question

True

answer

True or false: IV fluid therapy is considered a treatment.

question

Crystalloids

answer

Which kind of fluids are the "first in line"/mainstay of fluid therapy?

question

Consider patients: - hemodynamic status - serum electrolyte measurements - acid-base balance - suspected or confirmed underlying disease

answer

How do you choose what fluids to give a patient?

question

1. When expansion of the intravascular volume is necessary to establish adequate tissue perfusion and oxygen delivery (hypovolemia, severe dehydration, and non-cardiogenic shock) 2. Correction of electrolyte imbalances and restoration of acid-base balance to normal. 3. With CRI's for drug administration 4. During surgical procedures 5. As a mainstay of treatment of many medical diseases (renal insufficiency/failure, pancreatitis, GI disease, Addisonian crisis, sepsis, and DKA)

answer

When is IV crystalloid fluid administration part of the therapeutic plan?

question

predominately water with sodium chloride or glucose as the primary component

answer

What do crystalloid fluids consist of?

question

hypotonic, hypertonic, and isotonic

answer

What are the 3 types of crystalloid fluids?

question

Osmolarity

answer

Hypotonic, hypertonic, and isotonic are all terms that refer to the __________________ of the solution.

question

Less than serum

answer

Hypotonic fluid osmolarity =

question

The intracellular space

answer

Most of the fluid in a hypotonic solution typically goes where?

question

Used as a maintenance fluid for patients who have a high risk of fluid retention.

answer

When would you use a hypotonic crystalloid?

question

When treating shock

answer

When do you NOT use a hypotonic crystalloid?

question

0.45% NaCl (half strength saline)

answer

Give an example of a hypotonic crystalloid:

question

closest to serum

answer

Isotonic fluid osmolarity =

question

For maintenance and shock therapy

answer

When would you use an isotonic fluid?

question

1 - 0.9% NaCl (normal strength saline) 2 - Lactated Ringers 3 - Normosol-R

answer

Give 3 examples of an isotonic crystalloid:

question

greater than ECF

answer

Hypertonic fluid osmolarity =

question

increase vascular pressure by drawing fluid from the interstitial and extracellular space.

answer

Hypertonic fluids are given because they...

question

Shock

answer

Hypertonic fluids are used to treat...

question

7% NaCl

answer

Give an example of a hypertonic crystalloid:

question

In very small boluses

answer

How are hypertonic crystalloids generally given?

question

1. 0.9% NaCl 2. Lactated Ringers 3. Normosol-R

answer

What are the 3 most common fluids used?

question

1 - Hypercalcemia and metabolic alkalosis 2 - Animals with acidosis

answer

0.9% NaCl: 1 - Fluid of choice for... 2 - Not recommended for...

question

1 - Acidotic patients 2 - Hypercalcemia

answer

Lactated Ringers & Normosol-R: 1 - Recommended for... 2 - Not recommended for...

question

They have lower sodium and chloride concentrations, and higher calcium and potassium than normal saline.

answer

What is significant about the ingredients in Lactated Ringers & Normosol-R compared to Normal Saline?

question

- 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)

answer

Colloids: - Osmolarity - Function - Examples (4)

question

It restores and maintains intravascular pressure

answer

What is the advantage of administering a colloid with a crystalloid during resuscitation or maintenance?

question

Hetastarch and Dextran

answer

What are the two synthetic colloids?

question

Synthetic colloid with high molecular weight = stays in the vascular space for 12-48 hours

answer

Hetastarch:

question

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.

answer

Dextran:

question

Plasma and Packed Red Blood Cells

answer

What are the two natural colloids?

question

the ideal colloid to increase oncotic pressure and assist with hypoproteinemia

answer

Plasma =

question

Given to animals who have significant RBC anemia and decreased oxygen carrying capacity

answer

Packed Red Blood Cells (pRBCs) =

question

the amount of fluid necessary for a normally hydrated animal that is NPO ( = nothing per os)

answer

Maintenance fluids =

question

2-3mL / kg / hr

answer

Maintenance fluids formula:

question

TRUE

answer

True or False: Total replacement fluids includes maintenance fluids.

question

represents the amount of fluid needed to replace losses.

answer

Replacement Fluids:

question

You need an estimated % dehydration. This value is determined by Dr based on physical exam and lab work.

answer

What do you need in order to calculate replacement fluids? Where does it come from?

