Fluid Therapy

Question 1

why is hypovolemia a problem?

Answer 1

decreased organ perfusion
ischemia
multi-organ failure

Question 2

why is hypervolemia a problem?

Answer 2

organ dysfunction
impaired healing

Question 3

what are insensible losses estimated to be?

Answer 3

22ml/kg/day

Question 4

what are insensible losses?

Answer 4

immeasurable
respiratory tract and skin

Question 5

what is hydration?

Answer 5

measure of interstitial fluid content

Question 6

how can you asses dehydration/hydration?

Answer 6

skin turgor
moisture of mucous membranes
enophthalmos?
+/- tachycardia and collapse if severe

Question 7

what is volume status?

Answer 7

measure of tissue perfusion

Question 8

what are the etiologies of hypovolemic shock?

Answer 8

hemorrhage
massive fluid losses

Question 9

what is cardiogenic shock?

Answer 9

diminished cardiac output due to decreased systolic function

Question 10

what do you need to do if a patient is dehydrated?

Answer 10

replace interstitial deficits

Question 11

what do you need to do if a patient is in shock?

Answer 11

improve perfusion

Question 12

when should you consider protein losing nephropathy in a dehydrated dog?

Answer 12

azotemic
TS <5.5

Question 13

how much weight gain does fluid overload produce?

Answer 13

> 10% from non-dehydrated baseline

Question 14

what are some obvious signs of fluid overload?

Answer 14

peripheral edema
respiratory compromise
body cavity effusion

Question 15

why is sodium and water retention a protective mechanism during critical illness and surgery?

Answer 15

maintaining effective circulatory volume
mitigates the systemic effects of hypovolemia

Question 16

what can cause impaired excretion of water and be a risk factor for fluid overload?

Answer 16

heart, kidney, or liver disease
increased vasopressin release

Question 17

what are the crystalloid fluids?

Answer 17

isotonic
hypotonic
hypertonic

Question 18

what is a crystalloid?

Answer 18

electrolyte solution with molecules that move across semipermeable membranes

Question 19

what are some hypotonic fluids?

Answer 19

0.45% saline
plyte-56
D5W

Question 20

what are some indications for hypertonic saline?

Answer 20

shock treatment
head trauma

Question 21

what are colloids?

Answer 21

solutions with molecules that are not easily able to move out of the vascular space

Question 22

what can albumin be used to treat?

Answer 22

significant hypoalbuminemia

Question 23

what can plasma be used to treat?

Answer 23

oncotic support when albumin transfusion is not available
replacement of clotting factors

Question 24

when can SQ fluids be useful?

Answer 24

small deficits
smaller patients

Question 25

what should your fluid therapy plan address?

Answer 25

dehydration daily maintenance requirements ongoing losses

Question 26

what is the maintenance fluid rate usually used for cats?

Answer 26

45 ml/kg/day

Question 27

what is the water content of pediatrics compared to adults?

Answer 27

higher water content: 80%

Question 28

what rate should you not exceed with potassium supplementation?

Answer 28

0.5 mEq/kg/h

Question 29

what is dextrose supplementation frequently needed for?

Answer 29

hypoglycemia neonates certain toxins

Question 30

what are the starting anesthesia fluid rates for dogs and cats?

Answer 30

dogs: 5 ml/kg/hr cats: 3 ml/kg/hr

Question 31

what is the total intravascular fluid volume (shock dose) for dogs and cats?

Answer 31

dogs: 90 ml/kg cats: 60 ml/kg

Question 32

what determines movement of body water?

Answer 32

hydrostatic oncotic osmotic

Question 33

what makes up "maintenance" requirement?

Answer 33

sensible losses: urine/feces insensible: respiratory tract and skin

Question 34

what is shock?

Answer 34

decreased delivery of oxygen to tissues

Question 35

how can you assess shock?

Answer 35

heart rate capillary refill time mucous membrane color blood pressure

Question 36

what are the types of shock?

Answer 36

hypovolemic septic cardiac

Question 37

what compensatory mechanisms are at play in shock to maintain blood pressure and cerebral perfusion?

Answer 37

increased heart rate increased stroke volume increased vascular tone

Question 38

what is the etiology of septic shock?

Answer 38

endotoxin release into systemic circulation trigger inflammatory mediators loss of vascular tone

Question 39

what are the etiologies of cardiogenic shock?

Answer 39

dilated cardiomyopathies pericardial effusion arrhythmias myocarditis

Question 40

what should you do if you assess a patient to be in shock?

Answer 40

10-20 ml/kg IV consider second bolus if indicated add blood if indicated

Question 41

what is a useful sign of hypervolemia?

Answer 41

weight gain

Question 42

why does water retention occur with critical illness and surgery?

Answer 42

sodium and water retention is a protective mechanism: circulatory volume and mitigate hypovolemia effects vasopressin release and activation of RAAS

Question 43

what are the risk factors for development of fluid overload?

Answer 43

impaired excretion of water abnormal function of the interstitial compartment

Question 44

how does ischemia/reperfusion injury contribute to development of fluid overload in critical illness?

Answer 44

increased capillary permeability

Question 45

what are the four Ds of fluid prescription?

Answer 45

drug dosing duration de-escalation

Question 46

if you're giving replacement fluids, what should you give?

Answer 46

isotonic fluids: crystalloids

Question 47

what does it mean that a fluid is balanced?

Answer 47

contain buffer: more physiologic

Question 48

what are some indications for hypotonic fluids?

Answer 48

maintenance fluid therapy patients with dehydration and fluid intolerance treatment of hypernatremia

Question 49

can you use hypertonic saline in an animal that is dehydrated?

Answer 49

no

Question 50

what does giving hypertonic saline too fast cause?

Answer 50

reflex bradycardia

Question 51

is plasma an efficient way to increase albumin?

Answer 51

no

Question 52

how are subcutaneous fluids dosed?

Answer 52

up to 20 ml/kg

Question 53

how long should replacement fluids for dehydration be delivered over?

Answer 53

8-24 hours 48-72 hours for patients at risk for fluid overload

Question 54

why are fluid requirements higher for pediatrics?

Answer 54

more extracellular fluid higher water content higher metabolic rate immature kidneys cannot concentrate urine

Question 55

what are the maintenance fluid rates for puppies and kittens?

Answer 55

90 ml/kg puppies 60-80 ml/kg kittens

Question 56

what rate of potassium supplementation should you not exceed?

Answer 56

0.5 mEq/kg/hr without attentive patient monitoring