question

Total body Water in adults and neonates

answer

50-70% in adults 80% in neonates

question

What is total body waters comprised of

answer

intracellular and extracellular fluid compartmentss

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Intracellular fluids (ICF)

answer

60% of TBW

question

Extracellular fluids (ECF)

answer

40% of TBW

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Interstitial fluids

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75% of ECF (30% of TBW)

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Intravascular fluid

answer

25% of ECF (10% of TBW)

question

When giving IV fluids

answer

intravascular space-> interstitial space -> intracellular fluid

question

When fluids are lost from the body:

answer

they are first lost from the ECF (intravascular and interstitial space), then from the ICF (Intracellular fluids)

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Most abundant electrolytes ECF

answer

Na+, Ca++, Cl-, HCO3- (bicarbonate)

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most abundant electrolytes ICF

answer

K+, Mg++, PO4-, proteins

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therapeutic fluids that are balanced resemble ECF in composition

answer

Na, Cl, HCO3-

question

LRS? (Lactated Ringers Solution)

answer

balanced solution

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Saline?

answer

unbalanced solution

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weight of the solute per 100 ml of solution (g%)

answer

0.9%=o.9/100ml or 900 mg/100 ml per liter (mEq/L) or per ml (mEq/ml)

question

what does milliequivalents express?

answer

express the concentration of electrolytes

question

Osmosis

answer

solutes move from area of high to lower concentration through a *semipermeable membrane*

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larger solutes/impermeable to membrane:

answer

water will be attracted towards solute

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Osmotic pressure:

answer

the ability f particles in solution to attract water

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Osmolarity and osmolaltiry

answer

measures of the osmotic pressure of a solution based on the number f particles in that solution

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Osmolarity

answer

based on # of particles/Liter solution

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Osmolality

answer

based on # of particles/Kg of solution

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Effective osmoles

answer

particles capable of generating osmotic pressure

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tonicity

answer

total effective osmolarity of a solution

question

Osmolarity of dog/cat serum:

answer

300 mOsm/L

question

Fluids @ 300 mOsm/L

answer

isotonic fluid - fluids move in and out of cell and between all fluid spaces at an equal rate

question

Fluids greater than 300 mOsm/L

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hypertonic fluid - causes fluid to shift into intravascular space from the interstitial space and cells so cells shrink

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Fluids less that 300 mOsm/L

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hypotonic fluid - causes fluid to shift out of intravascular space into the interstitial space and so cells swell

question

Indications for fluid therapy

answer

dehydration: water loss greater than water intake maintain hydration: normal hydration but losing excessive amounts of fluid replace electrolytes and nutrients correct hypovolemia: decrease in blood volume/plasma volume: bleeding or dehydration correct acid-base imbalances maintain an open IV line for administering medications

question

Sources of water intake

answer

water that is drunk water that is ingested with food water that results from normal metabolism

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normal routs of water loss

answer

urine fecal water sweat (horses) respiration (panting)

question

Sensible losses (measurable losses)

answer

urine

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Insensible losses (cannot be easily measured)

answer

fecal and respiratory losses

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Why do we need to supplement fluids

answer

decreased fluid intake (decreased appetite/anorexia) increased fluid loss: diarrhea, vomiting, polyuria, hemorrhage, burns, body cavity effusions

question

Vomiting

answer

Na+, K+, and Cl- loss

question

Diarrhea

answer

Na+ loss, K+ loss chronically

question

Skin Turgor test evaluates what?

