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Fluid Therapy, IV Caths
JJC Vet Tech 111
194
Veterinary Medicine
Undergraduate 1
01/27/2014

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Term
Fluids make up __% lean body weight?
Definition
60%
Term
TBW
Definition
total body water
Term
What are the three major fluid components of TBW?
Definition
2/3 = ICF (intracellular fluid)
Interstitial
Intravascular
Term
Composition of ECF?
Definition
75% Interstitial
25% Intravascular (plasma)
Term
ICF
Definition
intracellular fluid
Term
ECF
Definition
extracellular fluid
Term
Normal fluid losses for a dog or cat?
Definition
40-60mL/kg/day
20mL of which is through urine
Term
1 kg loss in body weight is equivalent to (what amount?) loss in body fluid?
Definition
1 L
Term
PCV
Definition
packed cell volume
Term
Examples of abnormal fluid losses?
Definition
-Dz with PU (diabetes)
-V/D
-increased respiration
-chronic/acute injury (ulcers/HBC)
-Reduced fluid intake
Term
Indicators of Hydration Status?
Definition
-skin turgor
-MM
-HR
-PCV
-weight
Term
<5% dehydration
Definition
Hx fluid loss, but no findings on PE
Term
5-6% dehydration
Definition
tacky MM, mild skin turgor
Term
6-8% dehydration
Definition
-dry MM
-moderate loss of skin elasticity
-slightly prolonged CRT
-slightly sunken eyes
-normal HR
Term
10-12% dehydration
Definition
-extreme loss of skin elasticity
-dry MM
-sunken eyes
-tachycardia
Term
>12% dehydration
Definition
-significant signs of shock
-death imminent
Term
1% increase in PCV = how much fluid loss?
Definition
10mL/kg
Term
Normal PCV for dogs? cats?
Definition
dogs- 45%
cats- 35%
Term
A PCV of .55 in a dog indicates a loss of __ fluids.
Definition
10mL/kg
Term
Replace dehydration losses (slowly/rapidly).
Definition
slowly
Term
Replace hypovolemic losses (slowly/rapidly).
Definition
rapidly, but monitor heart
Term
Contraindications for fluid therapy?
Definition
-risk of or pre-existing pulmonary edema
-pulmonary contusions
-brain injury
-congestive heart failure
Term
Signs of overhydration:
Definition
-serous ocular/nasal discharge
-restlessness
-shivering
-tachycardia
-respiratory distress
-crackles/rales
Term
Crystalloid example/s?
Definition
Normosol-R, "normal saline," 0.9% NaCl, LRS
Term
LRS
Definition
lactated ringer's solution
Term
Colloid example/s?
Definition
Hetastarch
Term
Tonicity of sub-Q fluids?
Definition
isotonic ONLY
Term
Routes of fluid admin:
Definition
-PO
-Sub-Q
-IV
-IP
-IO
Term
___ fluids should be used in hypovolemic patients.
Definition
colloid
Term
___ fluids should be used in dehydrated patients.
Definition
crystalloid
Term
How can you help sub-Q fluids absorb faster?
Definition
-warm up fluids
-gently massage area after administering
Term
What sort of animals might get IP fluids?
Definition
-neonates
-exotics
Term
What sort of animals might get IO fluids?
Definition
-birds
-neonates
Term
How much sub-Q fluid can we at JJC administer without a doctor's order?
Definition
50cc
Term
Max amount of sub-Q fluids per site for dog? cat?
Definition
dog: 150cc
cat: 100cc
Term
Routes for IV fluid administration:
Definition
-central (jugular, femoral to caudal vena cava)
-peripheral
-IO
Term
3 phases of fluid therapy?
Definition
-emergency phase
-replacement phase
-maintenance phase
Term
Purpose for emergency fluid therapy?
Definition
Treat shock and/or hypovolemia
Term
Amount of emergency fluids for dog? cat?
Definition
dog: 90mL/kg/hr
cat: 60mL/kg/hr
Term
What can one do to facilitate giving the proper amount of emergency fluids to a large dog?
Definition
use 2 caths at once
Term
3 components of replacement phase?
Definition
1. replace deficits
2. maintenance (normal losses)
3. replace continuing abnormal losses (V/D)
Term
Fluid deficit should be replaced over what time period?
Definition
24 hours
Term
Formula for fluid deficit replacement:
Definition
(% dehydration)(BW kg)(10)= fluid deficit mL
Term
sensible losses
Definition
losses that can be measured (eg urine)
Term
insensible losses
Definition
losses that cannot or are hard to be measured (eg panting, sweating)
Term
Formula for maintenance fluid replacement? Alternate formula?
