Fluid Therapy – Flashcards
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Osmotic pressure
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the pressure that draws water into a compartment in proportion to the number of particles present. Solutes provide this pressure
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Oncotic pressure
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Colloids don't diffuse freely through vascular endothelium so their presence in the vascular space provides colloid osmotic pressure
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Fecal Losses
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10-20 mL/kg/24 hours
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Urinary Losses
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20 mL/kg/24 hours or 1-2 mL/kg/hr
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Inevitable Losses (respiratory evaporation, sweat)
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20 mL/kg/24 hours
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Total Losses
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50-60 mL/kg/24 hours
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Crystalloids
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contain water and small-molecular-weight solutes that pass freely through vascular endothelium +Routinely used for most anesthetized patients
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Crystalloid- Isotonic, polyionic replacement
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+Balanced solutions that contain ions in concentrations that are similar to extracellular fluids +Includes Lactated Ringer's, Normosol-R, Plasma-Lyte A and R, and Isolyte S
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Crystalloid- Isotonic, polyionic maintenance
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+Closely corresponds with solute composition of total body water by having less Na+ & Cl-, and having more K+ than the isotonic polyionic replacement fluids +Designed for maintenance for over longer periods of time +Includes Normosol-M in 5% Dextrose and Plasma-Lyte 56 in 5 % Dextrose
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Crystalloid- Normal saline
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+Contains only Na+ and Cl- +Used for patients with Addison's Disease and for blood transfusions +Also used to hydrate exposed tissues during surgery, flush IV catheters, and to flush body cavities
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Crystalloid- Hypertonic saline
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Used in acute care settings to treat patients with hypovolemic, traumatic, or endotoxic shock to draw water into intravascular space
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Crystalloid- Dextrose
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+Only contains dextrose, but often packaged with other polyionic solutions +Used to support blood glucose in neonates, hypoglycemic or debilitated patients, or in diabetes mellitus patients that are receiving insulin +Also used to replace patients body water for simple dehydration or heat stroke +Not for long-term use
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Colloids
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contain large-molecular-weight solutes that do not freely diffuse across vascular endothelium so it stays in the intravascular space +Used to increase blood volume and blood pressure
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Colloid- Synthetic colloid
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+30 to 60% remains in plasma after 24 hours, and a smaller percentage can remain for as long as days to weeks after administration +Includes dextran, pentastarch, hetastarch or gelatin products
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Colloid- Blood products
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+Includes plasma, packed RBC's or whole blood +Used in patients with anemia, hypoproteinemia, coagulation disorders, or thrombocytopenia
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Crystalloids IV fluid administration rates during routine anesthesia and surgery:
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+10 mL/kg/hr during the first hour +5 mL/kg/hr for the remainder of the procedure
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Signs of fluid overload
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Ocular and nasal discharge, chemosis, SQ edema, increased lung sounds increased RR, and dyspnea
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Hemodilution
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Patients that are anemic, hypoproteinemic or have had profound perioperative hemorrhage episode are at risk
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Prescribed Rate
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+The fluid administration rate order by the doctor +Expressed milliliters per unit body weight per unit time -Usually mL/kg/hr
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Infusion Rate
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+The rate at which fluids should be administered expressed in milliliters per unit time (Usually mL/hr) +Determined by multiplying: Patient body weight X Prescribed rate
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Delivery Rate
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+The number of drops of fluid that must fall inside the drip chamber of an administration set to deliver 1 mL of fluid expressed in drops per milliliter (gtt/mL) +Determined by looking on packaging of the administration set
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Drip Rate
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+Rate at which fluids should be administered expressed in drops per unit time (usually gtt/min) +Determined by: Infusion rate X Conversion factor for hours to minutes X Delivery rate
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Infusion Time
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The total time the fluids will be administered expressed in hours
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Infusion Volume
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+The total volume of fluids to be administered expressed in milliliters or liters +Determined by: Patient body weight X Prescribed rate X Infusion time
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Administration Sets
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+Use macrodrip sets for infusion rates equal to or greater than 100 mL/hr or for patients weighing 10 kg or more +Use microdrip sets for infusion rates less that 100 mL/hr or for patients weighing less than 10 kg
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Most accurate way of monitoring fluid administration to a patient?
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Record fluids given and weigh patient daily
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What helps determine the amount of fluid deficit?
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Maintenance amount, dehydration status, and ongoing losses
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5 main routes of fluid administration
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SQ, IV, IP, intraosseous, and orally
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You have an orthopedic surgery patient coning into the clinic this morning to have demure fracture repaired. The dog weighs 7kg. You want to give the patient 10ml/kg/hr of LRS the first hour then 5ml/kg/hr for the next consecutive 4 hours. This totals 5 hours of fluids. How much will this patient get for the entire time?
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210 mL +Infusion Volume: Determined by: Patient body weight X Prescribed rate X Infusion time
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If a dog weighs 20kg, what type of fluid administration unit should be used?
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Macro drip
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What is the fluid drip rate if using a 60gtt/ml drip chamber set alone, for a 5 kg cat, and using a prescribed fluid rate of 10ml/kg/hr?
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0.83gtt/sec +50mL/hour
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A increased PCV and elevated plasma protein may indicate adequate hydration for a patient?
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False
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Persistent skin tent Depressed globes within orbits CRT 3 sec % dehydration rate?
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10
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What is/are the clinical indictions for fluid therapy during anesthesia?
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-To replace body fluid deficit -To increase urine production -To correct electrolyte disorders -To maintain body hydration
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Lactated Ringers is in what category?
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Isotonic, polyionic replacement
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Normosol-M is in what category?
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Isotonic, polyionic maintenance
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0.9% NS is in what category?
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Normal saline
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D5W is in what category?
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Dextrose solution
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Hetastarch is in what category?
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Synthetic colloid
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Millie, a 9 year-old Norfolk terrier, is having surgery today to remove a lipoma. She has Addison's disease. What IV fluid should be administered to her during surgery?
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0.9% Normal saline
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Calculate the drip rate in drops per minute for the flow rate of 25 mL/ hour using a micro dripper administration set.
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25 gtt/min
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A 42 kg dog's total blood volume is approximately :
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3.78 liters
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The clinical signs of dehydration are not detectable until:
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5-8% dehydration
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The delivery rate of a micro drip administration set is
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60 gtt/mL
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A increased PCV and elevated plasma protein may indicate adequate hydration for a patient? T or F?
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False
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