answer

evaluates hydration

question

the longer the skin takes to return to normal

answer

the more dehydrates the animal is

question

Is it more or less reliable in older animals

answer

less reliable because they have a decrease in elasticity

question

What are other indicators of dehydration

answer

dry mucous membranes increased capillary refill time increased heart rate weak, thready pulses reduced jugular distension (especially in horses)

question

Not detectable

answer

<5%

question

Slight loss of skin elasticity

answer

5-6%

question

Delay in return of skin to normal position, increase CRT, dry mucous membranes

answer

10-12%

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Prominent signs of shock and/or death

answer

12-15%

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Packed cell volume (PCV)

answer

increases with dehydration always evaluate in conjunction with TP (anemia)

question

Total plasma protein (TP)

answer

increases with dehydration

question

Urine specific gravity

answer

increases with dehydration as well

question

routes of fluid administration

answer

depends on nature of condition being treated, its duration and severity

question

methods of fluid administration

answer

intravenous subcutaneous oral intraperitoneal intraosseous

question

intravenous (IV)

answer

preferred when loss is great or disorder is severe *quicker more precise delivers of fluids*

question

Where do you put an IV?

answer

Cephalic, jugular, saphenous

question

Should you monitor the IV?

answer

yes! it requires close monitoring

question

What can happen if you dont watch the catheter

answer

obstruction, septiccemia, embolism, phlebitis

question

How long should you flush the catheter

answer

6-12 hours with heparinized saline

question

When should you replace the catheter

answer

72 hours

question

Subcutaneous (SQ)

answer

Needs not severe & not a good route if significant dehydration is already present

question

amount administered depends on size of animal and amount of loose skin

answer

generally between 50-200 ml per site

question

What happens if you overfill?

answer

sloughing can occur (dissects skin away from the blood supply)

question

Oral

answer

practical route as long as no severe disorders of the gastrointestinal tract: common in large animal

question

Intraperitoneal

answer

- large volumes of fluid can be given but absorption is slow - peritonitis s complicated - uncommon route

question

Intraosseous (femur, ilium, humerus)

answer

- very small animals and/or those with poor veins - sterile technique to avoid osteomyelitis

question

Volume of fluid to administer

answer

hydration deficit (Rehydration dose) maintenance requirement (maintenance dose) ongoing losses

question

hydration deficit (rehydration dose)

answer

amount of fluid that needs to be replaced to return animal to a normal hydration state

question

maintenance requirement (maintenance dose)

answer

amount of fluid requires to sustain the body on a daily basis- includes sensible and insensible losses

question

ongoing losses

answer

losses due to vomiting and diarrhea- estimated

question

*REHYDRATION DOSE* Give 80% over the first 24 hours Give last 20% over the next 24 hours

answer

*rehydration dose (ml) = (%dehydration X BW in kg) X 1000* convert % to a decimal - ex 10% = 0.1

question

example of rehydration dose

answer

8 lb cat 10% dehydrated 8lb = 3.6 kg total ml for rehydration = (0.1 x 3.6 kg) X 1000 = 0.36 x 1000 = 360 ml rehydration dose first 24 hours = 360 X 0.8 = 288 ml second 24 hours = 360 X 0.2= 72 mls

question

* MAINTENANCE DOSE *

answer

maintenance dose (ml)= 60 ml X BW in kgs

question

example of maintenance dose

answer

8 lb cat 8 lb = 3.6 kgs maintenance dose = 60 ml X 3.6 kg = 216 ml per day

question

Ongoing losses

answer

estimate volume of diarrhea or vomiting and then double- add to tally of daily fluids

question

example of ongoing losses

answer

cat vomited 10 ml, ongoing losses: 20 ml

question

PUT IT ALL TOGETHER!

answer

8 lb cat, 10% dehydrated, vomited 10 ml overnight- second day of rehydration * total ml for rehydration = (0.1 x 3.6) X 1000 = 360 mls * second 24 hours 360 ml X 0.2 = 72 mls * maintenance dose = 60 ml X 3.6 kg = 216 ml/day * ongoing losses = 20 ml * day 2 total 72 + 216 + 20 = 308 ml *day 1 total (0.8 X 360) = 216 + 0 =504 ml

question

Fluid resuscitation

answer

reverse shock, correct hypovolemia, increase low blood pressure, reverse hypoglycemia

question

dog shock dose

answer

60 - 90 ml/kg

question

cat shock dose

answer

44 - 60 ml/kg

question

emergency dose

answer

administer 1/4 of calculated dose as rapidly as possible (10-15 min) then reassess the patient VIA HR, CRT, mm color, BP, temp

