon- infection (osteomyelitis), fracture, maybe technically challenging in very small patients

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87
Q

How are SQ fluids absorbed

A

fluid is administered in the intersitium (between shoulder blades) and will be gradually absorbed and distributed across fluid compartments according to Starling’s forces
-speed of distribution dependent on hydration status and peripheral perfusion

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88
Q

What kinds of fluids can be given through the SQ route

A

Only administer isotonic fluids, usually LRS
-Hypo/hypertonic solutions (ie D5W) can cause significant irritation/ and otissue injury

*some isotonic fluids like Plasmalyte may sting and should be avoided

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89
Q

T/F: you can give hypotonic solutions through SQ route

A

False
Hypo/hypertonic solutions (ie D5W) can cause significant irritation/ and otissue injury

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90
Q

What are the indications to giving SQ fluids

A

1) Mild dehydration
2) patient cannot be hospitalized

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91
Q

What are the advantages to giving Sq fluids

A

1) inexpensive
2) easy technically
3) Can be administered by owners as needed

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92
Q

What are the disadvantages of giving SQ fluids

A

1) Unreliable absorption
2) Limited volume so not for severe dehydration
3) Slow absorption so not for shock
4) Limited options for fluid administered (only isotonic)

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93
Q

What is the dose of most SQ fluids

A

Dose dependent of the room between the shoulder blades as well as appropriate rehydration volume (eg 5% of body weight)

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94
Q

What are the complications of SQ fluids

A

pain, irriation
pressure necrosis
excessive admin
hematoma
infection: SQ cellulitis, abscess formation

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95
Q

When you are talking about dehydration, what are you talking about

A

Loss of isotonic fluid (aka ECF- loss of water AND salt)

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96
Q

Dehydration is loss of

A

ECF - water and salt

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97
Q

What are the 5 physical examination signs of dehydration

A

1) Mucous membranes
2) Skin elasticity (turgor)
3) Position of eye in orbit
4) Changes in body weight
5) Volume status
6) + Thirst mechanism

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98
Q

How can you examine dehydration in a patient

A

Physical signs
1) Mucous membranes
2) Skin elasticity (turgor)
3) Position of eye in orbit
4) Changes in body weight
5) Volume status
6) + Thirst mechanism (behavior change)

Bloodwork: PCV/TP and BUN, creatinine

Urinalysis: specific gravity

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99
Q

When do signs of hypovolemia due to dehydration become evident

A

When the patient is severely dehydrated (10-12%)

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100
Q

How does the eye position change in due to dehydration

A

Mild dehydration (5-7%): normal position

Moderate dehydration (8-10%): may be sunken

Severe dehydration (10-12%): sunken eyes

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101
Q

How does skin elasticity change due to dehydration

A

Mild dehydration (5-7%): slightly decrease

Moderate dehydration (8-10%): decrease

Severe dehydration (10-12%): stands in a fold

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102
Q

What do the mucous membranes look like when a patient is dehydrated?

A

tacky

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103
Q

T?F: dehydration decreases tear and saliva production

A

true

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104
Q

What influences membrane moistness

A

1) Hydration staus
2) Evaporation (panting)
3) Tear production influenced by KCS “dry eye”

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105
Q

How does the skin elasticity test determine hydration status

A

there is less fluid in the interstitial space and there is a decrease in elasticity/ turgor leading to an increased time to return to a normal position

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106
Q

Elasticity of the skin depends on

A

hydration status - also used to assess overhydration

also age
young: increase skin elasticity
old: decrease skin elasticity
obese: increase skin elasticity

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107
Q

How do young animals influence the skin elasticity test

A

they have increased skin elasticity

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108
Q

How do old animals influence the skin elasticity test

A

they have decreased skin elasticity

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109
Q

How do obese animal influence the skin elasticity test

A

they have increased skin elasticity

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110
Q

What other factors influence the position of the eye in the orbit for dehydration assessment

A

1) Obesity
2) Ocular disease
3) Breed and conformation

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111
Q

What causes the eye to sink with dehydration

A

sunken eye is associated with reduced volume of retrobulbar fat

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112
Q

What is the best way to assess hydration status

A

changes in body weight
get historical background
-normal dogs- no access to water
-induce dehydration (diuretics)
-monitoring body weight and physical examination findings

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113
Q

furosemide depletes a patients

A

extracellular fluid compartment

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114
Q

A patient that is 10% dehydrated lost

A

10% of their body weight
ex: 10 kg dog that is 10% dehydrated lost one L of water

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115
Q

What 2 factors triggers the thirst sensation

A

1) Decrease in ECF (aka dehydration) triggers ADH release which triggers RAAS system and triggers thirst centers in the brain to search out and ingest water

2) Increase in osmolality of the extracellular space (ie an increase in the concentration of sodium)

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116
Q

Dehydration is loss of ___________ fluid while hypovolemia is loss of ____________ fluid

A

interstitial; intravascular

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116
Q

What percent dehydration causes shock

A

> 10% dehydration you have significant hypovolemia
-Loss of intravascular fluid

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117
Q

What is the difference between dehydration and hypovolemia

A

ex: 10 kg dog is 10% dehydrated and losts 10% of BW= 1kg=1L

Dehydration is loss of ECF compartment 3.4 from intersitium= 750ml and 1/4 from IV = 250ml

10% dehydration in a 10kg dog corresponds to a loss of 250mL from the intravenous compartment

if 10kg dog, 800mL is blood volume so they lost 31% of blood volume. you see signs of hypovolemia for a loss of 30% of blood voluleme

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118
Q

A 10kg dog is 10% dehydrated. How much IV volume is lost

A

10 kg dog is 10% dehydrated and losts 10% of BW= 1kg=1L

Dehydration is loss of ECF compartment 3.4 from intersitium= 750ml and 1/4 from IV = 250ml

10% dehydration in a 10kg dog corresponds to a loss of 250mL from the intravenous compartment

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119
Q

You will see the clinical signs associated with hypovolemia when ______________

A

greater than 30% of blood volume is lost / >10% dehydrated

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120
Q

T/F: the body can compensate to maintain vascular volume but cannot do the same for interstitium volume

A

True

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121
Q

How does dehydration affect BUN

A

it will increase it

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122
Q

Dehydration is loss of ___________ fluid so you should replace with _____________

A

loss of isotonic fluid; replace with isotonic crystalloid

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123
Q

What is the time frame for correcting dehydration

A

4-24 hours
(average is 8-12 hours)
depends on: severity, speed of loss, compensatory, species, comorbidities (heart, lungs, kidneys), age, practicality, monitoring abilities

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124
Q

What is the equation for maintenance (dogs and cats)

A

Dogs:
132 x BW(kg) ^0.75 or
(*) 70 x BW(kg)^0.75
-preferred

Cats:
70x BW(kg)^0.75

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125
Q

Generally, what are the fluids rate for maintenance in dog and cat

A

40-60mL/kg/day
or
2-4mL/kg/hr or 1-2mL/kg/hr
Big dog or cat= lower end
small dog= higher end
or
30 x BW(kg) + 70(ml/day)

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126
Q

After fluid maintenance, you want to do fluid replacement, what should you use

A

Isotonic crystalloid
-too much Na and too little K
-add potassium to the fluid bag
-kidneys will handle the sodium load

hypotenoic crystalloid or true maintenance fluid- Plasmalyte 56 or Normosol-M when renal function is compromised or if in heart failure; for large animals

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127
Q

How should you account for abnormal ongoing losses (vomiting, diarrhea, burns, etc)

A

weight the losses or just do 1/2 maintenance for a lot of diarrhea or 1x maintenance for a lot of diarrhea

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128
Q

How do you monitor ongoing losses

A

Re-assess the patient by blocks of 4-12 hours
-PE
-BW
-Fluid balance (input versus output)
-Quantitative: urine output if urinary catheter or amounts of food/water eaten/drunk
-Qualitative: hypersalivation, diarrhea

