Fluid Therapy Flashcards by Lauren R.

What is the TBW [total body water] amounts for not-obese animals, vs. young animals, vs. old animals?

non-obese ~60% BW
young ~70% BW
old ~50% BW

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What are the blood volumes in dogs, cats, and horses? What % of body weight does this account for, roughly?

dogs = 80-90 mL/kg
cats = 40-60 mL/kg
horses = 80 mL/kg

blood makes up ~7% of BW

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What are the main sources of water for animals?

drinking
diet → wet food vs. dry food
metabolism (10-15%) → reactions produce water byproducts

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What is the difference between Sensible water loss vs. Insensible water loss?

Sensible = obvious, can see loss
Insensible = can’t see

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What are the types of Sensible & Insensible water losses?

Sensible:
- urination → obligatory (kidneys) + free (more urination)

Insensible:
- fecal → obligatory (needed to remove feces)
- respiration (panting)
- cutaneous (sweating)
- salivary (saliva)

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What are some ways that water gain is lost by animals to maintain a “zero balance” of water in the body?

sensible loss (~67%) and insensible loss (~33%)
environment → hot vs. cold
activity level → high vs. low
disease causing water loss
diet → solutes produced + need to be removed (urine, feces)

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What is polyuria?

excessive urine production

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What is polydipsia?

excessive thirst

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What are the water requirements for adult dogs, neonates, and cats?

dogs ~60 mL/kg/24 hr
neonates ~70 mL/kg/24 hr
cats ~45-50 mL/kg/24 hr

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What are the TBW fluid compartments, and what are there barriers between them?

Intracellular fluid (ICF) → within cells
Extracellular fluid (ECF) → outside cells
barrier = cell membranes

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How much body weight do ICF & ECF account for? How much body weight does water account for overall?

ICF = 30-40 % BW
ECF = 16-20% BW

40% + 20% = 60% of BW is water

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ECF can be broken down into compartments. What are those different compartments? How much do they account for?

barrier (vascular endothelium = blood vessels)
interstitial fluid (ISF) → ~14% BW
plasma (IVF) → ~5% BW
transcellular (pleural fluid) → ~1% BW

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The permeability of the compartment barrier is _____ with each substance: water, electrolytes, and _____.

is variable
colloids

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Water crosses ____ barriers, by way of _____.

ALL membranes
by way of: osmotic pull, with use of the concentration gradient

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Sodium, potassium, & chloride are all examples of ______. They can cross through _____, but NOT ______.

electrolytes
vascular endothelium
NOT cell membranes

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Where/what is the volume of distribution for electrolytes?

in the extracellular fluid (ICF) → 25% intravenous fluid + 75% interstitial fluid

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Colloids can cross ____ barriers, and are found within _____ & _____.

cross NO barriers
vascular space & plasma expanders

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What can happen if albumin levels drop?

fluid leaves/leaks out of vascular space → cause edema

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What does it mean when we say that fluid compartments maintain a “dynamic” equilibrium?

“Give and Take” relationship
dynamic bc when one compartment has +/- amount of fluid → another compartment’s fluid changes +/- with it

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Which fluid compartment is the first to be affected by maintaining the dynamic equilibrium? Why?

the ECF/plasma compartment → boundary membrane is semi-permeable for fluids & electrolytes (concentration gradient in play)

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What are the determinants of osmotic pull?

osmotically active electrolytes & molecules
water follows higher concentration gradient

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What is the difference between isotonic, hypotonic, & hypertonic solutions? How can they affect cells?

isotonic = equal solute concentration → no net water movement
hypotonic = low solute concentration → water enters cells, swells, bursts
hypertonic = high solute concentration → water leaves cells, shrinks

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Why would you give a patient with low BP a hypertonic solution?

to raise blood volume

hypertonic = increase solute concentration → osmosis: draw fluid from intracellular & interstitial spaces, put into intravascular space

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Electrolytes need _____ to cross cell membranes, in order to maintain balance.

pumps

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Which electrolytes are in the ECF vs. ICF?

