Fluids 2

Question 1

What are the possible routes of fluid administration?

Answer 1

1. Oral
2. Subcutaneous
3. Intraperitoneal (exotics)
4. Intravenous
5. Intraosseous

Question 2

How can fluids safely be administered to a patient with cardiac disease?

Answer 2

Orally through an NG tube

Question 3

You cannot use subcutaneous fluids to correct a fluid deficit that is greater than ______%.

Answer 3

5%

Question 4

What dose of subcutaneous fluids are typically given?

Answer 4

10-20 mL/kg (only give half the maintenance requirements at a time)

Question 5

Typically it is standard to give cats ______mL of fluids subcutaneously.

Answer 5

100 mL

Question 6

What are two limitations of subcutaneous fluids?

Answer 6

1. Volume limit (there is only so much room in the subcutaneous space)
2. Time (it takes too long for body to absorb)

Question 7

True or False: Subcutaneous fluids can be used to treat shock.

Answer 7

False. It will take too long to absorb. This must be done IV.

Question 8

Which electrolyte can we add to subcutaneous fluids?

Answer 8

Potassium

Question 9

Which compound should we not add to subcutaneous fluids?

Answer 9

Dextrose (acidic and causes irritation)

Question 10

Name two catheters we can place to give fluids IV.

Answer 10

1. Central venous
2. Peripheral intravenous

Question 11

What are central venous catheters?

Answer 11

Catheters that are inserted so that the tip of the catheter rests within a central vein (usually the cranial or caudal vena cava)

Question 12

Where do we typically place central venous catheters?

Answer 12

In the jugular vein

Question 13

What are some disadvantages of central venous catheters?

Answer 13

1. Expensive
2. Patients need to be sedated
3. More time consuming to place
4. More skill required to place them

Question 14

What catheter should be used to place in a very small animal (kitten)?

Answer 14

An intraosseous (IO) catheter

Question 15

In which bones are IO catheters normally placed?

Answer 15

Femur or humerus

Question 16

Why is lidocaine given in IO catheters as soon as they are placed?

Answer 16

Apparently putting the catheter in isn’t too painful, but the feeling of fluids rushing through is extremely painful. So we flush with lidocaine first to numb.

Question 17

True or False: Anything that can be given IV can also be given IO.

Answer 17

True

Question 18

Do IO catheters allow for rapid or slow absorption of fluids into the IV space?

Answer 18

Very rapid (considered synonymous with IV)

Question 19

True or False: It is acceptable to place IO catheters in bones with fractures.

Answer 19

False

Question 20

What are three possible complications of IO catheters?

Answer 20

1. Osteomyelitis
2. Bone marrow necrosis
3. Discomfort/pain

Question 21

What is an emergency venous cutdown?

Answer 21

The procedure involves making a small incision through the skin and underlying tissues to expose a superficial vein. Once the vein is visualized, a catheter is inserted directly into the vein to allow for the administration of fluids or medications. It is usually done on an extremity.

Question 22

If you are adding medications to your fluid bag, what is important you do?

Answer 22

Mix/invert the bag well and label

Question 23

Which type of crystalloid fluid is the best fluid to give to a blocked cat?

Answer 23

Balanced crystalloids

Question 24

What are two questions you must ask yourself before treating a sodium disorder?

Answer 24

1. Acute (< 24 hours) or chronic (> 24 hours)?
2. Did the body have time to spit out or make intracellular iogenic osmoles?

Question 25

What are iogenic osmoles?

Answer 25

Compounds produced by cells in response to changing osmolarity and can keep water where they are

Question 26

How long does it take for a cell to produce iogenic osmoles?

Answer 26

24-48 hours

Question 27

In sodium disorders, when is it acceptable to correct the Na concentration quickly?

Answer 27

When the change in Na is acute

Question 28

In sodium disorders, when is it NOT acceptable to correct the Na concentration quickly?

Answer 28

When the change in Na is chronic or unknown. If you don't know, air on the side of caution (assume chronic).

Question 29

What is a consequence of correcting a chronic hyponatremia too quickly?

Answer 29

Pontine demyelination

Question 30

What is a consequence of correcting a chronic hypernatremia too quickly?

Answer 30

Brain swelling/brain edema (causes neurological signs)

Question 31

What is pontine demyelination?

Answer 31

The loss of myelin sheath in neurons of the pons (in brainstem). Without myelin, neurons cannot conduct electrical signals.

Question 32

True or False: Pontine demyelination is reversible.

Answer 32

False

Question 33

How fast can a sodium disorder be corrected?

Answer 33

No more than 0.5-1 mmol/L/h ## Footnote Ex. A 20 mmol deficit would take 20-40 hours to correct.

Question 34

Practice calculation: How long would a 30 mmol sodium deficit take to correct?

Answer 34

30-60 hours

Question 35

Practice calculation: How long would a 12 mmol sodium deficit take to correct?

Answer 35

12-24 hours

Question 36

How should we treat a patient with a hypochloremic metabolic alkalosis with concurrent hypokalemia?

Answer 36

1. Treat hypochloremia (Give 0.9% NaCl CRI) 2. Treat hypokalemia (supplement with KCl)

Question 37

What are three things you could do for a patient in shock with hyperkalemia (ex. blocked cat)?

Answer 37

1. Treat with calcium gluconate (to protect the heart from hyperkalemia) 2. Dextrose bolus (to move K+ into cells) 3. Give isotonic crystalloid 4. Unblock

Question 38

Which is better to use in a cat with hyperkalemia, 0.9% NaCl or a balanced crystalloid?

Answer 38

A balanced crystalloid. You might think that NaCl is better since it doesn't contain any potassium, but because it has such high levels of chloride, this could cause hyperchloremia and a metabolic acidosis. Only use NaCl if it's a patient with a hypochloremic metabolic alkalosis.

Question 39

What are the steps to deciding how much Na to give to correct a deficit?

Answer 39

1. Calculate deficit (normal Na-patient's Na)