Fluid Therapy

Question 1

Crystalloids: general use?

Answer 1

replacement fluids

Question 2

Isotonic Crystalloids: composition?

Answer 2

similar to extracellular fluid (iso-osmotic, around 290-310 mOsm/L)

Question 3

Isotonic Crystalloids: examples?

Answer 3

.9% NaCl (saline), Lactated Ringer’s Solution, Plasmalyte-148, Normosol-R

Question 4

Isotonic Crystalloids: Usefulness?

Answer 4

useful in management of hypovolemic shock. Cause rapid intravascular expansion and do not cause a shift between the intracellular and extracellular compartment. A shock dose of isotonic crystalloid solution is approximately one blood volume.

Question 5

Hypotonic Crystalloids: general use?

Answer 5

maintenance fluids

Question 6

Hypotonic crystalloids: examples?

Answer 6

.45% NaCl
 1/2 LRS + 2.5% Dextrose
Plasmalyte-56
Normosol-M
D5W Water + 5% Dextrose

Question 7

Hypotonic crystalloids: uses/contraindications?

Answer 7

normal fluid losses are hypotonic in respect to the extracellular fluid, but contain more potassium than the ECF. Therefore, these fluids contain a higher load of K+. Should never be used to treat animals with signs of poor perfusion, nor as shock doses for expanding intravascular volume because they may lead to fatal cerebral edema (due to drop in plasma osmolality). Patients with cardiac and renal dysfunction may better tolerate these fluids because of restricted sodium and chloride contents.

Question 8

Hypertonic crystalloids: example?

Answer 8

7-7.5% saline (NaCl)

Question 9

Hypertonic crystalloids: effects?

Answer 9

causes transient osmotic shift of water from extravascular to intravascular compartment leading to transient expansion of intravascular volume. Additional crystalloid fluid therapy should follow its administration. Has positive rheologic effects by decreasing blood viscosity to increase microciculaotory perfusion.

Question 10

Hypertonic

Answer 10

hemorrhagic shock and traumatic brain injury

Question 11

Synthetic Colloids: what are they and what is proposed use?

Answer 11

starch molecules with high molecular weight, keeps molecule in vasculature a long time.

resuscitation. treating shock, particularly in patients with hypoproteinemia or increased capillary permeability. when cause of shock is not rapidly correctable. when large or rapid crystalloid boluses have failed or are contraindicated (pulmonary and cardiac disease).

Question 12

Synthetic Colloids: should we use? why/why not?

Answer 12

DON’T USE. Increase risk of kidney failure, mortality, and coagulopathies. No convincing evidence that they are superior to crystalloids.