- ECF = sodium, chloride, bicarbonate - ICF = potassium, magnesium

What are the 2 main regulators of water/electrolytes in the body?

pituitary gland & kidneys

How does the pituitary gland effect water in the body?

- pituitary gland regulates the amount of water in body - senses fluid balance, blood pressure → controls the release of ADH [antidiuretic hormone] → controls urine output/concentration

How do the kidneys affect water in the body?

- kidneys regulate the amount of water in the body - sense decreased blood flow/volume → releases Renin → releases Angiotensis → adrenal gland releases Aldosterone = sodium retained, water conserved, become THIRSTY

An animal becomes ______ when too much fluid loss happens.

dehydrated

What are the 3 types of fluid loss that can cause dehydration?

- primary water loss - water & electrolyte loss - blood loss

What are the main 2 ways that "primary water loss" occurs?

1. increased excretion → Diabetes Insipidus (c or r); renal failure 2. lack of intake = not drinking enough

"Water & Electrolytes" is the most common type of fluid loss. Is what ways does this happen?

happens with clinical conditions → vomiting, diarrhea, wounds, burns, ascites, peritonitis

What types of electrolytes are lost when "water & electrolyte" fluid loss occurs?

it depends on the type of loss/clinical condition (diarrhea vs. burns, etc etc)

What fluids are being lost when "blood loss" occurs?

loss of electrolytes, isotonic fluids, components of blood

The specific type of fluid loss can dictate any _____ a patient may have. For example, if the patient is vomiting, you know they are losing ___, ____, & ___.

- abnormalities - Na+, Cl-, K+

Why is potassium (K+) considered the "most critical" electrolyte/fluid?

potassium level has a very narrow range → any +/- can cause severe problems

When administering fluids for a patient, what should you do if they are Hypokalemic vs. Hyperkalemic?

- Hypokalemic = low K+ level → add K+ - Hyperkalemic = high K+ level → avoid ANY K+

How much water is lost when a patient is vomiting or has diarrhea?

~ 4 mL/kg per episode

How much body weight is an animal losing when they are anorexic?

0.1-0.3 kg / 24 hours / 1000kcal not eaten

What are the ways we can determine a patient's hydration status?

make a rough estimate → based on history (duration, v/d, diet), PE, lab tests

How much water is lost when an 8% dehydrated, 20 kg dog loses 1 kg?

0.08 x 20 kg = 1.6 kg → 1.6 L water loss (1 kg BW lost = 1 L water lost)

What are the three things you have to consider when calculating fluid therapy for a patient?

1. hydration status (%) 2. maintenance rate (60 mL/kg/24 hr) 3. ongoing losses (v/d = 4 mL/kg per episode)

WHEN should you run lab tests while trying to figure out hydration status? What are you typically going to look at & see when there has been fluid loss?

do lab tests BEFORE fluid therapy, look at: - PCV → HIGH PCV (high RBC, low plasma) - TP (albumin, immunoglobulins, clotting proteins) → INCREASE - USG → INCREASE - pH → ACIDOTIC

What are 2 other important clinical measurements you should monitor/assess when a patient is undergoing fluid loss & therapy?

- urine output → normal: 1-2 mL/kg/hr (less = problem) - CVP → monitor for TOO MUCH fluids/fluid therapy (normal: 0-3 cm H2O)

What are you looking at when assessing a patient's blood pH? What is a normal/healthy pH?

- pH = measurement of H+ in blood - normal range is narrow = 7.35-7.45 - less? < 7.35 = acidosis - more? > 7.45 = alkalosis

What can control an animal's acid-base to keep it balanced? What do they regulate?

- renal (kidneys) → regulate bicarbonate - respiratory (lungs, breathing) → regulate carbon dioxide - buffers (bicarbonate, proteins/Hb, phosphates) → accept/donate protons

What is the most common Acid-Base abnormality?