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129
Q

You are presented with a 3yo M/C Labrador retriever who has had diarrhea for the past 3 days. He got into the garbage the day before. Still drinking water. No hematochezia or melena.
T=101.3
P=108
R=30, mm pink
slightly tacky, CRT= 2sec
BW: 40kh
Skin tent is very mildly prolonged and the eyes are in their normal position in orbit. What is the amount of dehydration? What should you give for maintenance

A

Mild to moderate dehydration 5-8% (pick 6%)
Deficit = 40 x 0.06= 2.4 kg(L) lost
Fluid type: Isontonic crystalloid (LRS)
timeframe:
6hr = 400ml/hr
10 hours= 240ml/hr

Maintenance= 70x40^0.075= 1113mL/ day= 46mL/hr

Total= 446mL/hr for 6 hours or 286mL/hr for 10 hours

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130
Q

Shock is defined as

A

inadequate cellular energy production due to critical decrease in DO2 compared to O2 consumption VO2 in tissues

O2 need»»» O2 delivery

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131
Q

inadequate cellular energy production due to critical decrease in DO2 compared to O2 consumption (VO2) in tissues

O2 need»»» O2 delivery

A

shock

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132
Q

What is produced as a result of anaerobic respiration

A

Lactate

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133
Q

What are the results when there is a decrease in O2 delivery, seen in patients with shock

A

1) Anaerobic metabolism
2) Increased lactate production and decreased ATP production
3) Cell dysfunction and failure (pump dysfunction of NA-K ATPase leading to intracellular edema, leakage of intracellular contents extracellularly and inability to regulate intracelular pH)
4) Multi-organ dysfuction (MODS)

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134
Q

What is the result of pump dysfunction of Na-K ATPase during shock?

A

pump dysfunction of NA-K ATPase leading to intracellular edema, leakage of intracellular contents extracellularly and inability to regulate intracellular pH)

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135
Q

What could limit the delivery of O2 to tissues in dogs and cats?

A

1) Respiratory: hypoxemic
2) Heart: cardiogenic (Decreases in SV or HR)
3) Vessels: Hypoxemic- (Hemoglobin, SaO2, PaO2), Hypovolemic, Distributive
4) Organs/Cells: Metabolic

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136
Q

due a decrease in circulating blood volume
severe dehydration >10-12%
can be from GI losses (Parvovirus), excessive diuresis (AKI) or burn
or
Blood loss from trauma

A

Hypovolemic shock

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137
Q

Why might a patient be in Hypovolemic shock

A

due a decrease in circulating blood volume
severe dehydration >10-12%
can be from GI losses (Parvovirus), excessive diuresis (AKI) or burn
or
Blood loss from trauma

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138
Q

Why might a patient be in cardiogenic shock

A

shock due to decreased forward flow from the heart
1) Congesitve heart failure (Mitral valve disease, dilated/ hypertrophic cardiomyoapthy)
2) Cardiac arrhythmias (ventricular tachycardia, atrial fibrillation, bradyarrhythmia)
3) Cardiac tamponade (Obstructive shock)
4) Drug overdose- beta blockers, calcium channel blockers

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139
Q

How might a patient be in distributive shock

A

due to marked decrease or increase in systemic vascular resistance or maldistribution of blood

inadequate blood flow to organs, due to vasodilation- sepsis or anaphylaxis

obstruction of blood flow coming to heart or leaving heart
-Gastric dilation volvulus (GDV)
-Pulmonary thrombo-embolism (PTE), saddle thrombus
-heartworm disease, pericardial effusion

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140
Q

What is the result of obstruction of blood flow due to gastric dilation volvulus (GDV), PTE, saddle thrombus, heartworm disease, pericardial effusion?

A

Distributive shock
-due to marked decrease of increase in systemic vascular resistance or maldistribution of blood from the obstruction of blood flow from/away heart

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141
Q

How does sepsis lead to shock

A

vasodilation leading to inadequate blood flow to the organs (Distributive shock)

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142
Q

How does anaphylaxis lead to shock

A

vasodilation leading to inadequate blood flow to the organs (Distributive shock)

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143
Q

What are the different types of shock

A

1) Hypovolemic (decrease circulating blood volume from loss or dehydration- GI, diuresis, or burn)

2) Cardiogenic (decreased forward flow from CHF, arrhythmias, tamponade or drugs)

3) Distributive: inadequate blood flow from increased or decreased vascular resistance (sepsis, anaphlyaxis, GDV, PTE, HWI, pericardial effusion)

4) Hypoxemic shock: due to decreased O2 content in arterial blood from severe pulmonary disease, anemia, dyshemoglobinemia (CO toxicity, methmoglobinemia)

5) Metabolic shock: due to decrease in cellular metabolic machinery, hypoglycemia, cyanide toxicity, cytopathic hypoxia of sepsis

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144
Q

How does GDV lead to obstructie shock

A

there is compression of great vessel that decreases venous return and preload

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145
Q

How does cardiac tamponade lead to obstructive shock

A

there is compression of the heart leading to reduced diastolic filling

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146
Q

How does tension pneumothorax lead to obstructive shock

A

there is compression of the heart leading to reduced diastolic filling

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147
Q

What are potential causes of hypoxemic shock

A

due to decreased O2 content in arterial blood (CaO2= 1.34 x Hb x SaO2) + 0.0031 x PaO2)
1) Severe pulmonary disease
2) Low Hb: anemia
3) Dyshemoglobinemia: CO toxicity, methmoglobinemia

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148
Q

What are the potential causes of metabolic shock

A

due to decrease in metabolic machinery
1) Hypoglycemia
2) Cyanide toxicity
3) Cytopathic hypoxia of sepsis

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149
Q

What are the compensatory mechanisms for patients with shock

A

Goal to return to normal circulating volume and normal pressure

1) Increased sympathetic activity (EP/ NE) leading to Vasoconstriction (Increase HR and contractility)

2) Renin-Angiotensin- Aldosterone system activation + ADH release, leading to vasoconstriction-H20 and Na+ retention

3) Mobilization of fluid from interstitial to the intravascular space

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150
Q

What is the point of vasoconstriction as compensatory for patients with shock

A

Vasoconstriction under SNS activation leads to increase HR and contractility

Vasoconstriction under RAAS activation leads to H20 and NA2+ retention

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151
Q

What is the heart rate of patients with shock

A

Cats: HR <160 and HR >220 bpm

Dogs: HR >160 for small breed and >100 bpm for large breed

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152
Q

What are the pulse quality changes you will see in patients with shock

A

1) Pulse deficit
2) Bounding pulse: severe anemia and sepsis
3) Weak/Absent: femoral / metatarsal pulse- hypotension
4) Asymmetrical pulse: saddle thrombus of cats

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153
Q

What might you see with the CRT in patients with shock/ poor perfusion

A

> 2sec: vasoconstriction
<1s: vasodilation = sepsis

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154
Q

How might you have a patient in shock but their mucous membranes are injected

A

Sepsis, feber, pain, anxiety

155
Q

Why might a patient in shock have white mucous membranes

A

anemia, poor peripheral perfusion (Vasoconstriction)

156
Q

Why might a patient have brown mucous membranes

A

acetaminophen toxicity

157
Q

How might a patient have yellow mucous membranes

A

liver disease

158
Q

What will the mentation of a patient with shock be

A

dull and depressed

159
Q

What are the 3 stages of shock *

A

1) Compensated Stage: Mild to moderate alteration in perfusion parameters, Mid increase in lactate, and normal blood pressure

2) Decompensated Stage: moderate to severe alteration in perfusion parameters, major increase in lactate, low blood pressure

3) Terminal Stage: Severe alteration in perfusion parameters, even more major increase in lactate
Low blood pressure

160
Q

What is the goal of treating hypovolemic shock

A

to return to normal circulating volume + normal blood pressure

161
Q

How might hypovolemic shock occur

A

1) Severe dehydration >10-12%
2) Hemorrhage (trauma)

