Fluid Therapy Quiz for Veterinary Practice

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Questions and Answers

What is the primary characteristic of crystalloids?

They are hypertonic in nature.

They contain only electrolytes.

They contain large biologic molecules.

They are water-based solutions. (correct)

Which fluid type requires consideration of osmotic pressure and hydrostatic pressure during therapy?

Colloids (correct)

Electrolyte solutions

Crystalloids (correct)

Maintenance fluids

What is the purpose of providing maintenance fluids in fluid therapy?

Only to replace fluid losses

To support ongoing physiological functions (correct)

Only to rehydrate the patient

To administer electrolytes solely

Which of the following describes synthetic colloids?

They are artificially manufactured. Signup and view all the answers

In fluid dynamics, what is meant by the term reflection coefficient?

A factor affecting the movement of fluids across capillary walls. Signup and view all the answers

What condition should hypertonic bicarbonate not be used in?

Severe hypernatremia Signup and view all the answers

What is the total shock dose for resuscitating a 20 kg dog?

1800 mL Signup and view all the answers

What indicates early decompensatory shock in a patient?

Weak pulses and rapid heart rate Signup and view all the answers

In which scenario should hydroxyethylstarch be utilized for resuscitation?

In patients experiencing decompensatory shock Signup and view all the answers

What is the recommended administration volume for hydroxyethylstarch in resuscitation?

5-15 mL/kg Signup and view all the answers

What is the primary use of hypertonic saline?

Resuscitation of hypovolemia Signup and view all the answers

Which of the following crystalloids is categorized as unbuffered?

0.9% NaCl Signup and view all the answers

What characterizes maintenance crystalloid fluids compared to replacement crystalloids?

Lower osmolarity Signup and view all the answers

What effect does alkalinizing buffered crystalloid have on the body?

Raises blood pH Signup and view all the answers

Which of the following conditions is a contraindication for using hypertonic saline?

Dehydration Signup and view all the answers

Which of the following electrolytes is NOT typically found in 5% Dextrose in Water (D5W)?

Sodium Signup and view all the answers

What is one potential side effect of using hypertonic saline?

Bradycardia Signup and view all the answers

What is the primary purpose of providing maintenance fluids using crystalloids?

Maintaining fluid and electrolyte balance Signup and view all the answers

What is the maintenance fluid rate for a 6 kg dog?

240 mL/24h Signup and view all the answers

Which fluid type is preferred for rehydration purposes in animals?

Balanced, isotonic replacement crystalloids Signup and view all the answers

What is a major characteristic of the maintenance fluid needs?

They ensure homeostasis is maintained. Signup and view all the answers

A cat with 8-10% dehydration will likely show which of the following clinical signs?

Evidence of hypovolemia Signup and view all the answers

Which group of animals has the highest maintenance fluid rate according to the table?

Birds Signup and view all the answers

Which of the following is NOT part of the fluid therapy plan?

Exploratory surgery Signup and view all the answers

What percentage of dehydration might result in the signs of hypovolemic shock?

10-12% Signup and view all the answers

What factor can influence the perception of hydration status in obese animals?

Subcutaneous fat Signup and view all the answers

What is a primary use of albumin in veterinary medicine?

Severe hypoproteinemia Signup and view all the answers

Which of the following side effects is associated with the use of human albumin?

Facial edema Signup and view all the answers

Hydroxyethylstarches (HES) are primarily classified based on what two factors?

Molecular weight and degree of substitution Signup and view all the answers

In fluid therapy, which of the following steps must be completed first?

Resuscitation Signup and view all the answers

What is a significant risk associated with the use of Hydroxyethylstarches?

Increased mortality in specific situations Signup and view all the answers

How does albumin function in relation to oncotic pressure?

It promotes increased oncotic pressure. Signup and view all the answers

What is the dose of isotonic crystalloids typically recommended for shock resuscitation in dogs?

90 mL/kg Signup and view all the answers

What is a main function of synthetic colloids like Hydroxyethylstarches?

Provide oncotic support and plasma volume expansion Signup and view all the answers

What is a common side effect of both plasma and albumin transfusions?

Fluid overload Signup and view all the answers

What classification of Hydroxyethylstarches has a molecular weight of 450 kD?

Hetastarch Signup and view all the answers

What is the fluid deficit for a 500 kg horse estimated to be 8% dehydrated?

40 Liters Signup and view all the answers

What is the appropriate rate to replace a 1.6 Liter fluid deficit over 24 hours?

67 mL/hr Signup and view all the answers

If a 5 kg cat is estimated to be less than 5% dehydrated, how many milliliters of fluid deficit does it have?

250 mL Signup and view all the answers

In case of excessive losses, which type of fluid replacement is recommended?

Replacement crystalloid Signup and view all the answers

What is the total shock dose for a 20 kg dog?

1800 mL Signup and view all the answers

How much fluid should be administered initially for resuscitation of the aforementioned dog?

