IV Fluid Therapy – Flashcards
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predominately water with sodium chloride or glucose as the primary component
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What do crystalloid fluids consist of?
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hypotonic, hypertonic, and isotonic
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What are the 3 types of crystalloid fluids?
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Osmolarity
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Hypotonic, hypertonic, and isotonic are all terms that refer to the __________________ of the solution.
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Less than serum
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Hypotonic fluid osmolarity =
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The intracellular space
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Most of the fluid in a hypotonic solution typically goes where?
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Used as a maintenance fluid for patients who have a high risk of fluid retention.
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When would you use a hypotonic crystalloid?
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When treating shock
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When do you NOT use a hypotonic crystalloid?
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0.45% NaCl (half strength saline)
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Give an example of a hypotonic crystalloid:
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closest to serum
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Isotonic fluid osmolarity =
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For maintenance and shock therapy
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When would you use an isotonic fluid?
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1 - 0.9% NaCl (normal strength saline) 2 - Lactated Ringers 3 - Normosol-R
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Give 3 examples of an isotonic crystalloid:
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greater than ECF
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Hypertonic fluid osmolarity =
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increase vascular pressure by drawing fluid from the interstitial and extracellular space.
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Hypertonic fluids are given because they...
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Shock
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Hypertonic fluids are used to treat...
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7% NaCl
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Give an example of a hypertonic crystalloid:
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In very small boluses
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How are hypertonic crystalloids generally given?
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1. 0.9% NaCl 2. Lactated Ringers 3. Normosol-R
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What are the 3 most common fluids used?
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1 - Hypercalcemia and metabolic alkalosis 2 - Animals with acidosis
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0.9% NaCl: 1 - Fluid of choice for... 2 - Not recommended for...
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1 - Acidotic patients 2 - Hypercalcemia
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Lactated Ringers & Normosol-R: 1 - Recommended for... 2 - Not recommended for...
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They have lower sodium and chloride concentrations, and higher calcium and potassium than normal saline.
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What is significant about the ingredients in Lactated Ringers & Normosol-R compared to Normal Saline?
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- Greater than extracellular space - Does not pass through vascular membrane but remains intravascular to to assist with oncotic pressure - Hetastarch & Dextran (synthetic) - Plasma & pRBCs (natural)
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Colloids: - Osmolarity - Function - Examples (4)
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It restores and maintains intravascular pressure
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What is the advantage of administering a colloid with a crystalloid during resuscitation or maintenance?
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Hetastarch and Dextran
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What are the two synthetic colloids?
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Synthetic colloid with high molecular weight = stays in the vascular space for 12-48 hours
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Hetastarch:
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Synthetic colloid with a lower molecular weight than Hetastarch but has a larger variation of molecules = 1 - shorter duration within the vascular space (4-8 hours) 2 - greater oncotic pull to the vascular space.
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Dextran:
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Plasma and Packed Red Blood Cells
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What are the two natural colloids?
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the ideal colloid to increase oncotic pressure and assist with hypoproteinemia
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Plasma =
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Given to animals who have significant RBC anemia and decreased oxygen carrying capacity
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Packed Red Blood Cells (pRBCs) =
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the amount of fluid necessary for a normally hydrated animal that is NPO ( = nothing per os)
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Maintenance fluids =
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2-3mL / kg / hr
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Maintenance fluids formula:
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TRUE
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True or False: Total replacement fluids includes maintenance fluids.
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represents the amount of fluid needed to replace losses.
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Replacement Fluids:
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You need an estimated % dehydration. This value is determined by Dr based on physical exam and lab work.
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What do you need in order to calculate replacement fluids? Where does it come from?
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BW(kg) X % dehydrated X 1000 = mL to be replaced **(this amount PLUS maintenance should be given over 24 hrs)**
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Replacement Fluids formula:
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1. 5% 2. minimal physical signs of dehydration, tacky MM, slightly slow STT
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Mild dehydration: 1. % 2. CS
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1. 8% 2. slow STT; tacky & pale MM; tachycardia; weak pulses; depression
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Moderate dehydration: 1. % 2. CS
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1. 10% 2. all previous signs plus: skin loses elasticity, eyes are sunken, signs of hypovolemic shock are present
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Severe dehydration: 1. % 2. CS
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replacing for dehyration over the first 4-8 hours of fluid therapy
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Front-end loading =
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Replace 80% of deficit volume the first day, and the remaining 20% the second day.
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Besides front-end loading, what is another common way of replacing deficit fluid volume in patients?