162
Q

What are the clinical signs of a dog with hypovolemic shock

A

Compensated
a) level of consciousness is normal to decreased
b) CRT is normal to increased
c) Tachycardia (Small >140-160 while large is >100 bpm
d) Blood pressure is WNL/ hypertension
e) Good peripheral pulse
f) +/- Increased respiratory rate
g) +/- cold extremities

Decompensated
a) level of consciousness is decreased
b) CRT is increased majorly, pale mucous memebranes
d) tachycardia/bradycardia
e) Hypotension: SBP <90mmHg
f) Weak peripheral pulse
g) Cold extremities

163
Q

How does blood pressure change when a patient is in hypovolemic shock

A

at first there will be compensation to correct the blood pressure and it will be normal to hypertensive but then when it is decompensated, the patient will be hypotensive SBP <90 mmHg

164
Q

What are the clinical signs of hypovolemic shock in cats

A

Lethargy, laterla recumbency
tachycardia (HR> 220bpm) / bradycardia (HR <140 bpm)
Pale mucous membranes
Weak pulses
Hypotension
Hypothermia

165
Q

How do the clinical signs of dogs and cats in hypovolemic shock differ

A

cats dont really have the compensated/ decompensated shock they just come in with
Lethargy, laterla recumbency
tachycardia (HR> 220bpm) / bradycardia (HR <140 bpm)
Pale mucous membranes
Weak pulses
Hypotension
Hypothermia

166
Q

What is the pathophysiology of sepsis

A

1) Gram - (LPS) and Gram + (cell wall components) are a stimuli fro host immune system that cause cytokine storm (TNFa, IL-1, IL-6, IL-8, IL-4, IL-10, IL-13…)
2) Massive release of NO leading to powerful vascular smooth muscle relaxant -> vasodilatory state
3) Disturbances in endothelium permeability and microcirculation abnormalities

167
Q

What are the clinical signs of septic shock in dogs

A

Hyperdynamic phase: fever, tachycardia, CRT <1s. Hyperemic mucous membranes, bounding pulses, blood pressure within normal range

Hypodynamic phase: dull mentation, prolonged CRT, pale mucous membranes, tachycardia (bradycardia), weak peripheral pulse, hypotension (<90 mmHg)

168
Q

What are the clinical signs of septic shock in cats

A

Lethargy, lateral recumbency
tachycardia (HR >220 bpm) / bradycardia (HR <140bpm)
pale mucous membranes
weak pulses
Hypotension
Hyperthermia/ normothermia

169
Q

What are the bedside diagnostic tests for determining shock state (type)

A

1) Lactate, PCV/TP, blood glucose
2) Blood gas
3) Electrocardiogram
4) Pulse oximetry
5) Point of Care ultrasound (POCUS)

170
Q

What is normal lactate levels

A

<2-2.5 mmol/L

2-2.5: indicates poor perfusion
slight 2-3
mild: 3-5
moderate: 5-8
marked: 8-10
severe >10 mmol/L

get serial values rather than single one

171
Q

You have a patient with a blood glucose <65 mg/dL. What might be causes of the hypoglycemia

A

Sepsis!! might be cause of shock
Addisons Disease
Porto-systemic shunt

172
Q

What does Increased PCV and TP tell you

A

dehydration

173
Q

What does increased PCV with decreased TP tell you

A

acur blood loss

174
Q

What does decreased PCV with normal to increase TP tell you

A

possible IMHA

175
Q

What will you see on ECG of a patient with shock

A

1) Ventricular tachycardia,
2) supra-ventricular tachycardia
3) atrial fibrillation

*Helps dictating the treatment

176
Q

Cyanosis occurs when

A

5g/dL of Hb is not oxygenated
SpO2 = 67%, PaO2= 37mmHg (for normal PCV)

177
Q

Why might it be more tricky to evaluate blood pressure in cats

A

doppler tends to underevlauate systolic, reading closer to the mean arterial pressure

Hypotension <90mmHg
Normal BP >90mmHg

178
Q

What is normal BP

A

> 90mmHg

179
Q

What is the point of abdominal POCUS for determining the shock type

A

to identify peritoneal/ retroperitoneal free fluid

180
Q

What position should an animal be in for abdominal POCUS for determining shock type

A

right lateral recumbency

181
Q

What views should you look at for abdominal POCUS for determining shock type

A

1) Diaphragmaticohepatic
2) Splenorenal
3) Cystocolic
4) Hepatorenal

182
Q

What is the goal of thoracic POCUS for determining shock type

A

pleural/ pericardial effusion, comet tails, size of the left atrium

183
Q

What position are dogs in for thoracic POCUS

A

patient in standing or sternal position

184
Q

What do comet tails tell you

A

Blines to indicate the presence of an alveolar- interstitial pathology
important to look at the overall distribution of the B lines throughout the lung parenchyma

185
Q

What is normal LA/Ao ratio

A

Dogs: <1.3
Cats <1.6

Suspicious for CHF if
dogs >1.3
cats >1.6

Diagnostic for CHF is LA/Ao >2

186
Q

What are the 7 steps of shock resuscitations

A

1) Fluid or not?
2) What route?
3) What type?
4) How mich?
5) How fast?
6) End points of resuscitation?
7) What if it does not work?

187
Q

If you have a patient in shock. When should you give fluids? When should you not?

A

Yes: Hypovolemic and maldistributive

NO: Cardiogenic, anemic/ hypoxemic, metabolic

188
Q

When should you NOT give fluids to a patient that is in shock

A

when it is cardiogenic, anemic, or hypoxemic caused

important to get history, physical exam (cardiac auscultation), and blood pressure first

only use fluids for hypovolemic or maldistributive

189
Q

What is the best route to fix shock caused by hypovolemia or maldistributive

A

Intravenous first

if you cant- intraosseous

190
Q

How do you deliver large volumes quickly, say to correct hypovolemic shock*

A

Think of Poiseuille’s law where flow depends on pressure, radius, and viscosity

1) Increase pressure (gravity, slam bags, or rapid delivery system)
2) Increase the radius of catheter (increases flow rate by power 4)
3) Decreasing the length of catheter (use short catheter)
4) Increasing the number of catheters

Note: more viscous fluids will be more difficult to push

191
Q

How does the length of the catheter relate to the flow

A

inversely. the longer the slower flow

192
Q

Why might you not use a fluid pump to fix a patient in hypovolemic shock

A

It maxes out at 1L/hour and you want to deliver it faster

193
Q

What should you do if you want to deliver a large volume of fluids quickly to correct hypovolemic shock

A

Think of Poiseuille’s law where flow depends on pressure, radius, and viscosity

1) Increase pressure (gravity, slam bags, or rapid delivery system)
2) Increase the radius of catheter (increases flow rate by power 4)
3) Decreasing the length of catheter (use short catheter)
4) Increasing the number of catheters

Note: more viscous fluids will be more difficult to push

194
Q

Why do you not want to give hypotonic fluid to correct hypovolemic shock

A

because most goes intracellularly and intertitial (extra), small amount goes IV

VEP=8.3%

ex: 100mL given- behaves like water: 2/3 goes intracellular, 1/3 goes into extracellular and only 25% of that goes into the vascular space

195
Q

What is volume expansion power (VEP)

A

the amount of fluid in the vascular space at equilibrium
depends on individual fluid behavior in the body

196
Q

What is the Volume Expansion power of Isotonic saline

A

It does not go into intracellular compartment

*All goes into extracellular but 3/4 goes into interstitial while 1/4 goes into IV

VEP= 25%

197
Q

What is the volume expansion power of colloids

A

VEP= 100%

all goes into the IV

198
Q

What is the volume expansion power of hypertonic saline (7-7.5% NaCl)

A

500%

water is pulled from the intracellular and interstitial space

199
Q

Rank the following fluids (Colloids, Hypotonic, Isotonic, Hypertonic) by their Volume Expansion Power***
(Know this will be on test)

A

Hypotonic fluids: 8.3%
Isotonic fluids: 25%
Colloids: 80-120%
Hypertonic Saline: 500-700%

