Fluid Therapy
What are some circumstances that Sodium Bicarbonate would be added to a fluid additive?
Added to fluid to correct metabolic acidosis such as D+ & acid-base imbalance, severe hyperkalemia and when K+ IS >10mEq/L
After how long should you remove an intraosseous catheter?
24-48hrs MAX, can cause potential complications such as osteomyelitis.
Dextrose
Added to treat hypoglycemia which is seen in neonates, starvation, insulin overdose, insulinoma (pancreatic tumor produces excess insulin) & pregnancy.
Potassium (K)
Added to treat hypokalemia-low potassium
When is replacement fluid therapy provided for animals?
When they are dehydrated (dehydration = total body water/ ongoing losses).
Ongoing Losses Formula
total fluid loss x 2= ____mL (Total fluids includes- V+/D+/Polyuria/Bleeding) Quantify water losses: -Normal urine loss 1-2mL/kg/hr -Pee pad absorption- 1g of wt= 1mL of fluid
Dehydration Formula
% dehydrated (decimal) X Bodyweight (kg) X 1000mL/kg=_____mL
What are the indications for fluid therapy?
-Maintaining fluid homeostasis -Replacing a fluid deficit & or ongoing losses -Correcting acid bale &/or electrolyte disorders -Anesthetized patients *** -Treating Hypovolemia (decreased blood volume) -Increasing onotic pressure (pressure in the blood excreted by proteins)
<10kg: >10kg:
-Micro drip set (available in 50&60) -Macro drip set (available in 10, 15 & 20)
What is the 1st clinical sign seen with dehydration?
-Tachy or dry MM -Panting -Delayed skin turgor -Enophthalmos (posterior displacement of the eyeball)
What are signs of fluid overload?
-Weight gain -Hypertension -Serous nasal discharge -Chemosis (pitting of the edema) -Dyspnea/tachypnea (harsh sounds/crackles) -Decreased PCV & TP from hemodilution
Hypotonic crystalloids contains?
0.45% saline (NaCI)
What is the MAX dose that can be given of Potassium?
0.5mEq/kg/hr
Colloids add _____ mL of fluid for each 1mL given.
1-1.5mL (give crystalloids to reduce negative side effect)
Patients that are in shock should be reassessed every _______ min.
10-15min
VTI fluid is good for how long?
2wks
What is the normal potassium level?
4-6Meq/L (GI and Urinary losses decrease K)
What is the daily maintenance fluid protocol range?
40-60mL/kg/24hr
Subcutaneous absorption occurs over how many hours?
6-8hrs (30-60ml/kg/day)
Animals are made up of ___ water.
60%
Dehydration ___ is undetectable in dogs and cats.
<5%
What do Hypertonic crystalloids contain?
>0.9% saline dose is very low compared to other crystalloids & should be given slowly.
Fluid pump
A machine that accurately delivers fluid over a set period of time.
BES/balanced electrolyte solution- good for
Acidemia
What animal would you give and estimated subcutaneous fluid administration to?
Dog Supplies needed: -Fluid bag -Fluid admin set (choose largest needle)
Why would you give a patient with severe acidemia saline or a balanced electrolyte solution?
Because it has alkinizing effects due to bicarbonate precursors.
Maintenance Formula
Body weight (kg) x 40-60mL/kg/24hr= ____mL 22 % specified hrs = the increments in a 24hr period ____mL % the increments = ____mL total for the specified hrs (add all 3sums together and then divide by how many hrs to get the infusion rate per hr)
Hypertonic crystalloids range for dogs & cats?
Dog: 3-6mL/kg Cat: 2-4mL/kg
>5% Dextrose should be given through a _______.
Central vein (Hypertonic & can cause phlebitis)
Isotonic crystalloid range for cats & dogs?
Dog: 80-90mL/kg Cat:40-60mL/kg
Colloids range for cats & dogs?
Dog:10-20mL/kg Cat: 5-10mL/kg
What are the indications for hypotonic crystalloids fluid administration?
Correct a free water deficit &rehydration or maintenance fluids in specific patients***(Hypernatremia, cardiac dz & burns).
Why would you choose subcutaneous fluid therapy?
Correct or prevent mild-moderate dehydration in patients that cant be hospitalized and repeat fluid therapy such as renal failure.
Isotonic crystalloids is the fluid choice for?
Daily maintenance fluids provided for hospitalized animals that can not/ will not drink enough water to maintain homeostasis. Used when dehydration has been corrected and ongoing losses are no longer occurring.
12-15% = dehydration
Death may soon follow
If you want to add 50% Dextrose to a 1000mL bag and make a 2.5% & LRS solution, how much stock solution should be added?
Desired concentration (DC%) x desired volume mL (DV) % stock concentration (SC%) of Dextrose = ____mL ex: 2.5% DC x 1000ml DV % (50%SC) = 50mL to add to fluid bag
In Isotonic crystalloids Osmolality is _____ to blood Osmolality.
Equal
How does Over-hydration, fluid overload & hypervolemia occur?
Excessive amount/rate given, patient is fluid intolerant which decreases cardiac or renal function (causes hypervolemia)
What locations are intraosseous catheters placed?