Definition
40-60mL/kg/day (we use 50mL/kg/day)
1mL/#/hr
Term
How to estimate for ongoing abnormal losses?
Definition
estimate volume of V/D, double it

**Jan never does this
Term
Ongoing fluid losses from GIT must be replaced as they occur. If a puppy vomits 50mL, it must receive ___mL in the next __hr period.
Definition
100mL, 8hr
Term
Estimate % dehydration:
HR= 190 Bpm
RR= 100 bpm
MM= pale, tacky
moderately decreased skin turgor
Definition
10-12% because HR/RR increased
Term
Estimate % dehydration:
HR= 100 Bpm (dog) or 170 Bpm (cat)
RR= 25 bpm
MM= tacky
mild decreased skin turgor
Definition
5-6% because MM tacky, not dry
Term
Estimate % dehydration:
HR= 100 Bpm (dog) or 170 Bpm (cat)
RR= 25 bpm
MM= dry
moderately decreased skin turgor
slightly prolonged CRT
slightly sunken eyes
Definition
6-8% because MM dry, but HR still normal
Term
Estimate % dehydration:
HR= 100 Bpm (dog) or 170 Bpm (cat)
RR= 25 bpm
MM= pink, moist
Owner says pet has not been drinking.
Definition
<5% because no PE findings, but Hx of fluid loss
Term
Definition and symptoms of phlebitis?
Definition
-local venous inflammation
-inflammation, thickening, pitting edema, discomfort at site
Term
Signs of septicemia and bacterial endocarditis?
Definition
cardiac arrhythmias/murmurs, injected (red) MM, fever, leukocytosis
Term
Definition and signs of thrombosis?
Definition
-clotting/coagulation
-vein stands up on its own, ropelike vein, cold/painful limb
Term
If thrombosis is suspected, what should you do to assess perfusion?
Definition
use Doppler to assess perfusion; also blue toe pads indicate poor perfusion
Term
4 conditions in which a catheter should always be changed:
Definition
-signs of irritation
-unexplained fever
-bandage is wet or soiled
-tubing kinked or has clots
Term
A multilumen central catheter allows one to perform several functions simultaneously. Describe these functions.
Definition
-nutritional support
-meds/fluids
-CVP monitoring or blood samples
Term
If not using CRI, how often should you flush a central catheter?
Definition
at least 4 times a day with hep saline
Term
Diffusion vs Osmosis?
Definition
Diffusion: flow of particles through a semi-permeable membrane from an area of high solute concentration to low solute concentration

Osmosis: flow of water through a semi-permeable membrane from an area of low solute concentration to an area of high solute concentration
Term
Electrolytes are measured in the (ICF, ECF)?
Definition
ECF (serum)
Term
Major ECF electrolytes? Most abundant?
Definition
Major: Na, Cl, bicarbonate (CHO3)
Most Abundant: Na
Term
The distribution of water throughout the body is most affected by the electrolyte ___.
Definition
Na
Term
___ is the primary factor is determining ECF __ and osmotic ___.
Definition
Na, ECF volume, osmotic pressure
Term
Symptoms of hyponatremia:
Definition
-muscle weakness
-lethargy
-mental depression
-nausea
-inappetance
-hypotension
Term
Symptoms of hypernatremia:
Definition
-excessive thirst
-muscle weakness
-disorientation
-seizures
-coma
Term
Major ICF electrolytes:
Definition
K, Mg, phosphate (PO4^3-)
Term
Dominant electrolyte responsible for osmotic pressure in ICF?
Definition
K
Term
Which electrolyte is associated with nervous and cardiac functions?
Definition
K
Term
Symptoms of hypokalemia?
Definition
-muscle weakness, PU/PD, may affect insulin release
Term
What can cause hypokalemia?
Definition
-anorexia
-excessive loss (V/D)
-alkalosis (movement from ECF->ICF)
Term
Increased pH is called...
Definition
alkalosis
Term
Symptoms of hyperkalemia?
Definition
-class ECG changes (tall, tented T-wave)
-bradycardia
-weak myocardial contractility
Term
Decreased pH is called...
Definition
acidosis
Term
What can causes hyperkalemia?
Definition
-impaired renal excretion (K retained)
-urethral obstruction
-Addison's
-excessive K in fluid therapy
Term
Blood should be slightly ___ with a pH within the range of __ to __.
