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VETM 443 Pharmacology > Fluids > Flashcards

Fluids Flashcards

1
Q

What are the components that make up the intravascular space

A

blood
platelets
wbc
plasma
- electrolytes (Na/K/HCO3)
- albumin
- Ig
- coagulation factors

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2
Q

What are the components that make up the interstitial space?

A

lymph
electrolytes
protein
water

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3
Q

How does the inside of the cell differ from extracellular conditions?

A

active pumping of ions
- Na/K ATPase
- cotransporters

high Mg and K inside the cell

low Na inside the cell

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4
Q

What are the components of crystalloid fluid? What do they allow for?

A

electrolytes (Na/Cl)

water

small molecules like dextrose and buffers

it allows the fluid to enter all body compartments (because high water content)

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5
Q

Compare balanced with unbalanced crystalloid fluids

A

balanced: with buffers added

unbalanced = no buffers

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6
Q

What differs between fluids that are hypo - iso - and hyper tonic?

A

the dextrose concentration to alter the osmolarity relative to the surrounding environment

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7
Q

What is the electrolyte composition in the body?

A

most = Na
lots of Cl

way less K, glucose and HCO3

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8
Q

How do you calculate osmolarity

A

2(Na+K) + glucose (+ BUN sometimes)

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9
Q

What are osmotically active particles?

A

mainly…
electrolytes
glucose
urea

also keytones and mannitol

It depends on the number not the size of the particles

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10
Q

What is the blood osmolarity of dogs

A

290-310 mOsm/kg

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11
Q

What is the blood osmolarity of cats

A

290 - 330 mOsm/kg

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12
Q

List 3 types of isotonic crystalloid fluids.

A

0.9% NaCl

Plasmalyte

Ringer lactate

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13
Q

Compare the 3 types of isotonic crystalloid fluids

A

0.9% NaCl: no buffer

Plasmalyte: acetate buffer
- K and Mg

Ringer lactate: lactate buffer
- K and Ca

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14
Q

In what situation is 0.9% NaCl fluid indicated? What situation is it contraindicated?

A

indicated:
- hypochloremic metabolic acidosis (ex. a vomiting dog that loses Cl)

NOT for shock

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15
Q

Explain how fluid moves through body compartments when you give a isotonic crystalloid fluid

A

If giving IV bolus
- initially expands the vessel
- 75% of fluid will diffuse into the interstitium over 45 mins

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16
Q

How is potassium used in fluid support?

A

can use to reduce dilutional hypokalemia

must supplement in CRI
- if giving bolus it must be very small to avoid cardiac failure

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17
Q

When is magnesium used in fluid support

A

supplemented in critically ill patients as they are commonly low Mg

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18
Q

When is calcium used in fluid support

A

it can help increase vascular tone and contractility

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19
Q

What are 2 problems that you may encounter when supplementing electrolytes

A

calcium can precipitate with the citrate in blood products

potassium phosphate can precipitate with calcium
- don’t give with ringer lactate

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20
Q

What are 2 main uses for isotonic fluid

A

hypovolemia
- usually an acute problem

interstitial dehydration
- usually a chronic problem

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21
Q

What is isotonic fluids not useful for

A

tx intracellular dehydration

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22
Q

What are the adverse effects related to isotonic fluid

A

pitting/interstitial edema

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23
Q

What are the risk factors to consider before giving isotonic fluids

A

hypoalbuminemia
cardiac disease
pulmonary contusions
cerebral injury
sepsis
acute renal dz