200
Q

Rank the following fluids by their volume needed to be given for shock

A

Isotonic > Colloids > Hypertonic Saline

201
Q

What is your fluid for first line for shock in small animal clinical practice

A

Isotonic crystalloid
-cheap, readily available, and rapidly eliminated

colloids take a long time to go away if you give too much

202
Q

When do you not want to use isotonic crystalloids for shock

A

low albumin or COP
concerns about active bleeding (small volume is more appropriate)

High risk of volume overload when patient has heart murmur or lung disease

203
Q

When do you want to use colloids for shock

A

1) small volume resuscitation
2) transient response to crystalloids
3) no response to crystalloids
4) Low albumin or COP

204
Q

When do you not want to use colloids for shock

A

1) Coagulopathies
2) Renal failure

205
Q

When should you use hypertonic saline for shock

A

1) Large animal (EQ, V< large dog)
2) traumatic brain injury

206
Q

When should you not use hypertonic saline for shock

A

Severe hypernatremia or hyponatremia

207
Q

What are the pros and cons of hypertonic saline

A

Pros: small volume, improves cardiac output, improves oxygen delivery to tissue

Cons: Can only give once (seizures because it makes brain cells smaller), hypernatremia, bradycardia and vasodilation if “flash bolus”

208
Q

What are the shock doses of fluids for dogs **

A

It depends on VEP of fluid

Isotonic fluid: 80-100mL/kg

Colloids: 20mL/ kg

Hypertonic fluid: 5mL/kg

Blood products: 20ml/kg

*Give aliquot of shock dose- usually 25-33% depending on factors

209
Q

What is a typical shock dose of isotonic fluid in a dog

A

80-100mL/kg

210
Q

What is a typical shock dose of colloids in a dog

A

20ml/kg

211
Q

What is a typical shock dose of hypertonic fluid in a dog

A

5ml/kg

212
Q

What is a typical shock dose of blood products in a dog

A

20ml/kg

213
Q

What are the typical shock doses in cats **

A

Isotonic fluid: 40-60ml/kg

Colloids: 10ml/kg

Hypertonic fluid: 3ml/kg

Blood products 10ml/kg

about half of what the dog is
Give aliquot of shock dose- usually 25-33% depending on factors

214
Q

What is a typical shock dose of isotonic fluid in a cat

A

40-60ml/kg

215
Q

What is a typical shock dose of colloids in a cat

A

10ml/kg

216
Q

What is a typical shock dose of hypertonic fluid in a cat

A

3ml/kg

217
Q

What is a typical shock dose of blood products in a cat

A

10ml/kg

218
Q

When delivering a shock dose of fluids, you typically give an aliquot of ____________ of the dose but it depends on__________

A

25-33% of dose

depends on: severity, speed of loss, compensatory mechanisms, species, comobordities, age, practicality, monitoring abilities, cause of shock

219
Q

How fast should you give fluids for shock

A

aliquot of the shock dose (25-33%) over a period of time
usually 5 to 30 minutes depending on:
severity, speed of loss, compensatory mechanisms, species, comobordities, age, practicality, monitoring abilities, cause of shock

220
Q

T/F: you should always aliquot the shock dose

A

False- it is true you typically give 1/3 to 1/2 of the dose depending on factors but with hypertonic saline you need to give all of the dose over 5 minutes

221
Q

When should you not give 1/2 to 1/3 of the shock fluid dose?

A

Hypertonic Saline
-Must be given over 5 minutes
-Redistribute in all compartments in 20-30 munutes

*If too fast= bradycardia/ vasodilation
*If too slow: loses the VEP

Needs to be followed boy another type of fluid (colloids or isotonic crystalloid but at 1/4 the dose

222
Q

What happens in hypertonic saline is given too fast? What about too slow?

A

Too fast = bradycardia/ vasodilation

Too slow= loses the VEP

*Give over 5 minutes (ENTIRE DOSE)

223
Q

What kind of horse cannot handle hypertonic saline

A

Foals (infants in general)

224
Q

T/F: you should never use hypertonic saline in infants (foals, kittens, etc)

A

True

225
Q

What is unique about giving blood products to correct shock

A

Most clinicians will use higher aliquots of volume as a shock dose (10-20ml/kg)
Can be given fast 5-30 minutes
if possible equal volume of plasma and red blood cells

226
Q

If you give fluids to correct shock and it is not working, what should you do?

A

1) More fluids?
2) Positive inotropes (Dobutamine)
3) Vasopressors- Dopamine, Norepinephrine, Vasopressine

227
Q

Permissive hypotension

A

when there is a patient that is hypotensive with an uncontrolled hemorrhage

you need to keep systolic blood pressure 80-90 until hemorrhage is controlled
*Not too low, not too high

228
Q

What should you do if a patient is in septic shick

A

1) early fluid resuscitation (isotonic)
2) early use of a vasopressor (NE)
3) Early antimicrobial use
4) Find and control source of sepsis

*Use of artifical colloids is controversial

229
Q

What should you do when managing patients with burns to correct fluid

A

1) Higher volume of crystalloids (evaporative losses)
2) Use of colloids or albumin products (because of protein loss

230
Q

When do you use blood products for fluid resuscitation

A

Severe hypovolemic hemorrhagic shock
-more negative base excess
-higher lactate
-more severe shock (Higher HR, lower temp)
-Lower PCV and TP
-Higher Anumal trauam score
-Semi quantitative FAST 3 and 4

231
Q

You have a 30kg dog HBC that is obtunded, HR 160, white mm, CRT 4sec, poor pulses and cold extremities. How do you correct this shock

A

Fluids IV
Isotonic (LRS or Plasmalyte)
80-100mL/kg

2400-3000mL is shock dose, start with 1000mL

a pump will only deliver at 999mL/hr, instead use 18G short IV catheter without any extension set or T port and placing the liter bag in a pressure bag constantly pumped 300mmHg, 1 liter can be delivered in 7 minutes

Shoot for 10-15 minutes for a reasonable achievable goal

232
Q

What is the ROSE concept of fluid therapy for patients in shock

A

1) Resuscitation with fluids in order to stabilize the patient
2) Optimization of fluid therapy to support major organs, electrolyte status, acid base status, and other metabolic parameters such as oxygen delivery and lactic acidosis
3) Stabilization to provide continued support for the patient
4) Evacuation to minimize risk of volume overload and actively remove volume

233
Q

early goal-directed fluid management using fluid boluses for patient rescue

A

resuscitation of fluid therapy

234
Q

organ support and maintaining tissue perfusion using fluid boluses

A

optimization of fluid therapy

235
Q

conservative fluid management for maintenance and replacement

A

stabilization of fluid therapy

236
Q

late goal- directed fluid removal (de-resuscitation) to minimize risks of volume overload (generally weeks)

A

evacuation of fluid therapy

237
Q

How long can an adult horse go without food?

