L50: intro to fluid therapy

MCQ: what are the names of the 3 fluid compartments?

1. intracellular

2. interstitial

3. intravascular (plasma)

MCQ: what is the predominant force that determines fluid movement from the intravascular to the interstitial space?

starling’s forces

MCQ: what is the predominant force that determines fluid movement from the interstitial to the intracellular space?

osmotic forces

what forces are responsible for movement between intracellular and interstitial compartments?

osmotic forces (gradients)

what forces are responsible for fluid movement between interstital and intravascular compartments?

starling’s forces (hydrostatic pressure and oncotic pressure)

what is the modified starling’s hypothesis?

there is an additional pressure: the endothelial glycocalyx

what is the endothelial glycocalyx like?

like a guardrail for our highway of blood

what is the function of the endothelial glycocalyx?

1. regulate transvascular fluid movement, vasomotor tone, and inflammation

2. acts as anticoagulant

3. keep large molecules like albumin and RBC in intravascular space

what happens if the endothelial glycocalyx is damaged?

RBC leak into interstitium (even will low capillary hydrostatic pressure) and coagulation will occur

MCQ: what are some of the indications for fluid therapy?

1. hypovolemia

2. dehydration

3. pale mucus membranes

4. slow CPT

5. excessive loss of electrolytes

what are the goals of fluid therapy?

1. replenish normal intake if patient not eating or drinking

2. replenish excessive ongoing losses

3. replenish hydration if dehydrated

4. replenish volume if hypovolmeic

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

40-60 ml/kg/day

what are normal things that will lead to fluid loss?

1. urination

2. defecation

3. respiratory and skin

normal fluid intake

how much needed to drink per day to maintain homeostasis; “maintenance fluids”

what are some examples that can lead to excessive ongoing losses of fluids in the animal?

1. exercise

2. lactation

3. vomiting

4. diarrhea

dehydration is a deficit where?

interstitial space

what will happen if dehydration is very severe?

can lead to intersttital deficit and intracellular deficit

what can be the result if dehydration persists?

hypovolemia

what is the treatment for dehydration?

volume slowly replaced and delivered into vascular space where it will diffuse to interstitial space

what type of deficit is hypovolemia?

intravascular deficit

what can lead to hypovolemia?

1. dehydration

2. loss of volume in general (ex: whole blood loss)

hypovolemia needs to be…

fixed FAST

how many fluids will you give to a cat in the treatment of hypovolemia?

5-10 mL/kg over 15-30 minutes

how many fluids will you give to a dog in the treatment of hypovolemia?

15-20 mL/kg over 15-30 minutes

where is volume delivered in the treatment of hypovolemia?

volume quickly replaced and delivered into the vascular space

MCQ: what fluid compartment is deficient if the patient is dehydrated?

interstitial

MCQ: what fluid compartment is deficient if the patient is hypovolemic?

intravascular

what is the first step in fluid therapy?

identify which compartment is deficient in fluids to determine if patient is dehydrated, hypovolemic, or both

what are the physical exam parameters for identifying if patient is dehydrated and/or hypovolemic?

1. hydration parameters

2. perfusion parameter

what are the indirect measures for identifying if a patient is dehydrated and/or hypovolemic?

1. urine output and USG

2. lab parameters such as PCV/TS, lactate, and sodium

hydration parameters determines…

interstitial volume status = dehydration

what type of parameter is mucous membrane moisture level?

hydration parameter

what type of parameter is skin turgor?

hydration parameter

what type of parameter is sunken eyes?

hydration parameter

what type of parameter is demeanor (animal alert vs. dull)?

hydration parameter

what type of parameter is urine concnetration?

hydration parameter

what does perfusion parameters evaluate?

intravascular volume status = hypovolemia

what type of parameter is mucous membrane color?

perfusion parameter

what type of parameter is capillary refill time?

perfusion parameter

what type of parameter is extremity temperature?

perfusion parameter

what type of parameter is urine output?

perfusion parameter

what is another name for decreased perfusion?

shock

what is the most common cause of shock?

hypovolemia

why do animals that are severely dehydrated become hypovolemic?

there is no more fluid that they can steal out of the interstitial space

what does it mean if a mucous membrane is tacky?

animal dehydrated

what do we assess mucous membranes for?

1. color

2. moisture/tacky

3. CRT

how will mucous membranes be normally?

1. pink and moist

2. CRT= 1-2 seconds

what is considered abnormal for mucous membranes?

1. pale and tacky

2. CRT less than 1 or greater than 3 seconds

MCQ: if a patient has pink, tacky mucous membranes, with a CRT of 2 seconds, they are…

dehydrated

MCQ: if a patient has pale, moist mucous membranes, with a CRT of 3 seconds, they are…

hypovolemic

where do we assess for skin tent/turgor?

1. neck/shoulder

2. eyelid (foals)

what factors can affect skin tent?

1. age

2. nutrition status

what is increased heart rate a sign of?

decreased perfusion

what happens if cardiac output is low?

heart rate compensates by increasing

what happens if stroke volume is low?

heart rate compensates by increasing

what is important to understand about heart rate compensation in cats?

compensatory period is low and will quickly go to a low heart rate compared to dogs

what are low blood pressure and decreased strength of pulse a sign of?

low perfusion

where do we evaluate pulse quality and blood pressure in dogs and cats?

metatarsal and femoral arteries

where do we evaluate pulse quality in horses?

transverse facial artery

where do we evaluate pulse quality in cows?

coccygeal artery

what are cold extremities a sign of?

poor perfusion, the body is compensating by moving blood to more vital organs

where do we check extremity temperatures in large animals and horses?

ears

what does it mean if there is no urine output?

hypovolemia

what does it mean if there is concentrated urine?

dehydration, appropriate response

what does it mean if there is dilute urine with dehydration?

kidney disease or injury

what species do we do jugular fill in?

horses

what does it mean if jugular fill is delayed in a horse?

patient is hypovolemic

what species is sunken eyes not a sign of severe dehydration?

ADULT horses

what species is sunken eyes a sign of severe dehydration?

1. ruminants

2. small animals

3. foals

where do we look at mucuous membranes in ruminants?

1. vulva (female)

2. prepuce (male)

MCQ: Frenchie a dog comes in after 2 days of vomiting, anorexia, and diarrhea. Mucous membranes are pink and tacky. CRT is 2 seconds. Skin tent is prolonged. Is Frenchie dehydrated, hypovolemic, or both?

dehydrated

MCQ: Bella a goat was attacked by a dog. Her mucous membranes are pink and tacky. Her CRT is 2 seconds, Skin tent = 4 seconds. She has a high pulse. Is Bella dehydrated, hypovolemic, or both?

dehydrated

MCQ: Sally, a pony mare, had colic surgery. She has a CRT of 3 seconds. She has dark pink and tacky mucous membranes. Skin tent is prolonged, and she has a delayed jugular fill. Is sally dehydrated, hypovolemic, or both?

both

what is dark pink mucous membranes a sign of?

sign of sepsis typically seen in horses after colic surgery

MCQ: Beau, a DSH, has a 12 hour history of straining to urinate. He has pale pink very tacky membranes. His CRT is 3-4 seconds. Pulse is weak, extremeties are cold. Is Beau dehydrated, hypovolemic, or both?

both

MCQ: Ramon a horse has had intermmitent low grade colic for the last couple of days. His mucous membranes are pink and slightly tacky. CRT is 2 seconds. Pulse strong and jugular fill is normal. Is Ramon dehydrated, hypovolemic, or both?

dehydrated

MCQ: if a patient is dehydrated and hypovolemic which do you treat first?

hypovolemia