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60-90 mL/kg
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What amount of fluids should you give a dog in shock?
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40-60 mL/kg
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What amount of fluids should you give a cat in shock?
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1. The first third/half of the calculated volume is administered over 10-20 minutes and the patient is reassessed continually. 2. If shock is ongoing, the remainder of the calculated resuscitation volume is administered. 3. If crystalloid administration is insufficient to reverse shock or sustain resuscitation a colloid can be added.
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How do you administer fluids to a shock patient?
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When the sodium concentration is greater than 155 mmol/L
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When is a patient considered hypernatremic?
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Neurological signs occur due to intracellular dehydration causing brain cells to shrink. You will see these signs when sodium concentrations exceed 170 mmol/L
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What signs occur in a hypernatremic patients? When will you see these signs?
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Start with 0.9% Saline (normal saline) and then gradually bring the sodium levels down
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How do you treat a hypernatremic patient?
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When the sodium concentration is less than 140 mmol/L
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When is a patient considered hyponatremic?
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1. Hypoadrenocorticism (Addison's disease) 2. Renal Failure
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Causes of hyponatremia:
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Normosol-R, and then when sodium starts to rise switch to 0.9% Saline.
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How do you treat a hyponatremic patient?
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You don't want to change the sodium level too rapidly because you can make them worse. BRING CONCENTRATION UP/DOWN GRADUALLY!
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What is the most important thing to remember when treating hyper/hyponatremic patients?
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When the potassium concentration is 5-7 mmol/L
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When is mild - moderate hyperkalemia seen?
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When the potassium concentration is 6-8 mmol/L
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When is moderate hyperkalemia seen?
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IV administration of potassium free fluids and elimination of the factors causing the hyperkalemia
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How do you treat moderate hyperkalemia?
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When the potassium concentration is >8 mmol/L
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When is severe hyperkalemia seen?
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1. IV Calcium Gluconate 2. IV Dextrose 3. Regular insulin
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How do you treat severe hyperkalemia?
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calcium counteracts the cardiac effects of hyperkalemia without altering the level of potassium in the plasma
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How does IV Calcium Gluconate work to treat hyperkalemia?
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causes potassium to be shifted back into the cells through the effects associated with increased insulin secretion (pancreas)
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How does IV Dextrose work to treat hyperkalemia?
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can be co-administered as an IV bolus concurrently with dextrose (must give dextrose if you give insulin)
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How does Insulin work to treat hyperkalemia?
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Cardiac arrest / cardiotoxicity Bradycardia
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Severe hyperkalemia can cause what?
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1 - urethral obstruction 2 - rupture of the bladder or ureters 3 - oliguric or anuric renal failure 4 - hypoadrenocorticism
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Causes of hyperkalemia: (4)
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EKG abnormalities = bradycardia! abdominal pain diarrhea flaccid paralysis of the limbs
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Clinical signs of hyperkalemia:
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Inadequate intake of potassium (anorexia) Increased excretion (polyuria, vomiting or diarrhea) Intracellular translocation of potassium Chronic Renal Failure Diuretic therapy
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Causes of hypokalemia:
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True
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True or False: Most patient's on limited oral intake and IV fluid therapy develop hypokalemia and require potassium supplementation.
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- subtle/obvious muscle weakness (<2 mEq/L) - ventroflexion of the neck - stiff, stilted gait
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CS of hypokalemia:
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IV supplementation of potassium based on CS and serum values. (NOT MORE THAN 0.5mEq/kg/hr)
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Treatment for hypokalemia:
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Fatal bradycardia
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Oversupplementation of potassium causes what?
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1. Hydration 2. Fluid overload 3. Urine production 4. Blood values 5. Physical parameters (HR, RR/RE, MM, CRT, pulses)
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What do we look at to monitor response to fluid therapy?
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- STT - CRT - MM = color and moisture - pulse strength - alertness
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Hydration can be evaluated by:
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1. serous nasal discharge 2. subcutaneous edema 3. increased urine output with normal kidneys 4. ascites 5. restlessness 6. chemosis (swelling around the conjunctiva) 7. exophthalmos (bulging eyes) 8. coughing 9. increased RR 10. vomiting
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CS of fluid overload:
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approximately equal to fluid input
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Normal urine output =
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every 2 hours
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How often should you measure urine output?
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Urine collection systems such as a urinary catheter
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What is the easiest and best way to monitor urine output?
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PCV, TP/TS, electrolyte values
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What blood values can attest to a patient's response to fluid therapy?
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