Prin Of Med- Fluid Therapy

Front 1

What's the percent of TBW that makes up ICF?

Back 1

66% (60%)

Front 2

What's the percent of TBW that makes up the ECF?

Back 2

33% (40%)

Front 3

Interstitial fluid makes up what percent of ECF?

Back 3

75% ECF

Front 4

Intravascular fluid makes up what percentage of ECF?

Back 4

25% ECF

Front 5

ECF is what percent of BW?

Back 5

20%

5%- intravascular
15%- interstitial

Front 6

ICF is what percent of BW?

Back 6

40%

Front 7

Osmotic pressure is determine by ______ and NOT by ____?

Back 7

1- the # of nonpermeative particles in a solution

2- their total weight/valence/size

Front 8

OsmolaLity of a solution is :

Back 8

concentration of osmotically active particles

Front 9

Osmolality is expressed in terms of :

Back 9

osmoles of solute per Kg of solvent.

Front 10

An osmole is:

Back 10

the amount of substance that dissociates in the solution to form one mole of osmotically active particles

Front 11

Main extracellular ion is:

Back 11

Na

Front 12

Main intracellular ion is:

Back 12

K

Front 13

Main intravascular ion is:

Back 13

Plasma proteins

Front 14

Which membrane is permeable to all ions in plasma except for hte plasma protein ANIONS?

Back 14

Capillary membrane

Front 15

List 5 indications for fluid therapy:

Back 15

1- maintain blood volume/blood pressure and perfusion (shock/hemorrhage)
2- replace TBW deficits(dehydration)
3-Maintain normal body water composition (anorexia/nothing per os)
4-Restore normal TBW composition (acid-base, electrolyte disorders)
5-vehicle to administer therapeutic agents (dextrose/dopamine/lidocaine)

Front 16

Example of a Sensible fluid loss:

Back 16

Urination

Front 17

Example of an Insensible fluid loss:

Back 17

Breating/Sweating/Feces

Front 18

Name 5 Mechanisms of Excessive Fluid Loss

Back 18

1- vomiting
2-diarrhea
3-polyuria (renal failure or Dz interfering with urine concentration- hypoadrenocorticism/diabetes mellitus or insipidus)
4- Sequestration(third spacing- trapped and lost from circulation) [ascites/pancreatitis]
5- losses via trauma in skin/burns

Front 19

List some objective findings in terms of Assessing Fluid Loss.

Back 19

Acute changes in:

Hematocrit
Body Weight
Total Protein
Serum Sodium

Front 20

Depending on the predominant state of dehydration, what objective findings for assessing fluid loss could be seen as normal, increased or decreased?

Back 20

Serum Sodium

Front 21

What could affect the PCV and Total protein levels therefore should be taken into consideration when assessing fluid loss?

Back 21

Anemia/Polycythemia/hyperproteinemia/hypoproteinemia

Front 22

What are some clinical parameters that can be used to measure the degree of dehydration?

Back 22

-History (fluid loss, dec. fluid intake)
-Skin turgor (can be underestimated in obese animals/over in emaciated. Old skin loses elasticity

-Mucous membranes
- CRT/HR/RR

Front 23

What clinical signs are associated with a less than 5% dehydration?

Back 23

History of Fluid Loss
NO clinical signs

Front 24

What clinical signs are associated with a 5% dehydration?

Back 24

-slightly dry MM
-Subtle loss of skin elasticity

Front 25

What clinical signs are associated with a 7% dehyration?

Back 25

-Dry MM
-Decrease skin turgor
-CRT 2-3s

Front 26

What clinical signs are associated with a 10% dehydration?

Back 26

- Dry MM
-Skin Tent (TEN=TENt)
-prolonged CRT
-increased HR
-sunken eyes

Front 27

What clinical signs are associated with a 12-15% dehydration?

Back 27

Shock
Imminent Death

Front 28

Name 3 types of fluids.

Back 28

-Colloids
-Dextrose Solutions
-Crystalloids

Front 29

Define a crystalloid and give an example.

Back 29

A fluid that is isotonic with plasma and contains NA as the major osmotically active particle.

ex: 0.9%NaCl
P-148
LRS

Front 30

Define a Colloid and give an example.

Back 30

Contain large MW particles whic do not readily diffuse into interstitial space and thus remain in the plasma or intravascular volume longer than crystalloids.

ex: Plasma, Blood, Dextrans, Pentastarch

Front 31

give an indication for a dextrose solution and give an example.

Back 31

Glucose in water is rapidly metabolized to COI and water... therefore dextrose solutions are mainly used to supply free water needs

Front 32

What is the composition of replacement solutions?

example?

Back 32

High Na
Low K

It resembles ECF
ex: LRS, P-148

Front 33

What is the composition of maintenance solutions?

example?

