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Flashcards in IV fluids Deck (114):
1

What is the major component of all body fluids?

Water

2

When there is equilibration of water between compartments, what has been reached?

Homeostasis

3

What is the approximate total body water value for adult dogs & cats?
Neonates?

- 60%
- 80%

4

Do older patients have more or less total body water than adults?

Less

5

What is the 60:40:20 rule?

60% BW is water, 40% ICF, 20% ECF

6

Fluid needs are estimated based on what?

Lean body weight

7

How do you calculate lean body mass with a normal body weight?
With an obese body weight?
With a thin body weight?

- Normal body weight x 0.8
- Obese body weight x 0.7
- Thin body weight x 1.0

8

Is ICF composition similar to or different from ECF?

Very different from ECF

9

Is it easy or difficult to change ICF?

Difficult

10

ECF is composed of what?

Any fluid that is not inside a cell.

11

Changes in hydration are markedly affected where?

ECF

12

Where do we target when trying to change hydration status?

ECF

13

How much of ECF is intravascular?
What is this portion mostly composed of?

- 1/4
- Plasma

14

3/4 of ECF is composed of what?

Interstitial fluid

15

What does blood volume equal?

Plasma + erythrocytes

16

What is the blood volume of cattle?

60 mL/kg

17

What is the blood volume of dogs?

90 mL/kg

18

What is the blood volume of horses?

70 (TBs 100) mL/kg

19

What is the blood volume of cats?

65 mL/kg

20

What is the blood volume of sheep?

60 mL/kg

21

What is the blood volume of pigs?

50 mL/kg

22

What differs significantly between ECF and ICF?

Concentration of solutes

23

When total number of anions and cations in all body fluids is equal, what is maintained?

Electroneutrality

24

What are the 2 primary ECF cations?
Which is most abundant?

- Na+, K+
- Na+

25

Which ECF cation is present in small amounts but very physiologically important?

K+

26

What are the 2 primary ECF anions?

Cl-, HCO3-

27

What are the 2 primary ICF cations?

K+, Mg2+

28

What are the 2 primary ICF anions?

Organic phosphates, proteins

29

In diseased states, fluids are usually initially lost from where?

ECF

30

What are 3 types of fluid & solute loss?

- Loss of hypertonic fluids (solute in excess of water)
- Isotonic loss
- Loss of hypotonic fluids (water in excess of solute)

31

Which type of fluid/solute loss is the one most commonly seen under anesthesia?

Isotonic loss

32

Most of ECF is in what 2 areas?

- Interstitial compartment
- Intravascular space

33

Fluid division between plasma and interstitium maintains what?

Effective circulating volume

34

What are 4 examples of forms of water loss?

- Urinary
- Fecal
- Respiratory (panting)
- Cutaneous evaporation

35

What are 2 examples of cutaneous evaporation?

- Salivary (cats)
- Eccrine sweat glands (dog foot pads)

36

The function of renal solute load in diet and obligatory renal water losses for urinary solute excretion determine what?

Water requirements

37

What is the water requirement for small dogs?
Large dogs?
Cats?

- 60 mL/kg/d
- 40 mL/kg/d
- 50-80 mL/kg/d

38

Are maintenance fluids given in anesthesia?

No

39

How are maintenance fluid rates calculated in very large (> 50 kg) or very small (

- BWkg^0.75 x 70 = mL/day
- (BWkg x 30) + 70 = mL/day

40

What are 4 factors a patient history can uncover?

- Duration of issue
- Estimate losses
- Eating/drinking
- Panting, febrile

41

What is the most common fluid given in anesthesia?

Crystalloids

42

Solutions with electrolyte and non-electrolyte solutes able to enter all body fluid compartments are known as what?

Crystalloids

43

Where do crystalloids primarily exert their effects?

Interstitium & ICF spaces

44

In a balanced crystalloid, the composition resembles what?

ECF

45

What type of crystalloid composition does not resemble ECF?

Non-balanced

46

What are 3 examples of balanced crystalloids?

- Lactated Ringers (LRS)
- Normosol-R
- Plasma-Lyte 148

47

What is an example of a non-balanced crystalloid?

Saline

48

Every 1 mL of blood loss should be replaced with how much crystalloid?

3 mL

49

Where do colloids primarily exert their effects?

Intravascular compartment

50

What are 2 indications for the use of colloids?

- Shock
- Hypoproteinemia

51

What are 4 examples of colloids?

- Plasma
- Dextrans
- Hydroxyethyl starches
- Hemoglobin-based oxygen carrying fluid

52

What are 4 examples of parenteral route of administration for fluids?

- Subcutaneous
- Intraperitoneal
- Intraosseous
- IV

53

Subcutaneous fluid is only given in what type of patient?

Stable

54

What can prevent good uptake of fluids given SQ?

Vasoconstriction

55

What type of fluid is given SQ?

Isotonic

56

What are 4 things to be cautious about when giving fluids SQ?

- Thermal burns
- Infection
- Cellulitis
- Skin necrosis

57

Are there any advantages to giving fluids intraperitoneally?

No, can be potentially hazardous.

58

Capillary beds of medullary vascular system allow access to the vascular space for what route of administration?

Intraosseous

59

What is an alternative route of administration to IV in neonates?

Intraosseous

60

What is a form of administration that is used short-term in emergency situation?

Intraosseous

61

What is the preferred route of administration when blood volume expansion is needed?

IV

62

Which route of administration is better in a critically ill patient, IV or SQ?

IV

63

What are 6 potential complications of IV fluid therapy?