450-600 mL Signup and view all the answers

What is a possible treatment option for a cat with intermittent vomiting estimated to be 5% dehydrated?

20 mL/kg subcutaneously Signup and view all the answers

What is the maximum rate at which hetastarch can be administered for non-shock use?

50 mL/kg/day Signup and view all the answers

Study Notes

Fluid Therapy

Fluid therapy is used for cardiovascular, respiratory, and hemolymphatic conditions.

Learning Goals

Students should be able to distinguish between crystalloids and colloids.
Different classifications of crystalloids.
Distinguish between synthetic and biologic colloids.
Understand the uses, indications, and side effects for fluids.
Able to describe the components of a fluid plan.
Create a fluid therapy plan for a patient.
Recognize the indications for electrolyte/dextrose supplementation and calculate dosages.

Fluid Balance

Adult body water content is 60-70%.
Neonates can have up to 90% body water content.
Body fluids are divided into intracellular fluid (ICF) and extracellular fluid (ECF).
ECF is further divided into plasma and interstitial fluid.

Fluid Dynamics

Fluid dynamics depends on osmotic pressure, oncotic pressure, hydrostatic pressure, and reflection coefficient.
A formula is provided to calculate fluid dynamics.

Fluid Therapy (Second Mention)

It includes actions like replacing losses, resuscitation, rehydration, and administering maintenance fluids
Drugs and electrolytes are incorporated into fluid plans as vehicles.

Categories of Fluids

Crystalloids, including isotonic replacement, maintenance, and hypertonic crystalloids, are categorized.
Colloids are another category, also including biologic and synthetic colloids.

Crystalloids

These are water-based solutions.
Crystalloids contain small, easily-permeable molecules.
They redistribute quickly, with less than one-third remaining in the vascular space after 30-40 minutes.

Crystalloid Characterization

Tonicity (e.g., isotonic, hypertonic, hypotonic).
Buffer content (e.g., acidifying versus alkalinizing).
Electrolyte content (e.g., balanced versus unbalanced).
Replacement versus maintenance purposes.

Tonicity

Isotonic: general use
Hypertonic: resuscitation
Hypotonic: free water replacement

Buffer content

Buffered fluids (e.g., Lactated Ringers Solution, Plasmalyte) tend to be alkalinizing
Unbuffered fluids (e.g., 0.9% NaCl) are typically acidifying.

Replacement Crystalloids

Specific electrolyte compositions (Na+, Cl−, K+, Ca2+, Mg2+) and osmolarity (Osm) are listed for various solutions (e.g., 0.9% NaCl, Lactated Ringer's, and Normosol R & P-lyte).

Maintenance Crystalloids

The Na+, Cl−, K+, Ca2+, Mg2+, and Osm values for different maintenance fluids (0.45% NaCl + 2.5% dextrose, 1/2 strength LRS + 2.5% dextrose, and Normosol M + 5% dextrose) are shown.

5% Dextrose in Water (D5W)

D5W provides free water and acts as a diluent.
The composition of D5W is provided (Na+, Cl−, K+, Ca2+, Mg2+, Osm).

Hypertonic Crystalloids

These solutions pull fluid from interstitial spaces.
Hypertonic saline is primarily used for resuscitation in cases of severe diarrhea for calves (the guide provides dosages based on age and clinical presentation).

Hypertonic Saline (Detailed)

Contraindications: dehydration, hyper- or hyponatremia.
Potential side effects: dehydration, hypernatremia, bradycardia, hypotension, bronchoconstriction

Uses for Crystalloids

Used to replace losses, resuscitate hypovolemia, for rehydration, and ongoing excess losses.

Choosing a Crystalloid

Consider serum sodium levels, acidemia/alkalemia, calcium levels, concurrent drug therapy, and liver disease.

Potential Side Effects

Fluid overload, edema, effusions, GI stasis, and dilutional coagulopathy.

Replacement vs. Maintenance Crystalloids

Key differences are pH, potassium concentration, sodium concentration, and the presence of calcium and magnesium.

Colloids

Large molecules primarily located within the plasma.
Provide oncotic pressure and are affected by the Gibbs-Donnan effect.

Available Colloids

Biologic (Plasma, Albumin, Canine, Human).
Synthetic (Hydroxyethylstarches, Gelatins).

Uses for Plasma

Provides clotting factors.
Used for hypoalbuminemia.
Used for providing immunoglobulins.
Utilized to combat failure of passive transfer.

Potential Side Effects of Plasma

Transfusion reaction.
Fluid overload.

Albumin

Provides oncotic pressure.
Acts as a drug carrier.
Carries bilirubin and free fatty acids.
Has anti-inflammatory and anti-coagulant properties.

Albumin Replacement

Species-specific albumin is available, primarily canine.
Human albumin is found in 5% and 25% concentrations.

