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SAMS > Introduction to Fluid Therapy > Flashcards

Introduction to Fluid Therapy Flashcards

(47 cards)

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1
Q

Volume control

A

RAAS system

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2
Q

Osmolality control

A

Anti-diuretic hormone

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3
Q

Fluid gains vs fluid loss

A
  • gains: water and food, aerobic metabolism

- loss: sensible (2/3, urinary/fecal), insensible (1/3, skin/respiratory)

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4
Q

Total body water accounts for ____ body weight in dogs and cats

A

60%

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5
Q

Water movement is controlled by

A
  • osmosis

- starling’s forces

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6
Q

Important clinical concepts

A
  • water freely moves between all 3 compartments

- sodium containing fluids stay within extracellular space (interstitium and intravascular)

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7
Q

Pathologies in fluid homeostasis manifest in one of 2 main ways

A
  • volume of fluid compartment changes

- tonicity of fluid compartment changes

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8
Q

Fluid therapy is indicated to:

A
  • replace a deficit in a fluid compartment
  • change the electrolyte concentration of a compartment
  • shift fluids from one compartment to another
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9
Q

Other indications for fluid therapy

A
  • shock resuscitation
  • correct dehydration
  • maintain hydration
  • promote diuresis
  • anesthesia
  • increase oncotic pressure
  • correct electrolyte abnormalities
  • replace blood components
  • nutritional support
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10
Q

Intravascular

A

Shock

- perfusion parameters

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11
Q

Interstitial

A

Dehydration

- skin turgor, mucous membrane moisture

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12
Q

Intracellular

A

Hypernatremia

- [Na]

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13
Q

Perfusion parameters

A
  • mucous membrane color
  • capillary refill time
  • heart rate
  • pulse quality
  • temperature
  • mentation
  • bp
  • lactate
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14
Q

Look at the stages of shock!!!

A

Look at the stages of shock!!!

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15
Q

Interstitial evaluation

A

If severe enough, dehydration is an intravascular problem (>10%)
- only changes the intracellular compartment if the sodium is severe affected

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16
Q

Interstitial parameters

A
  • skin turgor: affected by BCS and age

- gingival moisture affected by: panting (falsely dry), nausea (falsely moist)

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17
Q

Estimating dehydration

A
  • <5%: not detectable
  • 5% tacky mm
  • 8%: dry mm, decreased skin turgor
  • 10%: retracted globes, persistent skin tent, hypovolemia
  • 12-15%: hypovolemic shock
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18
Q

______ compartment cannot be evaluated on physical exam

A

Intracellular

- [Na] loosely reflects volume status of intracellular compartment

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19
Q

Severe hypernatremia =

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A

Intracellular deficit

  • as extracellular osmolality increases, water leaves intracellular space and cells become dehydrated
  • hypotonic fluid loss –> hypernatremia –> intracellular dehydration
20
Q

Fluids are categorized by _______

Study These Flashcards
A
  • particle size: crystalloids (small), colloids (large)

- tonicity: hypotonic, isotonic, hypertonic

21
Q

Isotonic crystalloids

Study These Flashcards
A

Freely distribute among extracellular spaces

  • great for rehydrating interstitial space
  • takes large volumes to expand intravascular space
  • balanced: LR, plasmalyte
  • unbalanced: 0.9% saline
22
Q

Balanced isotonic crystalloids

Study These Flashcards
A

Fluid of choice due to:

  • buffer that combats metabolic acidosis
  • more physiologic amounts of Na and Cl
23
Q

Unbalanced isotonic crystalloids

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A

Supra-physiologic amounts of sodium and chloride

  • reserved for situations bc it is an acidifying solution that lacks a buffer
  • used for metabolic alkalosis, hypercalcemia, drug incompatabilities
24
Q