- Extravasation
- Thrombosis/thrombophlebitis
- Volume overload
- Infection
- Embolism
- Exsanguination

64

What are 2 examples of drugs that can cause extravasation?

- Thiopental
- NSAIDs

65

What are 7 basic things that are monitored during fluid therapy?

- HR
- RR
- CRT
- MM color
- Temperature
- Mentation
- Urine production

66

What are 4 other measurements taken during fluid therapy?

- Central Venous Pressure (CVP)
- Systemic Arterial Blood Pressure (ABP)
- Pulmonary Capillary Wedge Pressure (PCWP)
- Cardiac output (CO)

67

Anesthesia and surgery disrupt what?

Homeostasis

68

What is the goal of peri-anesthetic fluid management?

Correct abnormalities as much as possible before anesthetic event.

69

Most anesthetic drugs negatively effect what?

Cardiovascular and renal function

70

What are 4 reasons to administer IV fluids?

- Maintain patent IVC
- Counteract effects of anesthetic drugs
- Replace insensible losses
- Replace procedural losses

71

What are 6 concerns with peri-anesthetic fluid management?

- Hypovolemia
- Hypervolemia
- Anemia
- Hypoproteinemia
- Acid base and electrolyte abnormalities
- Abnormal glucose

72

What are 4 reasons hypoproteinemia is significant with anesthesia?

- Many anesthetic drugs are highly protein bound
- More drug available when protein levels are low, leads to more profound effects
- Low protein leads to loss of fluids from intravascular space
- Hypotension & pulmonary edema likely

73

What species is more prone to over-hydration?

Cats

74

What is the peri-anesthetic fluid rate for most dogs?
For cats?

- 10 mL/kg/hr
- 5 mL/kg/hr

75

Does redistribution of crystalloids happen quickly or slowly?

Quickly

76

How much crystalloid remains intravascular 15 minutes after infusion?

20-30%

77

Blood loss should be replaced with how much fluid?

3-4 times the volume of blood lost

78

Where do crystalloids get redistributed?

Interstitial space

79

Fluid has to be administered cautiously with what 3 conditions?
What is the dose lowered to?

- Cardiac disease
- Anuric renal failure
- Geriatric
- 2-5 mL/kg/hr

80

What can be used to treat anesthetic induced hypotension?

Fluid bolus

81

How much crystalloid can be given as a rapid bolus in addition to the continued hourly rate?

5-10 mL/kg over 15 minutes (or less)
The same amount as an hourly rate, but all given within 15 minutes.

82

How much is a shock rate fluid bolus?

1 blood volume/hour

83

What are 4 examples of fluid delivery set sizes?

- 10 drops/mL
- 15 drops/mL
- 20 drops/mL
- 60 drops/mL

84

Which size fluid delivery set is used in larger patients?
Smaller?

- Larger: 10 drops/mL
- Smaller: 60 drops/mL

85

Is it ok to bolus supplemented bags of fluids?

No

86

How much K+ can safely be given in an hour?

0.5 meq/kg/hr

87

What can be given in large volumes to expand ECF volume without changes in electrolyte composition?
What is the exception? Why?

- Crystalloids
- Saline: saline is not balanced

88

Which type of crystalloid is acidifying?

Normal saline (0.9% NaCl)

89

What type of cases may normal saline be a good choice for management in?

Chronic renal cases

90

What is an example of a balanced electrolyte solution (BES)?

Lactated Ringers Solution

91

What is the alkalinizing agent in LRS?

Lactate

92

What does LRS contain that one needs to be aware of if transfusing blood?

Calcium

93

Caution with LRS use should be used in what condition and in what species?

- Lactic acidosis
- Reptiles

94

What is a common choice for anesthetized patients?

LRS

95

What is the alkalinizing agent for Normosol-R and Plasmalyte 148?

Acetate

96

Normosol-R and Plasmalyte 148 may cause what with very rapid administration?

Vasodilation

97

Caution needs to be used with Normosol-R and Plasmalyte 148 in what type of patient?
Why?

- Diabetic ketoacidosis patients
- These fluids increase blood ketone concentrations

98

What is an example of a resuscitation crystalloid?

Hypertonic saline (7.5% NaCl)

99

Where does hypertonic saline draw fluid?

Into intravascular space

100

Hypertonic saline always has to be followed up with what?

Replacement crystalloid

101

What is the administration dose of hypertonic saline?

4 mL/kg IV

102

What is hypertonic saline used to increase?

ICP

103

The component of total osmotic pressure in plasma contributed by colloids is known as what?

Colloid osmotic pressure (oncotic pressure)

104

What are 3 uses for colloids?

- Correct hypovolemia
- Support colloid osmotic pressure
- Hypoproteinemic patients (TP

105

Oncotic pressure provided by colloids depends on what?

Number of particles

106

Duration of action of colloids depends on what?

Size of particles

107

What is the most commonly used synthetic colloid in vet medicine?

Vetstarch (hetastarch)

108

Hetastarch is metabolized by what?
What will this cause in the patient?

- Amylase
- Increase in amylase levels

109

What is the infusion rate of hetastarch?

2-5 mL/kg/hr

110

What is the maximum amount hetastarch that can be given per day?
Vetstarch?

- 20 mL/kg/day
- 40-50 mL/kg/day

111

What can too much start lead to?

Coagulopathies

112

What are 6 examples of negative effects that can be seen with hetastarch?

- Volume overload
- Coagulation
- Renal failure
- Hepatic failure
- Anaphylaxis
- Pruritus

113

What are 2 examples of colloid blood products?

- Plasma protein (FFP, whole blood)
- Lyophilized albumin

114

Plasma protein is used primarily for what?

Clotting factors