question

BW(kg) X % dehydrated X 1000 = mL to be replaced **(this amount PLUS maintenance should be given over 24 hrs)**

answer

Replacement Fluids formula:

question

1. 5% 2. minimal physical signs of dehydration, tacky MM, slightly slow STT

answer

Mild dehydration: 1. % 2. CS

question

1. 8% 2. slow STT; tacky & pale MM; tachycardia; weak pulses; depression

answer

Moderate dehydration: 1. % 2. CS

question

1. 10% 2. all previous signs plus: skin loses elasticity, eyes are sunken, signs of hypovolemic shock are present

answer

Severe dehydration: 1. % 2. CS

question

replacing for dehyration over the first 4-8 hours of fluid therapy

answer

Front-end loading =

question

Replace 80% of deficit volume the first day, and the remaining 20% the second day.

answer

Besides front-end loading, what is another common way of replacing deficit fluid volume in patients?

question

60-90 mL/kg

answer

What amount of fluids should you give a dog in shock?

question

40-60 mL/kg

answer

What amount of fluids should you give a cat in shock?

question

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.

answer

How do you administer fluids to a shock patient?

question

When the sodium concentration is greater than 155 mmol/L

answer

When is a patient considered hypernatremic?

question

Neurological signs occur due to intracellular dehydration causing brain cells to shrink. You will see these signs when sodium concentrations exceed 170 mmol/L

answer

What signs occur in a hypernatremic patients? When will you see these signs?

question

Start with 0.9% Saline (normal saline) and then gradually bring the sodium levels down

answer

How do you treat a hypernatremic patient?

question

When the sodium concentration is less than 140 mmol/L

answer

When is a patient considered hyponatremic?

question

1. Hypoadrenocorticism (Addison's disease) 2. Renal Failure

answer

Causes of hyponatremia:

question

Normosol-R, and then when sodium starts to rise switch to 0.9% Saline.

answer

How do you treat a hyponatremic patient?

question

You don't want to change the sodium level too rapidly because you can make them worse. BRING CONCENTRATION UP/DOWN GRADUALLY!

answer

What is the most important thing to remember when treating hyper/hyponatremic patients?

question

When the potassium concentration is 5-7 mmol/L

answer

When is mild - moderate hyperkalemia seen?

question

When the potassium concentration is 6-8 mmol/L

answer

When is moderate hyperkalemia seen?

question

IV administration of potassium free fluids and elimination of the factors causing the hyperkalemia

answer

How do you treat moderate hyperkalemia?

question

When the potassium concentration is >8 mmol/L

answer

When is severe hyperkalemia seen?

question

1. IV Calcium Gluconate 2. IV Dextrose 3. Regular insulin

answer

How do you treat severe hyperkalemia?

question

calcium counteracts the cardiac effects of hyperkalemia without altering the level of potassium in the plasma

answer

How does IV Calcium Gluconate work to treat hyperkalemia?

question

causes potassium to be shifted back into the cells through the effects associated with increased insulin secretion (pancreas)

answer

How does IV Dextrose work to treat hyperkalemia?

question

can be co-administered as an IV bolus concurrently with dextrose (must give dextrose if you give insulin)

answer

How does Insulin work to treat hyperkalemia?

question

Cardiac arrest / cardiotoxicity Bradycardia

answer

Severe hyperkalemia can cause what?

question

1 - urethral obstruction 2 - rupture of the bladder or ureters 3 - oliguric or anuric renal failure 4 - hypoadrenocorticism

answer

Causes of hyperkalemia: (4)

question

EKG abnormalities = bradycardia! abdominal pain diarrhea flaccid paralysis of the limbs

answer

Clinical signs of hyperkalemia:

question

Inadequate intake of potassium (anorexia) Increased excretion (polyuria, vomiting or diarrhea) Intracellular translocation of potassium Chronic Renal Failure Diuretic therapy

answer

Causes of hypokalemia:

question

True

answer

True or False: Most patient's on limited oral intake and IV fluid therapy develop hypokalemia and require potassium supplementation.

question

- subtle/obvious muscle weakness (<2 mEq/L) - ventroflexion of the neck - stiff, stilted gait

answer

CS of hypokalemia:

question

IV supplementation of potassium based on CS and serum values. (NOT MORE THAN 0.5mEq/kg/hr)

answer

Treatment for hypokalemia:

question

Fatal bradycardia

answer

Oversupplementation of potassium causes what?

question

1. Hydration 2. Fluid overload 3. Urine production 4. Blood values 5. Physical parameters (HR, RR/RE, MM, CRT, pulses)

answer

What do we look at to monitor response to fluid therapy?

question

- STT - CRT - MM = color and moisture - pulse strength - alertness

answer

Hydration can be evaluated by:

question

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

answer

CS of fluid overload:

question

approximately equal to fluid input

answer

Normal urine output =

question

every 2 hours

answer

How often should you measure urine output?

question

Urine collection systems such as a urinary catheter

answer

What is the easiest and best way to monitor urine output?

question

PCV, TP/TS, electrolyte values

answer

What blood values can attest to a patient's response to fluid therapy?

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