A

2-3 weeks

lots of glycogen

(foals only for 6-12 hours)

238
Q

Why might a large animal be in hypovolemic shock

A

1) Hypovolemia/ dehydration from GI disease, liver disease, renal disease, neurologic disease

2) Blood loss (around 8-10L loss)

239
Q

Why might a large anumal be in distributive shock

A

1) Sepsis
2) Toxemia
3) Anaphylaxis

240
Q

T/F: cardiogenic shock is uncommon in large animals

A

true- but treatment is focused on cardiac function and oxygen support

241
Q

Why might you give fluids in large animals

A

1) Resuscitation (Hypovolemic/ Distributive/ Cardiogenic)
2) Maintenance (Supprotive care for disease or adverse effects of medication like Banamine)
3) Replacement (Water, electrolytes, proteins for GI disease, Liver, renal, neurologic
4) Nutrition: Adults, neonates, requirements, volume

242
Q

What are parameters of the CV system that you can assess when looking at the hydration status of large animals

A

1) Heart Rate: Tachy or bradycardia
2) Mucus membranes: pink (shock or anemia), bright pink (increased capillary circulation), red (poor capillary perfusion), grey/blue: hypxia
3) CRT: <3seconds or prolonged
4) Blood pressure: pulse quality poor and jugular refill slow
5) PCV/TP: best for monitoring and evaluations of trends
not good for predicting hydration at initial exam since factors associated with disease can affect these

243
Q

T/F: PCV/TP in large animals is helpful in determining hydration of the animal *

A

False
best for monitoring and evaluations of trends
not good for predicting hydration at initial exam since factors associated with disease can affect these

244
Q

What do pale mucous membranes of a horse tell you

A

Shock; Anemia

245
Q

What do red/brown mucous membranes tell you on a horse

A

poor perfusion; methemoglobinemia

246
Q

What do bright pink mucous membranes on a horse tell you

A

increased perfusion; polycythemia

247
Q

What do red/ purple mucous membranes in a horse tell you

A

poor perfusion; toxemia

248
Q

eyeball recession in large animals

A

very good for assessing hydration stayus in calves
acceptable in ruminants and camelids
estimate mm recession and multiple by 1.6

not accurate in horses although eyeball recession is seen in hypovolemic foals

249
Q

T/F: eyeball recession is an effective method of hydration assessment in horses

A

not accurate in horses although eyeball recession is seen in hypovolemic foals

250
Q

How do you determine the hydration status of cows using eyeball recession

A

estimate mm recession and multiple by 1.6

251
Q

Where are places you can do a skin tent in large animals

A

point of shoulder, neck, eyelid

variable by species, gender, and age

*Does not work well in animals with thick skin (male llamas)

252
Q

What is seen of the neurologic status of animals that are dehydrated

A

lethargic obtinded, stuporous, comatose

(affects end-organ perfusion)

253
Q

What is the temperature of patients that are severely dehydrated

A

cold extremities= poor peripheral perfusion

further coolness extends up the limb = more severe circulatory collapse
extremities warm up as shock is resolved

254
Q

What is normal urine output

A

1-2ml/kg/hr

(out 50% of intake)

decreased by poor hydration, shock ,renal injury)

255
Q

Large animals have renal azotemia if they have

A

elevated creatinine and an isosthenuric or hyposthenuric urine specific gravity

256
Q

T/F: In horses and cattle, increases in urea nitrogen can be modest in renal azotemia due to excretion of urea into GI system

A

True

257
Q

Why can you get pre-renal or renal azotemia with septic or hypovolemic shock in large animals

A

the decreased perfusion of the kidney that occurs with hypovolemic or septic shock can result in renal ischemia and consequent renal damage

Bacterial and toxic insults from septic shock can also damage the renal tissue

258
Q

In large animals without renal disease, you would expect creatinine to ______ within 12-24 hours of fluid therapy

A

Half

259
Q

In large animals, a core-peripheral temperature change of greater than 13F equals

A

less than 65% of CO

260
Q

How do you do skin turgor in large animals to estimate the percent dehydration

A

pinch skin and twist 90 degree, hold for 1 second and release
measure the time it takes to return to normal
% dehydration = (2x seconds it takes) -4

261
Q

What is the equation to estimate % dehydration in large animals using a skin tent

A

pinch skin and twist 90 degree, hold for 1 second and release
measure the time it takes to return to normal
% dehydration = (2x seconds it takes) -4

262
Q

What is the equation to estimate dehydration in cows using eye recession

A

Estimated Dehydration (% of BW= degree of eye recession into orbit (mm) x 1.6

263
Q

Dehydration in calves i estimated to be _________ when their eye recession into the orbit is greater than 4%

A

greater than 8% dehydrated

264
Q

What the result of fluid therapy to reduce lactate levels in horses

A

Hyperlactatemia is not solely due to dehydration but also the disease processes going on.
Lactate will decrease but doesnt go down all the way due to other processes going on (ie sepsis)

The rate of lactate clearance is associated with prognosis

265
Q

What are the levels of dehydration in calves (moderate, marked, and severe)

A

Moderate (5-8%) Eyeball recession of 2-4mm and skin tent of 4-6 seconds

Marked(8-10%) Eyeball recession of 4-6mm and skin tent of 6-7 seconds

Severe (10-15%) Eyeball recession of 6-8mm
and skin tent of 7-10 seconds

266
Q

What is anion gap and how do you calculate it

A

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

267
Q

If the plasma concentration of bicarbonate decreases to buffer the effect of the increased chloride concentration, the patient is in _______________

A

Hyperchloremic acidosis

268
Q

If the plasma concentration of bicarbonate decreases to buffer the effect of the increase in unidentified anions (lactate), the pation is in

A

Lactic acidosis

269
Q

If the plasma concentration of bicarbonate increases to buffer the effect of the decrease in chloride concentration, then the patient is in

A

hypochloremic alkalosis

270
Q

if the plasma concentration of bicarbonate decreases to buffer the effect of the decrease in weak concentration, then the patient is in

A

hypoproteinemic acidosis

271
Q

is there increased protein (TP or albumin) with metabolic acidosis or alkalosis

A

metabolic acidosis

272
Q

is there a decrease protein (TP or albumin) with metabolic acidosis or alkalosis

A

metabolic alkalosis

273
Q

Why is dextrose mostly used in adult horses

A

to reduce the levels of triglycerides (negative energy balance)

274
Q

When might you give sodium bicarbonate

A

in ruminants suffering from neonatal diarrhea or GI disease.
it is alkalinizing to resolve the metabolic acidosis (adding in Na+)
Rarely used in horses

275
Q

when might you give magnesium to a horse

A

when they do not do well with calcium supplementation

276
Q

why is treatment of metabolic acidosis using sodium bicarbonate so common in cows

A

because it is likely due to hyponatremia in calves and accumulation of strong anions (lactate) in cases of GI disease (enteritis, rumen acidosis, metabolic disorders, sepsis)

277
Q

What is the base excess

A

calculated parameter that helps determine the variation of patient bicarbonate from the expected normal bicarbonate

Positive number with metabolic alkalosis and negative number with metabolic acidosis.
(BE= Patient HCO3 - 24)

278
Q

Base excess is _____ with metabolic acidosis and ______ with metabolic alkalosis

A

Positive number with metabolic alkalosis and negative number with metabolic acidosis.
(BE= Patient HCO3 - 24)

279
Q

How do you determine how much sodium bicarb you need to give to return the base excess to normal?

A

HCO3- requirement: BW (kg) x BE x (0.4 to 0.6)

0.4-0.6 is the fluid compartment for HCO3-
We use 0.5

280
Q

When do you give dextrose to horses

A

1) Hypoglycemia
2) Anorexia
3) Negative energy balance- hypertriglyceridemia

*Add to crystalloid fluids at 1-5%

281
Q

When adding Dextrose to fluids for supplementation, what percent makes it isotonic vs hypertonic

A

5% - isotonic
>10% Hypertonic

282
Q

Why might you give 5% dextrose in water

A

istonic and delivers free water (No sodium) when dextrose is metabolize

foals do not metabolize sodium well

283
Q

T/F: foals do not metabolize sodium well

A

True. give D5W

istonic and delivers free water (No sodium) when dextrose is metabolize

284
Q

What should you be careful when supplementing potassium

A

Supplement orally if possible 0.2-0.4g KCl/kg/day

Mut IV max is
hourly: 0.5mEq K+/kg/hr
daily: 3-5mEq K/kg/24 hours (preferred because at an hourly rate the daily limit will be reached in 6-10 hours)

It can have effects on heart if you exceed this

285
Q

When is calcium supplemented

A

to treat periparturient hypocalcemia in cattle, sheep, and goats
Too rapid admin can result in cardiac arrest so recommended to admin over a period of at least 15 minutes

hypocalcemia is also observed with several medical conditions including septicemia, enteritis, and hepatic lipidosis

286
Q

Why might you need to supplement calcium in horse with Gi disease

A

they are hypocalcemia and they will benefit from calcium supplementation to help impove GI motility and improve muscle strength

