Fluid Therapy (WIP)

Fluid therapy indications

maintaining hydration, replace fluid deficit, treating shock, improve/increase urine production, replace ongoing losses

Electrolytes

sodium, potassium, calcium

sodium

helps heart and muscles function, too much can lead to swelling

potassium

helps with urination

Calcium

help the bones and heart beat and muscle functions

Total body water (TBW)

total water in body, 60%. Spread across ICF (intracellular fluid) and ECF (extracellular fluid)

Passive transport

no energy required. is what fluids use

Active transport

requires energy. not used by fluids

Crystalloids

various electrolytes in water. smaller molecular weight

Hypotonic crystalloids

Fluid goes into cells to expand them. hypOtonic = Overload of fluids. lower sodium load, good for use in patients with heart and kidney disease. Water greater than electrolytes. Used to replace free water deficit and hypernatremia.

Types of hypotonic crystalloids

Dextrose 5%, 0.45% NaCl, Normosol M, Plasmalyte 56 (last 2 for maintenance)

Isotonic crystalloids

water and electrolytes in equal portion. 0.9% NaCl, plasmalyte 148, normosol R, LRS . Used for resuscitation, rehydration, and replacement of ongoing losses. patients with acute kidney injury, tissue edema

0.9% NaCl

normal saline, isotonic crystalloid. acidifying.

hypertonic

electrolytes greater than water. 3% and 7% hypertonic NaCl. hypErtonic= dEhydrate. RECHECK. GETTING CLARIFICATION. not commonly used but is used for resuscitation, patients with head trauma, crashing animal

Resuscitation phase

restore vascular volume. reverse hypovolemic shock

Replacement phase

correct dehydration, replace and maintain fluids. isotonic crystalloids

maintenance phase

after dehydration is corrected, hypotonic and isotonic crystalloids

Factors determining routes of administration

patient stability, disease process, fluid deficit and ongoing losses, expected length of hospitalization, characteristics of fluid loss

Colloid

high molecular weight suspended in isotonic crystalloid. Remains in vascular space. Not commonly used. natural and synthetic types

natural colloids

plasma, albumin solutions. used in transfusion medicine

Synthetic colloids

hetastarch. used in resuscitation and hypoproteinemia

Routes of fluid administration

Intravenous (IV): fast and versatile

Subcutaneous (SC): slow over time

Intraosseous (IO): Fast, alternate to IV

Enteral: often used for large animal

Intravenous fluid administration

Can be given through multiple sites, aseptic technique (central lines sutured in place, used with multiple lumen catheters).

SubQ fluid administration

large volumes of fluids for slow absorption over time, gradual fluid replacement, should be isotonic

Intraosseous fluid administration

Alternative for patients in which IV access is not positive, rapid dispersion of fluids through bone marrow and the medullary venous channel

Enteral fluid administration

often used in large animal, can be used with IV fluids

Indications for transfusion: Blood

Acute hemorrhage, chronic or hemolytic anemia

Indications for transfusion: Platelet

Severe thromocytopenia with hemorrhage or need for surgery

Indications for transfusion: Plasma

Coagulopathy, hypoalbuminemia, failure of passive transfer of immunity

Transfusion reactions

Erythema (redness), Urticaria (Rash), Pruritus (itching), anaphylaxis (severe allergic reaction), Death, Shock, Fever

Anemia

Low RBC volume which leads to being anemic b/c that is where iron is stored

Fluid therapy complications

Volume overload, pulmonary edema, peripheral edema, coagulation abnormalities, cavitary effusion, electrolyte/acid base disturbance

Potassium- Fluid additive

used to treat hypokalemia

Dextrose-Fluid additive

Used to treat hypoglycemia

Sodium bicarbonate- Fluid additive

Used to treat metabolic acidosis (extreme cases), severe hyperkalemia, chronic metabolic acidosis (large animals)