question

example of shock 8 lb shocky cat

answer

8 lb = 3.6 kgs *cat shock dose*: 44-60 ml/kg 44 ml/kg X 3.6 kg = 158 ml administer 1/4 quickly- 40 ml, the reassess. give remaining fluids over next hour

question

drip rate

answer

(volume of infusion (ml) / time of infusion (min)) X drop factor (gtt/ml)

question

why should you not administer fluids too rapidly

answer

administering fluids too rapidly or in too great a volume can be *life threatening*

question

Careful monitoring is necessary

answer

physical exam labratory findings- PCV, TP Central venous pressure mental status hydration status heart- rate and rhythm respiration body weight body temperature (hypothermia) body position urine output

question

signs of overhydration

answer

restlessness increased lung sounds (crackles) tachycardia dyspnea serous nasal discharge

question

are bags or bottles labeled?

answer

yes, they are labeled to indicate any additives tape should be placed to indicate the volume that should be delivered by certain time

question

Crystalloid solution

answer

Electrolyte solutions that can enter all body compartments Isotonic high-sodium (replacement solutions) Hypotonic low-sodium (maintenance solutions) Hypertonic saline solutions

question

Colloid solution

answer

Large molecular weight particles, confined to vascular space; used to expand the plasma volume Synthetic colloids Starch based colloids Natural colloids

question

crystalloid solutions

answer

Administration results in rapid equilibration of fluid between the intravascular and extravascular spaces 10 % intravascular, 30 % interstitial, 60 % intracellular Isotonic high-sodium (replacement solutions) Hypotonic low-sodium (maintenance solutions) Hypertonic saline solutions

question

Isotonic crystalloid solution

answer

Sodium content and osmolality close to ECF Large percentage of infused fluid will leave intravascular space within 30 minutes Treat shock, vomiting, diarrhea, pancreatitis Used with caution or not at all in patients in which sodium retention may be a problem (heart or renal disease)

question

Hypotonic Crystalloid Solutions

answer

Sodium content and osmolality less than ECF Infusion hydrates the extracellular space Extracellular space has a higher osmolality that pulls the fluid out of the vasculature into space Treat hypernatremia or conditions which sodium retention is a problem

question

Hypertonic Crystalloid Solutions

answer

Osmolality greater than that of ECF Causes fluid to move out of the intracellular/interstitial space and into intravascular space Treat shock (by increasing intravascular volume) May be beneficial in treating brain edema

question

Crystalloid Solutions Isotonic high-sodium

answer

Physiologic Saline Lactated Ringer's Solution Ringer's Solution Normosol R Plasma-Lyte

question

Crystalloid Solution Hypotonic solution

answer

Dextrose 5% in Water Dextrose 2.5% with 0.45% Saline Half-strength Lactated Ringer's Solution with 2.5% Dextrose

question

Isotonic Crystalloid Solutions Physiologic Saline

answer

0.9% NaCl, normal saline, isotonic saline Osmolarity = 308 mOsm/L Replacement solution used to increase plasma volume or correct a Na+ deficiency (hyponatremia) Nonbalanced solution, not suitable for maintenance

question

Isotonic Crystalloid Solutions Lactated Ringer's Solution (LRS)

answer

LRS-commonly used - can be administered by any route Balanced electrolyte replacement solution Also used for maintenance (usually w/ added K+) Contains lactate which the liver converts to bicarbonate to buffer acidosis

question

Isotonic Crystalloid Solutions Ringer's Solution

answer

Balanced replacement solution More sodium, calcium and chloride than LRS Also used for maintenance (usually w/ added K+) No lactate (buffer) - can be used for metabolic alkalosis Limited use in veterinary medicine