287
Q

How do you treat periparturient hypocalcemia in ruminants

A

Administer 1ml/kg Calcium Gluconate IV over at least 15 minutes

288
Q

How do you deliver calcium for large animals for supportive care

A

Add up to 25ml Ca gluconate per liter of crystalloid fluids that are given at a maintenance fluid rate
Decrease this amount if admin fluids at a higher than maintenance rate

289
Q

Why might you give magnesium (MgSO4) to arge animal

A

1) Horses with ileus
2) Cardiac arrythmias
3) Refractor hypokalemia and hypocalcemia

290
Q

What are the different fluid administration route in large animals

A

Oral: functional GI tract, cheap, less invasive, nutrition, rehydration for midly affected animals

IV: Requires IV access, vein complications, shock tx, dysfunctional tract

SQ: IV cather not possible, moderately rapid absorption (1-2 hours), limtied volume due to volume to surface area

IO: neonates

291
Q

Why do they use distilled water mixed with crystal salt (ECF) for IV fluid therapy in livestock

A

Cost- commercial IV fluids are very expensive for that size

292
Q

What are the different drip sets used in large animals

A

10 drop/ml: 1 drop/sec= 360ml/hr
15 drop/ml: 1 drop/sec= 240

293
Q

What IV catheter size should you choose for hypovolemia shock treatment in horses

A

10G, 12G, 14G most commonly
diameter affects rate of the fluid

294
Q

How do you do fluid resuscitation on horses

A

Isotonic crystalloid
10-20ml/kg
20-30minutes
Re-assessment of clinical and lab parameters
Usually 2-3 boluses

ex 20x500kg= 10,000 or 10 L bolus
reasess and repeat as needed

295
Q

What is the goal of fluid resuscitation in large animals

A

rapid correction of deficit
minimizing effects of fluid overload
incremental approach and frequent reassessment
goal: restore tissue perfusion

296
Q

What is maintenance rate for adult livestock

A

3ml/kg/hour

range 2-4 ml/kg/hr

ex: 500kg= 36L/day

297
Q

What is the maintenance rate of equine

A

2-3 ml/kg/hr

60ml/kg/day

less when not eating (1ml/kg/hr)

ex: 500kg = 30L/day

298
Q

How do treat for ongoing losses in livestock

A

can be due to enteritis, colitis, sweating

expectation is 5-10% BW
so add another 2-4 ml/kg/hr
*twice maintenance

299
Q

T/F: maintenance fluid rate and requirements are the same for neonates and adults

A

False- they have different physiology

300
Q

Oral fluid therapy is commonly used in livestock. But why is it not used in horses, contraindicated?

A

Gi diseases and shock: abdominal distension, diarrhea, reflux, colic (with the exceptions of large colon impaction and some large colon displacements)

*Will increase abdominal distension and discomfort
Fluid absorption is also diminished.

301
Q

When should oral fluids not be used in horses

A

Gi diseases and shock: abdominal distension, diarrhea, reflux, colic (with the exceptions of large colon impaction and some large colon displacements)

302
Q

Foals do not drink water until

A

they are 1 month or older

303
Q

How is oral fluid therapy performed in livestock

A

Ruminants: Oral gastric tube
Calves: bottle, bucket, oro or nasogastric tube

horses: nasogastric tube
foals: pan/ bucket/ nasogastric tube

304
Q

When should you do oral fluid therapy in horses

A

when they have functional GI tract and no shock

305
Q

Oral fluid therapy stimulates the

A

gastrocolic reflex- encourages movement

306
Q

What should you always do when performing oral fluid therapy

A

always check for reflux first

307
Q

What is added to fluids in oral rehydration therapy in livestock

A

1) Electrolytes
2) Glucose or glycine
3) Alkalizing activity (acetate, propionate, citrate, bicarbonate)

308
Q

What is significant about colostrum in dairy breeds

A

there is high milk production that dilutes colostral IgG

need to administer >10% BW within 6 hours of birth (while >5% BW within 6 hours for nondairy breeds)

309
Q

How much colostrum should you deliver to neonates

A

dairy breeds: need to administer >10% BW within 6 hours of birth (while >5% BW within 6 hours for nondairy breeds)

ex: 50kg foal is 2.5L, administer max 500ml at one time (or per hour)

310
Q

How much milk (replacer) to calves and foals drink per day *

A

Calves drink 15-20% BW/day
Foals drink 20-25% BW/day

311
Q

Feeding larger volumes of milk (replacer) increases the risk of

A

Clostridial Enterocolitis
*start at lower volume per feeding and gradually increase

312
Q

What might increase the milk (replacer) you feed to neonates by 50%

A

cold weather

313
Q

What is the blood volume of a horse

A

about 8% of BW= 40L

314
Q

How do you perform rapid volume expansion in a horse

A

Hypertonic Saline (7.2% NaCL) and then should always be followed by volume administration using BES (Balanced Electrolyte Administration)

315
Q

What vein is best for rapid fluid resuscitation in horses

A

Jugular vein - large bore catheter: 10 or 12G
two catheters
large bore admin set to connect fluid bag to cathether

316
Q

why is oral fluid resuscitation not ideal for hypovolemic horses

A

if hypovolemic, blood flow to the GI tract is reduced

317
Q

What is proper IV catheter care in the horse

A

clean gloves
flush q6hrs
limit aspiration
end cap: remove or wip with alcohol before use, change it daily, and do not lay down
inspect: at least q6hr, leakage at insertion, pain, heat, swelling
check wrapping

318
Q

What are the indications for using dextrose in horses *

A

1) Hypertrigylceridemia
2) Prolonged anorexia
3) Breeds are risk: miniature horses, ponies, donkeys, overweight animals
4) Laminitis- hyperinsulinemia

319
Q

What are reasons to stop fluid therapy in a horse

A

1) Clinical and laboratory assessments
2) Eating and drinking (not 100%)

320
Q

When do you give plasma in adult horses

A

colitis, DIC concerns, and to replenish clotting factors

321
Q

When should you give blood transfusions to adult horses

A

1) Acute or Chronic
2) PCV <20% (nx is 33%)
3) Elevated lactate
4) Blood loss estimated >30% of blood volume
5) HR (>80bpm), mucus membrane color, sweating, colic, cold extremities, hypotension

322
Q

What is usually the first lime therapy in adult horses to combat hypovolemia

A

BES

323
Q

What should you do for oral fluid therapy in a horse

A

*only for large colon impaction or large colon displacement
-Use a nasogastric tube
5-8L q 2-6 hours

with electrolytes (BES)
NaCl (28g), NaHCO3 (17g), KCl (3g), 5L water

324
Q

What is caloric requirements for 500kg adult horse for maintenance

A

16.4Mcal/day (33kcal/kg/day)

325
Q

What should you for maintenance support in a horse with inability to eat

A

small bore nasogastric feeding tube
-complete pelleted feed
or parenteral nutrition (IV) of dextrose, protein, lipids

326
Q

What is the blood volume of a foal

A

16% of BW (different from the 8% of adult)
so for a 50kg foal, it is about 8L

327
Q

What is the normal urine of USG of foals

A

1.001-1.010

328
Q

Milk is low in _______ so foals are not very tolerant to supplementing ________

A

sodium

329
Q

How do you do fluid resuscitation on a hypovolemic foal?