Uses for Albumin

Used for severe hypoproteinemia.
Used in shock poorly responsive to crystalloid therapy.

Possible Side Effects of Albumin

Fluid overload, transfusion reactions, facial edema, anaphylaxis, vomiting, fever, delayed immune-mediated disease, and death.
Species-specific concerns and limited availability.

Synthetic Colloids: Hydroxyethylstarches (HES)

Polysaccharides similar to glycogen, primarily amylopectin.

HES Classification

Classified by molecular weight (high, medium, low) and degree of substitution.

Hydroxyethylstarches (HES) (Detailed)

Specific colloid types (e.g., Hetastarch, Pentastarch, Tetrastarch) with their average molecular weights, degree of substitution, and half-lives are listed.

Uses for Hydroxyethylstarch (HES)

Used for plasma volume expansion and in resuscitation (vascular leak, oncotic support, hypoproteinemia).

Potential HES Side Effects

Fluid overload, anaphylactoid reactions, pruritus, coagulopathy (platelets, vWF, VIII), dilutional coagulopathy.
Acute kidney injury, increased mortality, and cardiac by-pass issues are possible consequences.

Fluid Therapy Plan (Detailed)

The plan is divided into four sections: resuscitation, rehydration, maintenance, and ongoing losses.

Resuscitation

Should be the first part of a fluid therapy plan.
Must be completed before proceeding with other parts.
Common fluids used in resuscitation: isotonic replacement crystalloids, hypertonic saline, colloids, RBCs.

Fluids for Resuscitation

Replacement fluids only
Hypertonic saline (typically 7.2%).
Colloids (such as hydroxyethylstarches).
Plasma/albumin (sometimes).
RBCs (severe anemia cases)

Fluids for Shock Therapy

Isotonic crystalloids, hypertonic saline, and hydroxyethylstarches for shock treatment.
Specific dosage guidelines are presented by species (cat/camellid, dog/ruminants/horses, birds, reptiles).

Isotonic Replacement Crystalloids in Resuscitation

Administration of 1/4 to 1/3 of the total shock dose.
Fluid administration should occur over 10-30 minutes depending on species.
Considerations for redistribution should be made during administration.

Hypertonic Saline for Resuscitation

3-5 mL/kg, potentially repeated as necessary
Sodium levels should be checked if giving additional fluid.
Not indicated for severe dehydration or in patients with hypernatremia/hyponatremia.

Hypertonic Bicarbonate in Calves

Treatments for diarrheic calves categorized by clinical assessment and base deficit are demonstrated.

Hydroxyethylstarch in Resuscitation

Used in hypoproteinemic shock and when crystalloids are insufficient, usually given in boluses.
Dosage varies by species (cat, camellid, dog, horses, ruminants).

Treatment (detailed overview)

Fluid therapy is separated into the four stages of treatment; resuscitation, maintenance, rehydration, and ongoing losses.

What clinical stage of shock? and What category of shock?

These questions refer to clinical situations and should be carefully interpreted based on the presented symptoms.

Treatment (Example case discussion)

An example of a case study (Lucky the dog) is presented and further discussion of the treatment plan.
The amount of fluid to be administered is calculated based on the animal's body weight.
Types of fluids considered, and administration method is discussed.

Maintenance fluid needs

Fluids to maintain homeostasis in an animal.
Includes normal losses and cases with low serum sodium.
Maintenance fluid rates for various animals (e.g., cats/camellids/exotics, dogs/ruminants, horses/mammals, birds, reptiles).

Rehydration/Replacement

Replacing fluid losses, frequently from vomiting, diarrhea, or urinary issues.
Fluid administration (e.g., 1-2 days) is determined by the animal's body weight and degree of dehydration.
Examples provided (for a 16kg dog and 500kg horse).
An example of an outpatient scenario with vomiting is presented.

Dehydration (detailed overview)

Clinically, dehydration can be assessed, with different levels of dehydration corresponding to specific clinical signs.
The given example is of species-specific dehydration in dogs, cats, and small mammals.

Ongoing Losses

Includes excessive fluid loss from vomiting, diarrhea, urination, and/or third spacing.
Measurement and estimation of losses to adjust fluid therapy accordingly.
The use of replacement crystalloids, given the characteristics of ongoing losses.
Examples for calculating ongoing losses.

Examples (Further Overview and calculation)

Calculation examples are provided demonstrating how to calculate the fluids based on the degree of dehydration.
The presentation provides examples for a cat, dog, and horse.

Routes of Fluid Administration

Enteral (voluntary, tube, gavage, per rectum).
Subcutaneous, intraperitoneal/intracoelomic, intravenous, and intraosseous.

Fluid Supplementation

Types of fluid supplementation for various situations.
The mentioned supplements include potassium, dextrose, and bicarbonate.

3 years, 6 kg Cat

Case study indicating a jaw fracture, indicating the use of maintenance fluids and calculating required quantities.