Metabolic acidosis → - LOW plasma bicarbonate - HIGH hydrogen ions (H+) - LOW pH in blood

What will happen if an animal's Acid-Base is unbalanced? How will they compensate?

hyperventilate, hypoventilate, or kidney control (of bicarbonate)

How do you measure a patient's Acid-Base levels?

measure blood gases → **arterial sample or venous sample

What are the 6 questions you should ask yourself when coming up with a fluid therapy plan?

1. is it needed? 2. what type of fluid? 3. what route? 4. what rate? 5. how much? 6. when to stop?

A fluid therapy plan should be supportive, maintaining ______ in the patient.

homeostasis

What are the 3 types of dehydration?

- Hypertonic = loss of hypotonic fluid → pure water is lost (not electrolytes) - Isotonic = loss of isotonic → equal parts water + electrolytes lost (V/D) → MOST COMMON - Hypertonic = loss of hypertonic fluid

What are the differences between Crystalloids and Colloids? How can you further divide them?

- Crystalloids = have small solutes (electrolytes) that can freely move between vessels/tissues - Colloids = have larger molecules that stay in vessels longer - Crystalloids can be divided into Balanced fluids or Unbalanced fluids

What are the differences between Balanced & Unbalanced fluids? What are examples of each?

- Balanced = like ECF, alkalizing quality (ex: LRS) - Unbalanced = unlike ECF, acidifying quality (ex: 0.9% saline)

What is added to IV fluids when a patient is hypokalemic? What is the proper rate for this additive?

Potassium is added → KCl rate: NEVER FASTER than 0.5 mEq/kg/hr

What is the most common route of fluid therapy? What is the time limit for this route?

IV → ~72 hr time limit

What routes can be used to administer fluid therapy?

- IV - subQ - oral - IP - IO

Fluid rate flow potential is determined by ____.

orifice radius / diameter → bigger = faster, smaller = slower

What is the fluid replacement rate for healthy dogs & cats undergoing rapid/severe loss?

- dogs = 80-90 mL/kg/hr - cats = 45-50 mL/kg/hr (1 blood volume/hr)

What is the fluid rate during anesthesia/surgery? How would "major surgery" affect this rate?

- Sx rate = 5 mL/kg/hr - Major Sx = DOUBLE basal rate → 2 x 5 mL/kg/hr =10 mL/kg/hour

What are the methods of maintain fluid rates during fluid therapy?

- gravity flow - pressure infusion - burettes - syringe pump - volumetric infusion pumps

What are the sizes of drip set (chambers) for adults vs. pediatric/small?

- adult drip set = 10-20 gtt/mL - pediatric drip set = 60 gtt/mL

What are the equations to figure out a patient's hydration deficit, maintenance requirement, and ongoing losses?

- hydration deficit → BW (kg) x dehydration % (decimal) = deficit (Liters) - maintenance → 60 mL/kg/day in dogs, 40-45 mL/kg/day in cats - ongoing losses → 4 mL/kg per episode

How can you estimate blood loss?

- blood pool → 12"x12" = 100 mL(cc) - 4x4 sponge → 5-10 mL/each - 12x12 lap sponge → 50 mL(cc) - suction bottle → (PCV in bottle x volume fluid) / divide by patient's PCV

When should fluid therapy be stopped? What reason?

- hydration is restored - Sx/Anesthesia completed - self maintaining w/ oral intake

What is the best method of stopping fluid therapy? Should it be immediate?

No, taper down by 22-50% per day

What are some complications when using a catheter for fluid therapy?

- extravasation (leak from blood vessel to surrounding tissues) - thrombosis (blood clot) - thrombophlebitis (blood clot in vein) - infection - catheter embolism - air embolism - exsanguination

What are some signs of overhydration? (volume overload)

- restlessness - weight gain - serous nasal discharge - chemosis - shivering - tachypnea - coughing - dyspnea - tachycardia - polyuria - pulmonary edema

Fluid Therapy Flashcards

(68 cards)