A

10-20ml/kg
Most are recumbent and hypovolemic foals need 2-3 fluid boluses

ex: 50kg foal: 1 L bolus administered 2-3 times

**Monitor perfusion parameters and urine production

330
Q

How do you treat failure of transfer of passive immunity in a goal

A

Plasma IV
1-2L/50 kg foal

or

Colostrum via NG tube (1.5-2L/ 50kg foal; 500ml) good quality

331
Q

How do you treat Clostridial entercolitis in foals

A

IV- maintenance, replacement, nutrition

or disease with functional GI tract: Colostrum or milk via nasogastric feeding tube

332
Q

How do you treat neonatal isoerytholysis in foals

A

resuscutation can include oxyglobin or blood transfusion

333
Q

What are the problems you get when doing oral fluid/milk therapy in foals that are sick (dysfunctional GI tract)

A

GI related diseases: ileus, colic, gas accumulation, diarrhea

rare to do oral- do IV fluid instead

334
Q

How do you manage IV fluid therapy more conservatively in foals

A

Rate: 2-4ml/kg/hr
but there is a fluid restrictive rate (not at altitude) of
100ml/kg/day for first 10kg BW
50ml/kg/day for 2nd 10kg BW
25ml/kg for remaining kg BW

*Monitor foals closely for adequacy of fluids or fluid overload

335
Q

What are the same across mammals in regards to fluid therapy

A

1) Maintenance: 2-3ml/kg/hr
2) A quarter shock dose = 20ml/kg IV as bolus
3) When in doubt, balanced crystalloids

336
Q

What is the difference between maintenance fluid doses in adult and neonate livestock

A

Adults: 2-3mL/kg/hr

Neonate: 3-4mL/kg/hour

337
Q

What is the Holliday Segar Rule

A

It is a rule to account for maintenance fluid requirements in neonates livestock
For first 10kg: 4mL/kg/h (100mL/kg/day)

For second 10kg: 2mL/kg/h (50mL/kg/day)

For every kg thereafter 20mL/kg/day (1ml/kg/h)

338
Q

When should you give maintenance fluids to livestock

A

1) Patient is not drinking for extended time
2) Behicle for fixing electrolyte/ acid base/ energy disturbance without overproviding fluid volume
3) Increased maintenance requirements in the face of increased metabolic rate (ex: sick, weather, etc)

339
Q

Most patients will have decreased ____________ while being administered isotonic fluids if you are keeping up with requirements (blood pressure and osmolarity)

A

decreased thirst drive

340
Q

When should you consider doing fluid therapy in neonate livestock

A

as soon as there is slight separation in eyeball recession 6-8% dehydrated and neck skin tent of 5-10 seconds

341
Q

What is the most accurate representation of the patient’s current hydration status if the kidneys are working in livestock

A

Urine specific gravity

342
Q

What is the labwork evidence of dehydration in livestock

A

USG: >1.025 in adults and >1.014 in neonates
*the best (when kidneys are working)

Elevated PCV/TS

Elevated Serum Lactate: Dehydration, Sepsis, and Liver disease

Pre-renal azotemia: elevations in creatinine which decrease 50% over 12-24hours of fluid therapy. >1.8mg/dL in all species except camelids (Creatinine <2.7mg/dL) *

343
Q

What is the replacement rate for livestocks

A

based on the est % dehydration
(BW kg x % dehydration = L to replace)
as bolus or CRI

20ml/kg (1/4 shock dose) is also reasonable

344
Q

What are the ongoing losses that you should account for in livestock

A

1) VOmiting (pigs)
2) Diarrhea
3) Sepsis
4) Excess urine production
5) Lactation (140L/day)
6) Osmotic GI “loss”

345
Q

T/F: you can do oral for volume repletion in pigs

A

False_ no pigs, they need to be heavily sedated

346
Q

When should you not use oral hydration for volume depletion in livestock

A

1) Never pigs
2) No ileus or vomiting
3) No bloated animals

347
Q

Where can you give IV fluids in pigs

A

ear catheter, other livestock is jugular

348
Q

T/F: livestock are at lower risk of thrombophlebitis compared to other species (horse, dog, cat, etc)

A

true

349
Q

T/F: it is really difficult to give SQ fluids in livestock

A

true- their skins are really tight

350
Q

what species are especially tolerant of clean but non-sterile IV fluids

A

ruminants like cows and goats

this is a reasonable costsaving measure, particularly in production animals

351
Q

What livestock species do you worry about with fluid overload

A

Camelids and neonates

also other animas if they have cardiac disease and pulmonary disease

also dont want to damage the glycocalyx

352
Q

What is a normal pH of livestock

A

7.35-7.45

353
Q

the amount of bicarbonate needed to bring your pH back to a normal range

A

Base deficit (BE)

calculate the bicarb needs:
Weight (kg) x 0.6 x base deficit = mmol of HCO3-

354
Q

In livestock, how do you correct the base deficit

A

with bicarbonate
-correct half the base deficit as a slow bolus and the remainder over 12-24 hours
-8.4% Sodium bicarbonate contains 1meq/mL
-Baking soda contains 12mmol/g of HCO3
-Isotonic bicarb: 150mEq of NaHCO3/L (12 g of baking soda; 150ml of HCO3)

355
Q

Calves with scours that present in lateral recumbency likely have a base deficit of at least

A

10

356
Q

What is the physiochemical “Stewart” approach

A

that acid base balance is determined by the balance of OH- / H+ ions in solution rather than just pH alone
‘H+ concentration is determined by 3 independent variables
1) Strong Ion difference
2) Partial pressures of CO2
3) Total Weak Acids (Atot)

357
Q

‘H+ concentration is determined by what 3 independent variables

A

1) Strong Ion difference
2) Partial pressures of CO2
3) Total Weak Acids (Atot)

358
Q

What is the strong ion difference

A

strong ions are those which fully dissociate in water and the difference between these anions and cations is the strong ion difference

[Na+] + [K+] - [Cl-]= SID3

must maintain electroneutrality

H20 + CO2 <-> H2CO3 <-> H+ + HCO3

359
Q

What is normal TCO2 in livestock

A

20-30mmol/L

360
Q

Plasmalyte has:
Na: 140
Cl: 98
K: 5
What is the SID of this fluid

A

[Na] + [K]- [Cl]
= 47mmol/L

this is high so plasmalyte is a slightly alkalinizing solution

361
Q

If you have a normal strong ion difference, what might be causing your acid-base disturbance?

A

Some sort of anion gap due to
1) unmeasured anions like albumin and phosphate
2) Total weak acids (A-) like uremic acids, organic acids, salicylate (Aspirin/ Peptobismol)
3) Lactate

362
Q

What might substances might be causing an anion gap in livestock

A

K- ketones
L- lactate
U- uremic acids
E- ethylene glycol

363
Q

How do you correct hypocalcemia in livestock

A

IV- as bolus via simplex or in crystalloids, 1 bottle CMPK or CalGluc/cow (can be scaled down for small ruminants

Oral: calcium gluconate oral paste

*Sq may be irritating

364
Q

What is the max rate of potassium in livestock before cardiac monitoring is required

A

0.5mEq/kg/hr

if higher they can get standstill

365
Q

If you give a 205mEq bottle to a 680 kgcow over 30 minutes, why might you be worries

A

this is at a rate of 0.6mEq/kg/hr which is over the 0.5mEq/kg/hr in which you need to begin to monitor their heart for standstill

366
Q

You have a goat with urolithiasis. What should you do?

A

1) Post-Renal Azotemia will resolve readily after the obstruction is removed.

2) Fluids to drive potassium down
a) dextrose at 1-2x maintenance requirement
b) Isotonic with low potassium concentration (0.9% NaCl)

3) Calcium gluconate (25-50ml/L)

4) Insulin

*Should drive potassium down

367
Q

What should you do before panicking about hyperkalemia in livestock?

A

Make sure the sample was not hemolyzed

368
Q

When should you worry about providing energy in livestock

A

1) Animals off feed for >2 days
2) Negative energy balance (lactation or pregnancy)
3) Neonates off feed >4-6 hours
4) Causes of hypoglucemia (sepsis, hyperinsulinemia, and liver disease)

369
Q

What might falsely elevate serum potassium in livestock

A

Hemolysis

370
Q

Why should you not tube neonatal ruminants more than a couple times

A

Omasal groove will go away if they do not nurse
if you drop milk into the rumen and they will end up with ruminal acidosis

371
Q

How might you correct livestock with hyperglycemia

A

these are often camelids that have blunted insulin response in face of disease or animals with sepsis

Give insulin as SC bolus or CRI

372
Q

Camelids often develop a blunted __________ response in the face of disease

A

blunted insulin response in the face of disease

373
Q

Does hyper or hypoglycemia develop because of sepsis

A

hyperglycemia

374
Q

Potter, a 3-year old, 20 kg FS (female spayed) Pointer mix, presents to your clinic for an acute onset of vomiting (~ 12 hours, vomited large amounts of liquid 10+ times). The owner also reports that she may have ingested some of her bedding material 3 days ago. On initial physical exam, she is very dull with a temperature of 99.2 degrees F, pulse rate=160 beats/minute, respiratory rate 10 and pale pink mucous membranes with ~ 3 second capillary refill time. She is unable to stand on her own without assistance.