Definition
alkaline, 7.2-7.6
Term
Acid-base balance is maintained by (3 things):
Definition
-blood buffers
-lungs
-kidneys
Term
On the pH scale, 14 is most ___ and 0 is most ___.
Definition
14 = most alkaline/basic
0 = most acidic
Term
Lots of H+ indicates a ___ and a (low/high) pH.
Definition
H+ indicates an acid with a low pH
Term
Lots of OH- indicates a ___ and a (low/high) pH.
Definition
OH- indicates an alkaloid/base with a high pH.
Term
What does a CRT <1 sec indicate?
Definition
tachycardia from hypovolemia
Term
What does a CRT >2 sec indicate?
Definition
poor perfusion, shock
Term
Obese animals may appear (more/less) hydrated than they actually are.
Definition
obese animals appear more hydrated than they are
Term
With normal skin turgor, tented skin returns to its original shape within __ to __ sec.
Definition
2-3 sec
Term
Normal urine output?
Definition
1-2mL/kg/hr
Term
decreased HCT/TPP indicate:
Definition
acute/chronic bleeding, hemodilution
Term
decreased TPP indicates:
Definition
hypoproteinemia
Term
increased HCT/TPP indicate:
Definition
dehydration
Term
increased SG of urine may indicate:
Definition
decreased water intake
Term
With isotonic crystalloid fluids, (amount) is lost from IV after (time).
Definition
2/3 lost from vessels after 30min
Term
How is fluid therapy affected when a crystalloid is combined with a colloid?
Definition
less fluid volume needed
Term
Na/K composition of replacement fluids? maintenance fluids?
Definition
replacement: composition similar to plasma, with high Na, low K

maintenance: composition differs from plasma, low Na, high K
Term
Difference between Normosol-R and Normosol-M?
Definition
Normosol-R(eplacement) - high Na, low K

Normosol-M(aintenance) - low Na, high K
Term
Most commonly used type of crystalloid fluid? (hint: type, not brand)
Definition
balanced replacement fluids
Term
Hypotensive shock should be treated with what tonicity of fluids?
Definition
hypertonic, to draw fluids into vascular system and increase volume/pressure
Term
Colloids consist of ___ starches.
Definition
hydroxyethyl
Term
Some brand name colloids?
Definition
Hetastarch, Tetrastarch
Term
Conditions treated with colloid fluids?
Definition
blood loss, hypoproteinemia
Term
According to Sirois text, what is the rule of thumb for using colloid fluids?
Definition
combine with crystalloid
Term
Possible complications of colloid fluid therapy? Why may these occur?
Definition
-bleeding tendencies
-aggravate coagulopathies

May occur because colloids decrease function of platelets which are needed for clotting.
Term
What can you give a patient receiving colloid fluid therapy to counteract possible complications?
Definition
plasma and other blood products to increase platelet function
Term
Patients with ___ should receive fluids rapidly.
Definition
hypovolemia
Term
Patients with ___ should receive fluids slowly.
Definition
dehydration
Term
Define "shock."
Definition
systemic blood pressure is inadequate to deliver sufficient oxygen and nutrients throughout the body
Term
When adding something to a fluid bag, always label the bag with 6 things:
Definition
-additive
-concentration
-amount
-your initials
-date
-time
Term
Oral fluid therapy is okay for what sort of patient?
Definition
mildly dehydrated, just needs maintenance fluids
Term
Negative aspects of sub-Q fluids?
Definition
-not absorbed well by severely dehydrated patients
-can cause hypothermia
-smaller volumes
Term
Which route of fluid delivery has the most rapid effect on blood volume?
Definition
IV
Term
Hypertonic solutions must be administered in...
Definition
a central vein, because blood will dilute the solution and minimize hemolytic effects
Term
What type of fluids can be administered IP?
Definition
isotonic crystalloids only
Term
Which bones are commonly used for IO fluid therapy?
Definition
femur, humerus, wing of ilium
Term
What type of fluids can be administered IO?
Definition
all solutions are fine
Term
How often should an IO cath be replaced?
Definition
every 72 hours
Term
Dysuria
Definition
difficult urination
Term
Stranguria
Definition
Straining to urinate
Term
Pollakiuria
Definition
scanty, frequent urination
Term
Anuria
Definition
no urination
Term
Azotemia =
Definition
increased BUN
AND
increased CREA
Term
BUN
Definition
Blood Urea Nitrogen
Term
CREA
Definition
creatinine
Term
By the time azotemia occurs, what percent of kidney function is lost?
Definition
75%
Term
What 2 things do you evaluate to assess renal function?