question

Isotonic Crystalloid Solutions Multisol-R or Normosol-R

answer

Balanced multiple electrolyte replacement solutions with a dual buffering system (acetate and gluconate) Acetate and gluconate metabolized outside the liver (advantage with liver disorders) Calcium free (Ca++ can cause clotting of transfused blood) Normosol-M in 5% Dextrose 5% dextrose in a balanced maintenance solution with acetate as a buffer (use instead of D5W if need maintenance fluids with dextrose)

question

Isotonic Crystalloid Solutions

answer

Plasma-Lyte Balanced replacement solution with acetate (47 mEq/L) and lactate (8 mEq/L) as buffers Plasma-Lyte M in 5% Dextrose Balanced maintenance solution with acetate and lactate in equal amounts (12 mEq/L)

question

Hypotonic Crystalloid Solutions

answer

Dextrose 5% in Water D5W - non-balanced solution that contains only dextrose and water Only provides 170 kcal/L - cannot meet the daily caloric needs of most small animals Not administered SQ Not used as a maintenance solution 2.5% Dextrose in Half-strength (0.45%) Saline with potassium added Used as a maintenance solution for patients with sodium restriction

question

Hypertonic Saline Solutions

answer

3%, 4%, 5%, 7%, 7.5% Especially useful in treating hypovolemic shock - small volumes 7.5% solution considered the upper limit of concentration to avoid phlebitis

question

Hypertonic Saline Solutions side effects

answer

Phlebitis Tissue irritation Re-hemorrhage in traumatic shock Electrolyte imbalances Fast administration Hypotension Bronchoconstriction Bradycardia

question

Colloid Solutions

answer

Contain large molecular weight particles, cannot cross cell membranes Fluid stays in intravascular space Particles are effective osmoles and pull fluid from the interstitial space into the vascular space = expands the plasma volume Useful when crystalloid therapy has not been successful Used for expansion of the plasma volume in patients with hypovolemia NOT due to dehydration, septic shock, or hypoalbuminemia Most effective fluid type for Tx of acute hypovolemia

question

Colloid Solutions Dextrans

answer

Large molecular weight polysaccharide solutions Used in the treatment of shock Remains in the vascular space for 4 to 8 hours Dextran 70 - most commonly used dextran solution 6% solution in 0.9% saline Contraindicated in patients with coagulopathies (clotting deficits) May cause allergic reactions in some animals

question

Colloid Solutions Hetastarch

answer

Large molecular weight starch 6% solution in 0.9% saline Used to treat hypovolemia and hypoproteinemia May also reduce intravascular inflammation and reduce vascular permeability and leakage Expands the plasma volume longer (12-36 hours) and has fewer side effects than dextrans Can cause volume overload, coagulopathies, and hypersensitivity reactions Expensive

question

Natural Colloid Solutions Fresh Frozen Plasma

answer

Centrifuged from whole blood and frozen within 6 hours of collection Contains albumin, other plasma proteins, and clotting factors Used to treat rodenticide coagulopathies, patients needing Factor VII or von Willenbrand's factor, or DIC Stored up to one year with preservation of the unstable clotting factors After one year becomes stored plasma - loses clotting factors

question

Natural Colloid Solutions Albumin

answer

Albumin produces over 75% of the oncotic pressure in plasma Useful in critically ill patients needing intravascular volume expansion Especially if hypoalbuminemic, edematous, or suffering from vascular leakage of fluid Caution if using the human form of Albumin

question

Natural Colloid Solutions Whole Blood

answer

Primarily used to treat patients with anemia Contains all the coagulation factors and platelets - can be used in patients with platelet and clotting disorders Transfusion given when PCV drops below 20% or hemoglobin drops below 7g/dL Should be started slowly and monitored for signs of transfusion reaction Panting Urticaria, vomiting

question

Fluid Additives

answer

Substances added to IV fluids to enhance the therapeutic effect Correct acid-base abnormalities, electrolyte imbalances, supplement calories, provide supplemental vitamins (replace those "washed out" by fluid therapy)