Back 33

Lower Na
Higher K

Normosol-M, Plasmalyte 56

Front 34

List 4 routes of fluid administration.

Back 34

1-Oral
2-SubQ
3-Intravenous
4-Intraosseus

Front 35

What are some benefits of using the Oral route for fluid administration?

What are the disadvantages?

Back 35

Benefit: easy/cheap/ safe/

Con: not if vomiting

Front 36

Where should SubQ fluids be administered?

Back 36

Between shoulder blades/areas of loose skin

Front 37

95% of Total Body Potassium is:

Back 37

Intracellular

Front 38

To avoid hypokalemia, what is most often used to supplement K?

What method of administration is most preferred when in fluid form?

Back 38

KCl

Slow IV infusion (but it can also be given SubQ). If possible, oral is best

Front 39

At what rate should potassium be given at to avoid acute hyperkalemia and its adverse effects?

Back 39

no greater than 0.5mEq/Kg/h

Front 40

Describe some disadvantages to the Oral route of fluid administration.

Back 40

- contra indicated if vomiting or GI disease
-may need to add glucose/amino acids/sodium to improve the absorption of the fluid (glucose facilitates sodium absorption and water follows-basis behind gatorade etc)

Front 41

What is a negative side effect of administering dextrose solutions subQ

Back 41

It may cause damage and tissue necrosis,

Front 42

What is the recommended amount of fluid per site that can be administered SubQ?

Back 42

20ml/kg

Front 43

Give an example when SubQ fluild would NOT be readily absorbed?

Back 43

When animal is 7% or more dehydrated (or in shock and are vasoconstricted).

Front 44

What is the most common route of fluid administration when moderate to severe fluid requirerements are needed?

Back 44

IV

Front 45

By decreasing the diameter of the catheter by 50% it increases the resistance by:

Back 45

16times
(2^4)

Front 46

List 3 peripheral veins that a cather may be placed in.

Back 46

Lateral and Medial Saphenous and cephalic

Front 47

Central veins for catheters are required for fluids with:

Back 47

High Osmolality and parenteral nutrition formulations.

Front 48

When performing intraosseus administration, what bone should be used?

in birds?

Back 48

Femur (medulla)

Ulna for birds

Front 49

Why can't the femur be used for intraosseus in birds?

Back 49

Because their air sacs extend into it.

Front 50

What are the three ingredients of fluid therapy?

Back 50

1. Replace deficit
2. Determine maintence
3. replace ongoing losses

Front 51

How do we determine the deficit?

Back 51

KNowing the percent of dehydration and the body weight, we can calculate:

Body weight (kg) X % dehydration= Volume deficit (L)

Front 52

In acute cases of fluid replacement how would you proceed to replace the volume deficit?

Back 52

50%-100% should be replaced within 4-6 hours and the remainder over the next 24 hours.

Front 53

In terms of maintenance, what are the daily fluid requirements for small animals?

Back 53

Estimated at 40-60ml/kg/day

therefore Small dogs=60ml/kg/day --> 3ml/kg/hr

Large dogs(>15kg)=40ml/kg/day--> 2ml/kg/hr

Front 54

What are examples of ongoing fluid losses?

Back 54

Vomiting
Diarrhea

Front 55

What is a standard replacement solution that is initially given to patients?

Back 55

P-148 or LRS

Front 56

Why are colloids sometimes combined with crystalloids for rapid rehydration in shock patients?

Back 56

Colloids hold the fluid in the vascular system longer, which is helpful for shock patients as they need the volume for circulation.

Front 57

What can be given to shock patient if the symptoms or reduced perfusion persists after fluid therapy?

Back 57

Vasopressors (e.g. dopamine)
to maintain blood pressure

Front 58

Examples of disorders associated with Metabolic ACIDosis

Back 58

Diabetes mellitus/diarrhea/vomiting/ shock/renal failure

Front 59

Give examples of alkalanizing fluids that may be given to treat metabolic acidosis

Back 59

Fluids that contain buffers:
P-148
LRS
Normosol

Front 60

Although rare, give some examples of disorders associated with metabolic alkalosis:

Back 60

Pure Gastric vomiting
over adminstration of bicarbonate or diuretics

Front 61

Give an example of an acidifying solution that may be given to treat metabolic alkalosis

Back 61

0.9% NaCl

Front 62

What are some steps that should be taken when monitoring fluid therapy?

Back 62

1.BW and PCV monitored daily
2. Acid-Base status/electrolyte should be assessed daily in critical patients or when indicated
3. Monitor patients frequently for catheter complications, wrong fluid rates/composition or overhydration

Front 63

What are some clinical signs of overhydration?

Back 63

1. Tachycardia/Tachypnea
2. Restlessness(need to pee)
3. Serous Nasal Discharge
4. Chemosis (conjunctiva edema)
5.Rapid Increase in Body Weight
6. Pulmonary Wheezes and Crackles