Based on primary survey information, is Potter in shock?

A

yes

375
Q

Which of the following fluids will create the highest short-term intravascular volume expansion?

A

Hypertonic (7.5%) saline

376
Q

A 2 year old FS Beagle (12 kg) presents with severe, acute vomiting and bloody diarrhea of 36 hours duration. She is obtunded, has a heart rate of 180 bpm, and has pale mucous membranes with a capillary refill time of 3 seconds. You place an intravenous catheter and run some initial bloodwork. Her PCV is 65% and her TP is 7.2 mg/dL. (3 points)

Pair the following “shock volume” with the appropriate fluid type for THIS patient
Hypertonic crystalloid
Isotonic Crystalloid
Synthetic Colloid

A

Hypertonic crystalloid: 60mL
Isotonic Crystalloid: 1000mL
Synthetic Colloid: 240mL

377
Q

Sadie is a 2 year-old female spayed Labrador presented for vomiting and diarrhea of 5 days duration. She weighs 25 kg. Her skin turgor is slightly decreased; she has pink but tacky mucous membranes with a CRT of 1.5 seconds. The position of her eye in the orbit is normal; her heart rate is 100 bpm with strong pulses. You estimate her to be have moderate dehydration (let’s pick 7% for our calculations).

The physical examination findings described above are characteristic of what type of fluid losses:

A

Extracellular fluid compartment (isotonic loss

378
Q

Which of the following is an indication for mechanical ventilation?
A) Hypoxemia without oxygen supplementation
B) Severe hypoxemia without oxygen supplementation
C) Severe hypoxemia on oxygen supplementation
D) Hyperventilation on oxygen supplementation

A

C) Severe hypoxemia on oxygen supplementation

379
Q

You are treating a llama that is sick and appears 5% dehydrated on presentation and has a presenting creatinine of 6.3 mg/dl. You initially replenish the calculated fluid deficit over the first 4 hours of fluid therapy and then maintain the llama on a balanced electrolyte fluid at a fluid rate of 6 ml/kg/hr. The following day, about 24 hours from the initiation of fluid therapy, you check a serum creatinine level again and it is 3.0 mg/dl. Normal creatinine for a llama is 1.2 to 2.6 mg/dl. Since the creatinine did not return to normal after 24 hours of fluid therapy, you determine that the llama must have renal failure.

A

False- The fluid therapy successfully decreased the creatinine in half within 24 hours. That is consistent with a normal response for pre-renal azotemia.

380
Q

You are treating a 40 kg septic calf that does not appear dehydrated, has hyperemic mucous membranes and extremities are still warm. Laboratory test results are below with normal values in parenthesis (normal):

Creatinine 3.8 mg/dl (0.6 – 1.0)

Glucose = 34 mg/dl (80-100)

Na = 133 mEq/L (132-144)

K = 3.3 mEq/L (3.8-5.6)

Cl = 101.8 (90-102)

Bicarbonate = 12.4 mEq/L (23-33)

Base Excess = -12 mEq/L

SID = 34.5 mEq/L (40-45)

Anion Gap = 22.1 (15-23)

Based on these findings, which of the selections below would be the best choice of initial fluid therapy to help resolve the major metabolic problems in this calf and replace 1/2 of the total body base deficit?

A

1 liter of plasmalyte with 2.5% dextrose and 120 mEq of sodium bicarbonate administered at a rate of 6 ml/kg/hr.

In this calf you want to address 3 primary things;

1) The azotemia noted by the elevated creatinine.

2) The hypoglycemia

3) The metabolic acidosis due to both low sodium and slightly high anion gap (probably lactate)

To do this, you would like a fluid rate above maintenance coupled with an appropriate glucose supplementation and 1/2 the Total Body Deficit of bicarbonate. Since you will have a higher than maintenance fluid rate, dropping the dextrose in the solution to 2.5% instead of 5% is justified. However, it is good to check after the first hour to make sure that is satisfying the needs of the calf.

381
Q

You examine a 9-year-old horse for signs of colic. The horse has been colicky for 3 days and during that time frame has been administered Banamine (flunixin meglumine) 500 mg PO q 12 hrs. After your examination you are suspicious of a large colon impaction. The horse’s examination findings are listed below:

Weight: 500 kg
HR: 62 bpm
RR: 18 bpm
T: 100.5F
MM: tacky, pink, CRT: 3 sec.
Extremities: cool, but not cold
PCV: 45%
TP: 7 g/dl
Lactate: 3 mmol/L
Creatinine: 3.5 mg/dl
What type of fluid therapy and rate is the most appropriate to use in this horse:

A

A combination of IV and enteral fluids: IV fluids at 3 L / hr and enteral fluids at 5 L every 4 hrs with electrolytes added

If the horse was not azotemic only providing enteral fluid therapy would likely be sufficient and effective. However, this level of azotemia paired with the known use of NSAIDs in a horse that was not eating well and therefore likely was not drinking enough is concerning for renal azotemia in addition to likely a pre-renal component. This is significant enough to warrant diuresis and attempt to prevent further renal injury. Therefore we would suggest the use of IV fluid therapy at twice maintenance. Additionally enteral therapy using BES (water with electrolytes added) is beneficial to hydrate the ingesta and stimulate GI motility.

382
Q

You are working with an owner that just lost a mare that was nursing a foal due to colic in the mare. The owners have purchased some Mare’s Match milk replacer for the foal. The foal is 3 weeks old and weighs 100 lb. The Mare’s Match label says to feed 25% of the foal’s body weight per day as liquid milk replacer. After discussing feeding plans with the owner, they decide that they can only feed 3 times daily. Based on this information, how many LITERS of Mare’s Match milk replacer should they currently feed to the foal per feeding based on calculations using the Mare’s Match label instructions

A

3.8

Total amount of milk replacer per day is calculated as

(100/2.2) X 0.25 = 11.36 L per day. Divided into 3 feedings, that would be 3.78 L or about 3.75 L per day.

383
Q

You examine a 440 lb steer with diarrhea. In your physical exam, you find that the eyeballs are recessed about 4 mm and the steer has a skin tent along the neck of about 6 seconds. Based on this information, you estimate that the steers hydration deficit in liters is:

A

Based on eyeball recession and skin tent, you estimate that the animal is 8% dehydrated. The steer weighs 200 kg (440 lb). Thus, the hydration deficit is

200 kg X 0.08 = 16 kg = 16 L

384
Q

You are ausculting a horse with a respiratory rate of 24 breaths per minute. Normal intensity bronchial breath sounds are heard at the larynx and trachea. The breath sounds over the thorax consist of bronchovesicular sounds in the cranial ventral thorax that are softer than the tracheal sounds. Vesicular breath sounds can be heard in the cranial dorsal lung fields and become softer to inapparent in the caudal dorsal lung fields. What would be the best clinical interpretation of the most likely respiratory pathology?

A

Normal

This is a standard description of normal breath sounds in most animals. Bronchial sounds are normally heard over the upper airways and in most animals. They are generally louder than the loudest thoracic breath sounds. Bronchovesicular breath sounds are typically heard in the cranial ventral thorax and then become more vesicular or absent as you move away from the large airways.

385
Q

T/F: PCV and TP is a good method at assessing hydration

A

it is not!
lactate is a good measure because it reflects tissue perfusion

386
Q
A

fluids, respiratory, muscles (7 decks)

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