question

Fluid Additives Sodium Bicarbonate

answer

Correct metabolic acidosis, hypercalcemia, hyperkalemia Measured bicarbonate level in patient and subtract from 24 mEq/L = bicarbonate deficit Amount for supplementation (mEq) bicarbonate deficit x 0.3 x weight (kg) CI: patient's with CHF, hypertension, hypocalcemia or hypokalemia, oliguria Incompatible with some products, esp. solutions with calcium (precipitates) Replacement done over several hours Available as: 8% = 1 mEq/ml 5% = 0.6 mEq/ml

question

Fluid Additives Potassium Chloride

answer

Supplement potassium deficits (hypokalemia) Normal serum K+ = 3.5 - 5.5 mEq/L Table 15-5 on page 317 for a guide to supplementation based on patient's potassium level (Scott's Sliding Scale) Diluted before administration - usually added to maintenance fluids *Rate of infusion is critical: Do not exceed 0.5 mEq/kg/hr (can cause life-threatening cardiac arrhythmias)*

question

Fluid Additives Potassium Chloride more

answer

Side effects May be life threatening - usually due to excessive rate Muscle weakness, cardiac conduction disturbances CI: hyperkalemia, renal failure, Addison's disease, acute dehydration Available as: 2 mEq/ml in 10 or 20 ml vials

question

Fluid Additives Calcium Supplements

answer

Treatment of milk fever, eclampsia, parathyroid gland disorders, downer cow syndrome, grass tetany Administered slowly to prevent cardiac complications (arrhythmias, cardiac arrest) Available as: Calcium gluconate - 10%, 23% Calcium chloride - 10% Combination products containing calcium, phosphorus, magnesium, potassium, dextrose

question

Fluid Additives 50% Dextrose

answer

Caloric supplementation Treat hypoglycemia - insulin overdose, parasites (puppies/kittens), insulinoma, fever, sepsis, liver disease Treat ketosis in ruminants Used as a stock solution to add to other fluids Available as 50% dextrose solution (500mg/ml)

question

Parenteral Vitamin/Mineral Products Water-Soluble Vitamins

answer

Vitamin B complex Thiamine (B1), riboflavin, niacin, d-panthenol, pyridoxine, cyanocobalamine (B12), biotin, choline and folic acid B vitamins are coenzymes for many metabolic reactions Added to IV fluids to restore normal levels Given parentally to stressed and debilitated animals Side effects: pain at injection site, allergic reactions Check label if giving IV to make sure formula is compatible with IV injection

question

Thiamine Hydrochloride (Vitamin B1)

answer

Treatment of thiamine deficiency in domestic animals Thiaminase in raw fish (cats) Polioencephalomalacia (ruminants) Side effects: hypersensitivity reactions and muscle soreness at intramuscular injection sites

question

Vitamin B12 (Cyanocobalamin)

answer

Used to manage Vit B12 deficiencies (anemia) Side effects: allergic reactions

question

Vitamin A

answer

Needed for eyes, skin, bone Prevention and treatment of vit A deficiencies Usually combined with Vit D or E

question

Vitamin D

answer

Prevention or treatment of vit D deficiencies (rickets, osteomalacia) Usually combined with Vit A or E

question

Vitamin E (alpha-tocopherol)

answer

Prevention and treatment of Vit E and selenium deficiency syndromes common in cows, sheep, pigs and horses

question

Vitamin K

answer

Required for the formation of vitamin K dependent clotting factors (II, VII, IX, and X) Discussed under poisoning treatments (anti-coagulant rodenticide poisonings)

question

Oral Electrolyte Preparations

answer

Often packaged as powders that can be mixed with water and given free choice or by stomach tube Used for calf scours (diarrhea in diary calves), replacement of electrolytes in performance horses (lost via sweat), dogs recovering from prolonged vomiting and diarrhea, hypokalemia in dogs and cats (chronic renal failure) Dosage forms: numerous; for potassium supplementation = Tumil-K®

question

How long should you flush the catheter

answer

6-12 hours with heparinized saline

Therapeutic, Nutritional, Fluid and Electrolyte Replacement – Flashcards

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