Lesson 50: Intro to Fluid therapy

What are the names of the 3 fluid compartments?

Intracellular

Interstitial

Intravascular (plasma)

What is the predominant force that determines fluid movement from the intracellular to the interstitial space?

Osmotic forces

What are the two main starling forces that move fluid between the interstitial and intravascular compartments?

Hydrostatic pressure

Oncotic pressure

What is the modified starling hypothesis?

That there is additional pressure due to the endothelial glycocalyx 

What regulates the transvascular fluid movement, vasomotor tone, coagulation, and inflammation.

The glycocalyx

What membrane interacts with plasma proteins, and keeps larger molecular like albumin and red blood cells in the intravascular space, based on weight, electric charge, and concentration?

The glycocalyx

what happens if the the glycocalyx is damaged?

Ablumin, RBCs leak into interstitium, pro-coagulation

What are the goals of fluid therapy?

1. Replenish normal intake if the patient isn’t eating or drinking

2. Replenish excessive ongoing losses

3. Replenish hydration if dehydrated

4. Replenish volume if hypovolemic

What is the normal amount of fluid the body loses per day?

40-60 ml/kd/day

What is the amount of fluid that is lost to be considered excessive ongoing losses?

~50 ml/kg/day

What is it called when the interstitial deficit ± intracellular deficit if very severe?

Dehydration

Persistant dehydration via increased losses, decreased intake, or both can result in what?

Hypovolemia

If there is an intravascular deficit from dehydration it can result in what?

Hypovolemia

What fluid compartment is deficient if the patient is dehydrated?

Interstitial

What fluid compartment is deficient if the patient is hypovolemic?

Intravascular

What are the physical exam parameters to identify dehydration/hypovolemia?

Hydration parameters

Perfusion parameters

What are the indirect measures to identify dehydration/hypovolemia?

Urine output/USG

Lab parameters such as PCV/TS, lactate, and sodium

Which type of physical parameter measures Mucus membrane moisture level, Skin turgor, Eyes, Demeanor, Urine concentration, PCV/TS?

Hydration parameter

What does the Hydration parameters measure?

Interstitial/intracellular volume status

What does perfusion parameters measure?

Intravascular volume status

Which type of physical parameter measures Mucous membrane color, CRT, HR, Pulse quality, BP, Extremity temp, urine output?

Perfusion parameters

What is another name for decreased perfusion called?

Shock

What is the most common problem that causes a decrease in perfusion?

hypovolemia

What are other examples that can cause shock/decreased perfusion?

Sepsis and Heart failure

What are the ways to assess mucus membranes?

Color

Moisture/tacky

CRT

What is the normal mucus membrane assessment?

Color: Pink

Moisture: moist

CRT: 1-2 sec

What is an abnormal mucus membrane assessment?

Color: Pale

Moisture: tacky

CRT: <1 or > 3

If a patient has pink, tacky mucus membranes, with a CRT of 2 seconds they are?

Dehydrated 

If a patient has pale, moist mucus membranes, with a CRT of 3 sec they are?

Hypovolemic

Where do you assess skin tenting/turgor?

Neck/shoulder and eyelid in foals

Prolonged skin tent is a sign of what?

Dehydration

What are factors that can affect skin tenting?

Age

Nutrition status

Increased HR is a sign of what?

Decreased perfusion

Review: What is the equation for CO?

CO= HR X SV

If CO is low…

HR compensates by increasing

If SV is low…

HR compensates by increasing

What are other factors that can increase HR other than CO and SV?

Pain/fear

Compensation only last so long → low HR

Cats quickly go from High to low HR

Decreased strength of Pulse and low BP are signs of what?

Low perfusion

What does cold extremities indicate?

Sign of poor perfusion

What does no urine output indicate?

patient is not perfusing kidneys

What does concentrated urine indicate?

Dehydration, appropriate response

What does dilute urine with dehydration indicate?

Kidney disease/injury

Which species can you palpate the bladder in?

Cats

If the jugular fill in horses is delayed what does this indicate?

Hypovolemic

Sunken eyes are a sign of severe dehydration in which species?

Ruminants and Small aminals

Sunken eyes are not a sign of severe dehydration in which species?

Horses

In small animals dehydration can be estimated from physical findings. What percentage of dehydration indicates hypovolemia?

>10%

Is the Frenchie de

Is Bella dehydrated, hypovolemic, or both?

Dehydrated

Is Sally dehydrated, hypovolemic, or both?

Both 

Is Beau dehydrated hypovolemic or both

both

Is Ramon dehydrated, hypovolemic, or both

Dehydrated