Definition
-Blood sample
-Urine
Term
What are 2 congenital bladder diseases?
Definition
-Persistent Urachal Diverticulum
-Persistent Patent Urachus
Term
CS of Persistent Urachal Diverticulum?
Definition
recurrent UTIS <12mo
Term
CS of Persistent Patent Urachus?
Definition
-frequent urination
-hematuria, pollikiuria, and stranguria if there's a UTI
-urine leaking from belly button
-common in <12mo with recurrent bladder infections
Term
How to Dx bladder diseases?
Definition
UA, pneumocystogram
Term
How to Tx bladder diseases?
Definition
Abx or Sx
Term
Cystitis
Definition
inflammation of the urinary bladder
Term
Causes of cystitis?
Definition
-bacteria
-yeast
-predisposing factors like uroliths, obstructions, repro tract infection, catheterization, glucosuria
Term
Glucosuria
Definition
excretion of glucose into the urine; may occur in diabetic pets
Term
What condition can occur in diabetic patients that would make them more likely to get a UTI?
Definition
glucosuria
Term
What is the most common cause of cystitis?
Definition
ascending route through the urethra
Term
CS of cystitis?
Definition
-pollakiuria
-stranguria/dysuria
-hematuria
-foul-smelling urine
-cloudy urine
-painful bladder
-more frequent licking of urethra
Term
How to Dx cystitis?
Definition
-UA
-Urine culture
-Pneumocystogram
-US - "snow globe"
-Cystoscope
-Bx of bladder
Term
Bx means __.
Definition
biopsy
Term
Abx means ___.
Definition
antibiotics
Term
What is the "snow globe" effect when ultrasounding the bladder?
Definition
Bounce transducer on bladder; crystals or other sediment will become suspended like "snow"
Term
How to collect urine for urine culture?
Definition
Cystocentesis only!!
Term
How to Tx cystitis?
Definition
-remove predisposing factors if possible
-Abx: 2wks, may need 4-6wks; do a FU 1-3d after finishing meds
Term
3 most common types of uroliths:
Definition
-struvite (magnesium phosphate)
-urate
-calcium oxylate
Term
Most common type of urolith in cats and dogs?
Definition
struvite (magnesium phosphate)
Term
What type of urolith can result from UTIs?
Definition
struvite (magnesium phosphate)
Term
What type of urolith is associated with alkaline urine?
Definition
struvite (magnesium phosphate)
Term
Some ___ uroliths are idiopathic.
Definition
struvite (magnesium phosphate)
Term
What type of urolith has a radiographic density of 2+ to 4+?
Definition
struvite (magnesium phosphate)
Term
How to Tx struvite (magnesium phosphate) uroliths?
Definition
-s/d to lower pH, then c/d
-Abx if there's infection
-Sx
Term
Common brand name product to acidify pet's urine?
Definition
Methigel
Term
s/d diet
Definition
for struvite uroliths - reduces pH
Term
c/d diet
Definition
give after Tx for bladder problem EXCEPT urate uroliths
Term
u/d
Definition
for urate uroliths - dissolves stones
Term
Urate uroliths are common in ___.
Definition
dalmations
Term
What type of urolith is associated with acidic urine?
Definition
urate
Term
What type of urolith has a radiographic density of 0 to 2+?
Definition
urate
Term
How to Tx urate uroliths?
Definition
-u/d diet (dissolves stones)
-allopurinol sid/tid
-Abx
-Sx (quicker relief)
Term
allopurinol
Definition
-inhibits secretion of uric acid into the urine
-dissolves urate stones
Term
What type of urolith has a variable urine pH?
Definition
calcium oxylate
Term
What type of urolith has a radiographic density of 4+?
Definition
calcium oxylate
Term
What type of urolith may be caused by a too acidic diet?
Definition
calcium oxylate
Term
What type of urolith is common in Schnauzers?
Definition
calcium oxylate
Term
What type of urolith can only be treated with Sx?
Definition
calcium oxylate
Term
All uroliths removed from a patient must be sent in for ___ ___.
Definition
quantitative analysis - find out what type it is
Term
FLUTD
Definition
Feline Lower Urinary Tract Disease
Term
FLUTD includes what Dzs?
Definition
-cystitis
-urethritis
-obstructions
Term
CS of FLUTD?
Definition
-pollakiuria, stranguria, hematuria, or inability to urinate
-urinate outside of box
-licking of genital area
-if obstructed: loss of appetite, V/D, weakness, severe electrolyte imbalance
Term
CS of uremia, and what it leads to?
