Exam 1: Introduction to Fluid Therapy

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39 Terms

1
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how are fluids gained

drinking, food, metabolic sources

2
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how are fluids lost

urination, salivation, evaporation, fecal, vomiting, diarrhea, exudates

3
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how do we know what to give and how much?

maintenance requirements

correction of fluid deficits

consideration of ongoing losses

4
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how are maintenance requirements generally described

  • approximate RER

  • not linear, equations often vary

5
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define fluid maintinence for dogs under 25kg

60ml/kg/day

6
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define fluid maintenance for dogs >25kg

40ml/kg/day

7
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describe fluid maintenance for cats

50 ml/kg/day

8
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what are the parameters for fluid deficit

  • hydration status

  • caridovascular status

    • volume status

9
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pt presents with serous nasal discharge, chemosis, pitting edema, jugular distention, and increased RR. Describe hydration and hypoperfusion

overhydration, no hypoperfusion pt

10
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pt presents with no detectable abnormalities. Described hydration and perfusion

<5% dehydration, hypoperfusion unlikely

11
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pt presents with mild decrease in skin elasticity (<2 sec) and tacky MM. Describe hydration and perfusuon

6-8% dehydrated, hypoperfusion unlikely

12
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pt presents with mild lethargy, decreased skin elasticity (>3 seconds), tacky MM, eyes appear slighly sunken, and slight prolongation of CRT. Describe hydration and perfusion

8-10% dehydrated

13
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pt presents with marked lethargy, loss of skin elasticity, dry or cold MM, eyes appear to be sunken in orbits, prolongation of CRT. Describe hydration and perfusion

10-12% dehydration, hypoperfusion likely

14
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pt presents recumbent/moribund, prolonged or absent CRT, loss of skin elasticity, dry and cold MM, eyes sunken. Describe dehydration and perfusion

>12% dehydration, hypoperfusion definite

15
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how do you calculate fluid deficit

BW x dehydration (decimal) = deficit in L
1kg= 1L

16
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how are crystalloids generally defined

  • fluids containing small molecular solutes only

  • electrolutes comprise the majority of solute

    • other small solutes (dextrose/glucose, lactate) are readily metabolized, no lasting osmotic effect from these solules

17
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what are the clinical considerations for crystalloids

  • electrolytes equilibrate throughout extracellular compartment in about 30 minutes

  • short lived osmotic effects

  • only 25% volume remains intravascular after 30-60 mins

  • fluid effects dependent on tonicity

18
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what are the general complications of crystalloids

  • volume overload in peripheral tissue and organ edema

  • inappropriate fluid shifts

  • induced electrolyte and acid base derangement

  • exacerbation of hemorrhage

  • dilutional coagulopathy

19
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what is the normal plasma osmolality of dogs

290-310

20
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what is the normal plasma osmolality of cats

311-322

21
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generally describe isotonic crystalloids

  • osmolality similar to plasma

  • minimal fluid shift between extra and intracellular compartments, tonicities between thm are unchanged

22
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what are the uses of isotonic crystalloids

  • dehydration from most common fluid losses (interstitial dehydration)

  • rapid volume expansion- hypovolemic shock

    • most electrolyte imbalances

23
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what are examples of isotonic crystalloids

  • 0.9%NaCl

  • plasma-lyte A/Normasol-R/ Vetivex

  • Lactated ringers

24
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what are the advantages of isotonic crystalloids

  • low cost

  • readily available

  • appropriate in most patients

25
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what are the disadvantages of isotonic crystalloids

  • quickly redistribute so large volumes are required for fluid resuscitation

  • hemodilution

  • ppotential for volume overload

26
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what are the specific complications of isotonic crystalloids

  • induced electrolyte imbalances

  • induction or exacerbation of acidosis

  • some drug compatibilities

27
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what is the general rule of fluid choice?

should be compared to the chemical composition of what it is replacing, plasma in most cases

28
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what are the acid base effects of fluids

  • many are acidic, however, effect on acid base balance is marginal due to lack of free H+

  • buffered fluids preferred for acidotic patients

  • alkalotic patients benefit from non-buffered

29
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what is a colloid

  • large hydrophilic molecules that do not pass freely across membranes

    • increased colloid oncotic pressure, persistent intravascular volume expansion

30
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what affects the effectiveness of colloids

  • number of molecules present

  • limited to intravascular compartmet

  • do not redistribute

31
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what are synthetic colloids

  • Hydroxyethyl starches (HES)

  • dextrans and gelatins in europe

32
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what are natural colloids

  • plasma

  • whole blood

  • albumin

33
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what are hydroxyethyl starches

  • derived from corn or potato starches

  • larged, branched glucose polymer chains

  • hydroxylated to prevent rapid degradation

  • broken down by a-amylase

  • excreted by the kidneys in small molecules

34
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what are the indications for hydroxyethyl starches

  • rapid volume expansion (hypovolemia)

  • pt in which lower resuscitation volumes may be beneficial such as trauma

  • hypoalbuminemia (low oncotic pressure)

  • patients unresponsive to crystalloids

  • some with vasculitis

35
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what are the advantages of hydroxyethyl starches

  • small volumes required- volume expanded by up to 1.5x volume administered

  • long duration of effects

  • increased colloid oncotic pressure

36
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what are the disadvantages of hydroxyethyl starches

  • higher cost

  • higher risk of volume overload

  • tissue accumulation within cells

  • long half life

  • interference with refractometer readings for TP

  • adverse reactions

37
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what are specific complications possible with hydroxyethyl starches

  • acute kidney injury (osmotic nephrosis)

  • impaired platelet function

  • impaired coag - vWF, factor VIII

  • delayed onsert refractory pruritus, allergic reactions

38
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how can body size affect the risk of adverse effects of hydroxyethyl starches

smaller weight preparations are bettwr

39
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in what cases are hydroxyethyl starches contraindicated

  • renal disease

  • sepsis

  • coagulopathy

  • hypertension