Basics
What force drives water between intracellular and interstitial layers? Interstitial and Vascular (plasma)?
Osmotic force
Starling's force
When would you supplement/add potassium in fluids?
Patient has not been eating
Which is the most common acid-base disorder?
Metabolic acidosis
What is the maintenance rate of fluids for Dogs, Cats, and LA?
What is the Bolus dosage for Dogs, Cats, and LA?
M:
Dogs/LA: 50ml/kg/day
Cats: 40ml/kg/day
B:
Dogs: 15-20 ml/kg
Cats: 5-10 ml/kg
LA: 80-90 ml/kg * 0.25
Golden Rule for anything on fluids??
ALWAYS monitor your pt
What are the goals of fluid therapy?
1) Replenish volume
2) Replenish normal intake
3) Replenish excessive ongoing loss
4)Replenish hydration if dehydrated
How do you calculate the max amount of potassium a patient can receive? Why is this so important?
Kmax = 0.5 mEq/kg/hr
K is tightly regulated within 4-5.5 mEq/L; high potassium can lead to bradycardia, bradycardic arrythmias and potentially cardiac arrest
Mixed Acid-Base disorders can happen; in what situation would an animal develop both metabolic acidosis and metabolic alkalosis?
kidney failure (acidosis) and severe vomiting (alkalosis)
Cardiogenic shock
- pump the heart to death, heart can not handle fluids due to a broken pump
How to convert ml/hr to drops/min?
= (drops/ml * ml/hr)/ 60 (min)
Name the different types of fluids. What is usually our first line in emergent cases?
Crystalloids: Hypertonic, Isotonic, Hypotonic
Colloids: Synthetic, Natural blood products
When we need to add potassium to fluids, what do we use? How much potassium is in the solution?
Potassium Chloride (KCl)
2 mEq K+/ml
What is the golden rule regarding sodium bicarbonate?
Not too much, too fast
When treating Shock with a hypertonic solution, what is the dose?
Colloid dose?
2-4 ml/kg IV -> have to replenish/restore, "pay it back"
5-10 ml/kg IV over 15 minutes
Difference between macro drip set vs a micro drip set?
Macro: 20 drops/ml
Micro: 60 drops/ml
Name some parameters of Hydration vs Perfusion.
Dehydration: MM-tacky, skin tugor, Sunken Eyes, urine conc., deameanor/mentation, PCV/TS, sodium
Hypovolemia: Pale MM, CRT refill prolonged, increased HR (unless its cats), decreased BP & pulse quality, cold extremities, mentation, and urine output
What is the golden rule regarding Sodium?
The rate of change of patient Na must be no faster than 0.5 mEq/L/hr
In sodium bicarbonate, what is the mEq of both Na and HCO3 in the solution?
156 mEq/L HCO3 and 156 mEq/L Na
How do you calculate deficit in animals?
Fluid deficit (L) = kg * % dehydration
(convert % to dec)
Betsy the Cow, 1700lbs, is hypovolemic
What is her total shock dose using 80ml/kg? Bolus?
1700lbs/2.2 = 772.7 kgs
772.7 * 80 ml/kg = 61.8 L = total shock dose
61.8L * 0.25 = 15.5 L bolus
Ember, 25kg is 5% dehydrated. What hourly fluid rate would Ember need to receive to replenish her normal values?
M: 25kg * 50ml/kg/day = 1250 ml
D: 25kg * 0.05 = 1.25 L
O: no ongoing losses
1.25 L + 1.25L + 0 = 2.5 L/day
~104ml/hr
Math: Cocoa Tea
40kg, receiving M+D+O fluids at 2 L/hr
Kmax =?
If Cocoa Tea needed 20 mEq KCL/L and has LRS (4 K+ mEq/L). How many ml of KCL needs to be added per 500ml of fluids?
Kmax= 40kg * 0.5mEq/kg/hr
Kmax=20 mEq/hr
20-4=16mEq of K+ needed
KCl has 2mEq of K+ -> 16/2 =8ml per L
4ml per 500ml
7 day old, 40kg calf with scours in sternal recumbancy.
Based on the chart, the bicarbonate requirement is 175 mEq. How many liters of isotonic Bicarb is needed?
175 mEq/156mEq/L = 1.12 L of Sodium bicarb
3 yo MN DSH, 3kg
10% dehydrated & hypovolemic
What amount/rate (use 5ml/kg) should we give this bolus?
15 ml over 15 minutes then reassess
You have 1 L bag of saline and a 500ml bottle of 50% dextrose solution.
Using this, how would you make a 5% dextrose solution?
50% dextrose = 50g/100ml -> what we have
5% dextrose = 5g/100ml =50g/1000ml -> what we need
(.50)(x)=(.05)(1000), x=100ml