Definition
-loss of appetite, V/D, weakness, severe electrolyte imbalance

-leads to acidosis, hyperventilation, cardiac abnormalities, shock, collapse and death in 3-5 days
Term
How to Dx an obstructed cat with FLUTD?
Definition
-painful bladder
-hard, inflamed penis (purple, bright red)
-signs of uremia
-inability to express bladder
Term
How to Dx a non-obstructed cat with FLUTD?
Definition
-painful bladder
-bladder is usually empty
Term
Other than palpation, how to Dx FLUTD?
Definition
-rads (eg stones but no blockage)
-Labs:
--CBC
--Chem (^BUN,^CREA), electrolytes
--UA
--culture
Term
An obstructed cat needs (less/more) sedation?
Definition
LESS! can't excrete drugs properly
Term
Tx for obstructed cat?
Definition
-sedate if needed
-catheterize, hydropropulsion
-monitor BUN/CREA/electrolytes
-cath stays in for 24-48hrs
-IV fluids
Term
Tx for non-obstructed cat?
Definition
-treat primary cause if known
-acidifying diets
-anti-inflammatories for persistent hematuria
Term
IV fluids are given to an obstructed cat for 3 purposes:
Definition
-correct fluid deficit -correct electrolyte abnormalities -diuresis
Term
Important things to tell a client whose cat has FLUTD:
Definition
-prophylactic measure to prevent recurrence
-Rx diet to keep pH 6.0
-encourage water intake
-monitor for recurrence
Term
ARF
Definition
Acute Renal Failure
Term
CRF
Definition
Chronic Renal Failure
Term
Causes of ARF?
Definition
-infection
-chemical (poison, grapes, etc)
-shock
-trauma
-obstruction
Term
CS of ARF?
Definition
-depression
-anorexia
-vomiting
-melena
-anuria or oliguria
Term
oliguria
Definition
scanty urine
Term
Dx for ARF:
Definition
-Hx of exposure
-signs of uremia
-oliguria/anuria
-dorsal lumbar pain
-^BUN,^CREA
-absence of Hx of CRF
-Bx kidneys
Term
Tx for ARF?
Definition
-Tx cause if known
-relieve obstruction if present
-urinary cath places, monitor output
-IV fluids (taper off)
Term
What to monitor in a pt with ARF?
Definition
-urine quantity/color/clarity
-PCV/TPP (hydration)
-electrolytes
Term
Prognosis of ARF depends on:
Definition
-etiology
-severity
-intensity of therapy
Term
Definition of CRF (not abbreviation):
Definition
inability of kidney to perform normal function due to result of gradual, progressive loss of renal function over long period of time
Term
Causes of CRF (11)?
Definition
-congenital
-infection
-parasites (Capillaria)
-immune-mediate (FIV)
-amyloid (Shar Peis)
-neoplasia
-toxins
-vascular Dz (FIP)
-infarction
-idiopathic
-diabetes
Term
How does amyloid protein affect kidneys?
Definition
it attacks kidney tissues and can lead to CRF
Term
What dog has problems with amyloid protein?
Definition
Shar Peis
Term
CS of CRF:
Definition
-PU/PD
-lethargy
-anorexia
-vomiting
-hypertension, arrythmias, tachypnea, hypothermia
Term
How to Dx CRF?
Definition
-PU/PD
-signs of uremia
-^BUN,^CREA
-isothenuria
-anemia
-small kidneys
Term
Isosthenuria
Definition
Urine SG = Blood SG

(normally urine SG is higher because the kidneys are excreting wastes!)
Term
Tx for CRF?
Definition
- general measures: avoid stress, fresh drinking water, vitamins in water
-dietary changes (low protein, low Na)
-Tx hyperphosphatemia (Amphogel, Azodyl)
-Tx anemia if needed (steroids, erythropoietin, blood transfusion)
-Tx vomiting w/Tagamet/Pepcid
-Tx uremia w/fluids
Term
What are Amphogel and Azodyl?
Definition
-drugs that treat hyperphosphatemia associated with CRF
-take at least SID for life
Term
How to Tx anemia in pt with CRF?
Definition
-no Tx if HCT >30 in dogs, >25 in cats
-steroids (Winstrol)
-erythropoietin (Epakatin, Epogen)
-blood transfusion
Term
Why might a blood transfusion be given to a pt with CRF?
Definition
Tx anemia
Term
Important consideration if giving a blood transfusion to a cat?
Definition
Must match blood types with cats!! Not as important in dogs.
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