Hypotonic crystalloids

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A

Distribute evenly among all fluid compartments

  • only used for hypernatremia/free water loss
  • isotonic in vitro but hypotonic in vivo
  • sterile water is hypotonic in vitro and in vivo (NEVER give to patient)
25
Hypertonic crystalloids
Used to manipulate fluid shifts in the body - increase intravascular expansion at a much lower volume --> short lived effect due to distribution between intravascular and interstitial space - used for shock or hemorrhage - can shift fluid out of intracellular compartment (cerebral edema)
26
Colloids
Fluids that contain large molecules with oncotic pull that stay within the intravascular space - synthetic: hetastarch - natural: whole blood, plasma, albumin
27
Colloid - confinement within the intravascular space provides ______
Volume expansion - intact and functional vessel is necessary! - improve oncotic pressure due to hypoalbuminemia - severe shock (esp w/ hemorrhage) - replace deficient blood product
28
Synthetic colloids
``` Advantages - inexpensive and readily available - increase volume expansion at lower doses - increase colloid osmotic pressure Disadvantages - dose dependent coagulopathy - worsens edema if escapes vasculature ```
29
Peripheral IV
Short term - cephalic and saphenous - fastest = largest bore and shortest lenth - don't perfuse a disease part of body
30
Intraosseous
Used when peripheral cannot be obtained - severe shock or neonates - trochanteric fossa, iliac crest (large dogs)
31
Central lines
Appropriate for long term catheterization, critical patients, multiple infusions, and extremely hypertonic fluids - jugular, femoral extending to caudal vena cava - permits frequent blood sampling
32
Treating intravascular compartment
- route: IV, IO - rate: fast, bolus over 10-20 min - fluid: balanced crystalloids, hypertonic saline, synthetic colloids
33
Shock strategies
- hypovolemic: large amounts of crystalloids, occasional use of hypertonic saline or colloids - hemorrhage and trauma benefit from limited volume resuscitation (smaller amounts of crystalloids, concurrent use of hypertonic saline, +/- blood products)
34
Resuscitation goals
Continue fluid resuscitation until the following have normalized: - physical exam perfusion parameters - blood pressure - lactate
35
Treating interstitial compartment
- route: IV, IO, SQ, PO - rate: correct over 12-24 hrs - fluid: balanced isotonic crystalloids
36
SQ fluids
Reserved for replacement of mild dehydration (5-8%) - isotonic crystalloids (hypertonic, hypotonic, or dextrose will cause tissue necrosis) - dose: 20-30 ml/kg
37
IV rehydration plan
- estimation of dehydration - provision of maintenance fluid requirements - estimate and replace on-going fluid losses
38
Estimating dehydration
Fluid deficit = % dehydration x body weight (kg) | - convert to hourly rate based on how fast you wish to correct dehydration (12-24 hrs)
39
Maintenance fluids
1 ml of fluid to metabolize 1 kcal of energy - maintenance fluids should match metabolic energy requirements - need to calculate using body surface area
40
Ongoing losses
GI and urinary are most common - others: fever, drainage, burns/wounds, third spacing - weight used to monitor trends - urinary cath and drains allow precise measurement of fluid losses
41
Discontinuing fluid therapy
- underlying dz is corrected/controlled - fluid deficits corrected - fluid losses have stopped - animal can consume water to stay hydrated
42
Treating intracellular compartment
- route: IV, PO - rate: slow! 48-96 hrs - fluid type: 5% dextrose in water administered IV, water consumed orally
43
Oncotic support
Indicated if albumin <1.5 g/dl or total protein <4.0 g/dl - synthetic colloids (most available option) - plasma is not ideal, albumin last resort
44
Diuresis
Fluids will be delivered at higher than maintenance rates to ensure perfusion and promote diuresis
45
Electrolyte supplementation
Potassium, calcium, magnesium | - all electrolytes affect hr and contractility if given too fast, CRI is ideal
46
_____ is the most common electrolyte abnormality
Hypokalemia | - skeletal muscle weakness is most common consequence
47
Hypokalemia
Potassium chloride may be added to any crystalloid - be cautious above 0.5 mEq/kg/hr of supplementation - risk for hyperkalemia and toxicity

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