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24
Q

What is overhydration

A

> 10% body weight

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25
What fluid should you give a dog that has hypochloremic metabolic acidosis and why?
0.9% NaCl - isotonic the elevated Cl in the fluid will allow for a reduction in bicarb - reducing HCO3 (base) = reduces pH HCO3 is elevated because it is a compensatory response due to the lack of Cl (attempting to maintain electrical balance - need more negative charge)
26
List 4 types of hypotonic crystalloids
0.45% NaCl D5W 2.5% dextrose in 1/2 strength lactate ringer soln normofundin
27
Explain why you cannot give D5W as a bolus
The dextrose is immediately taken up by RBC and thus what is left has the osmolarity equivalent to free water - results in lysis of RBC
28
Explain why you cannot bolus normofundin
It has high potassium - if you bolus = kill patient
29
What is the general feature of hypotonic fluid
half the concentration of Na and Cl as the body
30
Explain how fluid moves through body compartments when you give a hypotonic crystalloid fluid
when giving IV - dilutes the intravascular space - quick movement to interstitial space - fluid moves intracellularly
31
What is hypotonic fluid used for
maintenance fluid - for normal patients to account for physiologic losses when they require fluid but have cardiac disease if have hypernatremia not commonly used
32
What is hypotonic fluids not effective in treating?
shock it leaves the IV space too fast
33
How do you treat hypoglycemia with fluids?
bolus 50% dextrose with 0.9% NaCl - give quickly (1-2 mins) - 50% dextrose will overwhelm RBC ability to absorb all of it = avoid lysis to prevent future hypoglycemia - add 2.5 - 5% dextrose - no bolus - add to isotonic fluid
34
What is an example of hypertonic fluid
7.5% NaCl
35
Explain how fluid moves through body compartments when you give a hypertonic crystalloid fluid
via IV - water moves from interstitium (and maybe from intracellular space) - cause dilation of the intravascular space - after 45mins, 75% of the water will diffuse back to the interstitium
36
What is hypertonic fluids used for
hypovolemic shock in non-dehydrated patients cerebral edema
37
How does hypertonic fluid compare to using isotonic fluid?
a small volume of hypertonic fluid will induce a similar amount of IV fluid expansion as isotonic fluid
38
What is a colloid
fluid with large organic macromolecules and electrolytes - attract water - cornstarch/potato starch
39
List 2 examples of natural colloids
albumin fresh or fresh-frozen plasma
40
Provide 3 examples of synthetic colloids
hydroxyl ethyl starch dextran gelatin
41
Explain how fluid moves through body compartments when you give a colloid
via IV - cause IV fluid expansion - water bind the protein and starch to keep it in the vessel
42
What are colloids used for? Why?
theoretically good for hypovolemia because they induce a rapid IV volume expansion
43
What are some drawbacks to colloids
they induce a primary and/or secondary coagulation problem because it messes with platelet activation and the coagulation cascade acute renal injury (bc starch = bad) may cause dehydration
44
What are the reccommended things to consider before giving colloids
patient risk assessment can use in the short term to fix low bp in anesthesia NOT for the critically ill only use minimum amount
45
List the routes of fluid administration
IV PO SC IP IO
46
What are the benefits to SC fluid administration
easy fast minimal restraint maintain sterility no IVC
47
What sized needle should you use for SC fluid
18-22 G
48
How much fluid can you give SC
10-30ml/kg - cats usually just get 100ml 10-20ml per site there is no set volume required - more based on how much is tolerated
49
Does SC fluid correct dehydration? Why?
NO if >7% dehydrated should use alternate route of administration because only half the daily maintenance of fluid will be absorbed per day
50
How to calculate the maintenance fluid requirement?
30 * body weight in kg + 70 if active 70 * BW ^ 0.75 if sedentary 97 * BW ^ 0.655
51
What should you be sure to tell owners after giving their pet SC fluid
there may be leakage from the site and the fluid bump will fall into their elbows/chest
52
How long does it take for SC fluid to absorb
24-48h
53
What type of fluid is given SC? Which is not?
room temp/warm isotonic NOT dextrose (can cause lesions/inflammation due to acidosis) you can add 20-40 mEq/L of potassium
54
What is IV fluids mainly indicated for
to expand IV volume - hypovolemia acute loss more volume needed critically ill >5% dehydrated
55
What sites are used for IV fluids
peripheral sites - cephalic - saphenous (med/lat) central - jugular
56
Compare central and peripheral catheters
central: less common and more expensive - require sedation - can give hypertonic fluid - some have multi-lumens for non-compatible drugs peripheral: - higher risk of phlebitis if giving high osmolar fluid - difficult if the patient is small/thrombotic/edema/obese/status epilepticus/vasoconstricted/vascular collapse
57
What to do if you cant use IV for fluid administration
use IO if IO not available use the peripheral vein cutdown technique
58
When is IO fluid administration commonly used? How?
shock puppies and kittens (20-22G catheter) adult animals (bone biopsy needle) into the femur or humerus to administer med/fluid - anything that can go IV can go IO
59
What are some drawbacks with IO fluid admin
osteomyelitis difficult to maintain long term can cause bone marrow necrosis if giving more hypertonic solution may cause fracture - if it fractures the fluid will go out of bone into SC pain
60
When is PO fluid admin usually used
large animal
61
When is IP fluid normally used
exotics
62
How much fluid do you use to treat hypovolemia
fluid bolus and then 10-20ml/kg over 15-20 min
63
Can you give a fluid with added potassium to a blocked cat?
yes because when you unblock the cat it will normalize the electrolyte values
64
What should you do when you see a severe hyponatremia
STOP and consider - is it acute or chronic (< 24 or > 24h) - did the body have time to make iogenic osmoles
65
What are iogenic osmoles
molecules that act to increase the intracellular osmotic pressure to maintain water in the cell the cell can produce these in response to environmental change in 2-3 days
66
In what situation, if any can you quickly give fluids to treat severe hyponatremia?
if it is an acute problem in which there wasnt enough time to generate iogenic osmoles
67
What is something that you can do that causes pontine demyelination? Why?
if you give fluid too fast to rectify severe hyponatremia because water will rapidly leave the cell causing = shrink myelin sheath - reduced iogenic osmoles in the cell this is irreversible
68
How to safely fix severe hyponatremia
use a lactated ringer soln over 4 hours monitor adjust if if you are giving too high a concentration by adding 0.45% NaCL or D5W (hypotonic)
69
What is a safe rate to change Na concentrations with fluids?
0.5-1 mmol/L/h
70
How long will it take to fix a hyponatremia of 125 mmol/L (normal 145 mmol/L)
20 mmol/L deficit 0.5-1 mmol/L/h 20-40 h minimum
71
What should you do when you see a severe hypernatremia
STOP and consider - is it acute or chronic (< 24 or > 24h) - did the body have time to make iogenic osmoles
72
What will happen if you correct a hypernatremia too fast
neurologic signs due to intracellular edema and cerebral edema because cells were adapted to chronically high sodium environment - they made iogenic osmoles to compensate

VETM 443 Pharmacology (23 decks)

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