Femur, ilium & humerus
Colloids
Fluids are made of large (high molecular weight) molecules, suspended in an isotonic crystalloid. These fluids do not pass through the vascular endothelium quickly and also promote and increase in IVF. (stays in vessel for 24hrs)
what should be taken into consideration when using a gravity-fed system are?
For high fluid rates, the line can be completely open and a pressure bag is used. Beware that patient positioning can affect the flow of fluid!***
Vitamin B complex
Given to help energy metabolism in anorexic patients
What are some examples of synthetic colloids?
Hetstarch & Vetstarch
Solutions that contain __________________ suspended in crystalloid solution and when given IV remain in the intravascular space.
High molecular weight molecules
Normal saline use is?
Hypochloremia/ low chloride due to V+
>2.5% dextrose must go ____.
IV
Calculating the drip rate: per minute
Infusion rate mL/hr = ____mL/min
Large volumes/fluids given over time require __________ placement.
Intraosseous
What would be the best route for resuscitation fluids?
Intravascular in patients who are hypovolemic, severely hypotensive & decreased oncotic pressure.
What are the most commonly used type of fluids and why?
Isotonic Crystalloids. they are used for rehydration and/ or replacement for ongoing losses, daily maintenance, resuscitation (not always best choice) and to correct acid-base imbalances.
Ongoing losses tend to be?
Isotonic from V+, D+, PU, panting & bleeding
What are the three types of fluids that are considered Crystalloids?
Isotonic, hypotonic and hypertonic
Why would you would choose intravenous fluid administration?
Maintenance fluid in hospitalized patients, fluid resuscitation treating hypovolemia, maintain BP in anesthetized patients and correcting severe to moderate dehydration.
5-8% = ____ dehydration
Mild Delayed skin turgor, twist disappears quickly, MM tachy/dry & eyes dull and sunken.
8-10% = _________ dehydration
Moderate Delayed skin turgor; twist disappears slowly, mm tachy/dry, eyes dull and sunken with low tissue perfusion which causes the heart to beat faster to try perfuse the tissue, poor perfusion leads to pale mm.
What are the two types of colloids & describe them.
Natural: plasma or albumin solutions Synthetic: hydroxyethyl starch (HES) or hetstarch
What are some indications for Intraosseous fluid administration?
Neonates & patients with no venous access (ex: veins are thrombosed & severe hypovolemia, wounds/burns/fractures/edema & obesity.)
BES:
Normosal-M & plasma-Lyte 56 (Sometimes combined with dextrose)
Hypertonic crystalloids:l
Osmolality is higher than blood osmolality, provides more electrolytes than water (high amount of sodium & chloride) & promotes and increase intravascular volume.
Hypotonic crystalloids
Osmolality is less than blood osmolality & provides more h2o that electrolytes.
Solutions that contains electrolytes in water and are characterized based on their _________.
Osmolatity
What are some complications that might occur from fluid therapy?
Over-hydration/fluid overload/ hypervolemia
How would dehydration effect PCV and total protein?
PCV & TP high. The amount of water relative to the protein in whole blood gradually drops. (Fluid of choice Isotonic crystalloid)
Why should large volume of Fluid bolus should be given in different locations due to what?
Possible complication such as pressure necrosis
Why would you give a fluid intravenous?
Rapid Administration
0.9% sodium chloride OR saline
Rare to choose normal saline- only for metabolic alkalosis/ high alkalinity.
What would be some contradictions to not use Hypotonic Crystalloids?
Rehydration or maintenance fluids in any other patient & resuscitation because of the increase in intravascular fluid (increasing blood pressure & volume)
What are some indications to use Hypertonic crystalloids?
Resuscitation, traumatic brain injuries/ head trauma (decrease in intravascular pressure draws fluid from cerebral interstitium space between tissues) & can cause bradycardia.
A gravity fed system is manually adjusted using what?
Roller clamp
Burette
Safety device to prevent fluid overload in tiny patients. (place between the fluid and fluid admin set.)
Fluid bolus is typically given in the Subcutaneous tissue typically between what?
Scapulas (avoid axillary and inguinal area)
10-12% = _______ dehydration
Severe Delayed skin turgor; twist remain, MM dry possibly cyanotic, eyes dull dry, deeply sunken & decreased tissue perfusion with increased HR, pale MM, prolonged CRT and weak pulse
Fluids containing >2.5% Dextrose should never be given SC due to pain and tissue damage such as?
Skin sloughing & abscess formation
Cats are given an exact amount of SQ fluids through a ____________.
Syringe Supplies needed: -Fluid bag -Appropriate size syringe -Needle -Butterfly catheter
Finding the magic number
The final answer must be a whole number so we can actually count it. The number you get is the number of drops and the magic number is the seconds.
Syringe pump
Used to administer VERY small amounts of fluid/medications over time. (ex: mannitol)
What is an example of a natural colloid?
Whole blood, plasma & pRCBs
Calculating the drip rate: per second
___mL/min % 60sec/min = ___mL/sec
Drip rate: drops per second
___mL/sec x drip set # gtt/mL = gtt/sec
What are the units for a gravity fed system?
gtt/sec
Infusion rate: How many ___ to be infused each __ to reach the VTBI.
mL, hr VTBI % time of infusion (hrs) = mL/ hr infusion rate (ex: 1000mL % 24hr = 41.6mL/hr or 42mL)
What are the units used for a Fluid pump?
mL/hr aka infusion rate
