5 Written Questions
5 Matching Questions
- Signs and symptoms of hypernatremia include?
- Isovolemic Hypernatremia can cause Diabetes Insipidus Centrally, how?
- the Main solutes of ECFV are?
- IVNa = sodium concentration of infusate 3% is how much mEq?
- IVNa = sodium concentration of infusate 0.9% is how much mEq?
- a -Na+, glucose and urea
- b 154mEq
- c 513mEq
- d -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
- e -Head trauma
5 Multiple Choice Questions
- -Administer 0.9% NaCl at 200 - 400 ml/h until symptoms of hypovolemia improve, then lower to 100 - 150 ml/h (calculate volume deficit)
-No greater than 12 mEq/L/day increase in serum Na+
-Monitor serum Na+ q2-4h, signs of hypovolemia, volume overload
- -Diarrhea, sweating, diuretics, dehydration
-Hypovolemic: decrease in total body Na+ ↓ ECFV
-Renal response (the kidney makes concentrated urine, responsing to ADH)
-Uosm > 450 mOsm/kg (concentrated urine)
- -Fluids that contain water, dextrose, Na, Cl and other electrolytes
-0.9% NaCl (or normal saline [NS]), 0.45%NS, lactated ringer, Dextrose 5% Water (D5W)
- -there are substances in the blood that aren't being measured, there are exogenous compounds that aren't in the equation (Mannitol=hyperosmolol diuretic, sorbitol=induce diarrhea, ethanol, methanol=blindness cheap alcohol, ethylene glycol=antifreeze poisoning)
- -Absence or deficiency of ADH leading to excessive renal water loss and hypernatremia, urinate a lot = causing high [Na] hypernatremia
-TCA-antidepressants = cause SIADH commonly
5 True/False Questions
Primary or psychogenic polydipsia (drinking a lot of water= psychological condition); Intake of more water than kidneys can excrete (> 20L/day) what does this cause? → -Loop diuretic (excess Na+ and water) + D5W (to replace free water)
-Monitoring: serum sodium q2-4 hours, then q6-12 hours when serum sodium < 148 mEq/L and symptoms of hypernatremia resolves
total ECF sodium, are related to what abnormality? → -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
ratio of water to Na+, are related to what abnormality? → -Cases of abnormal ECFV size (hypervolemia vs. hypovolemia) are due to problems with the sodium control mechanism
Plasma/intravascular volume (vessels where blood is) → 1/4 ECFV
Treatment of Hypovolemic Hypernatremia is done by treating how? → -Initial: 200 - 300 ml/h of 0.9% NaCl until stable, regardless of what Na+ is (posterial hypotension).
-Water deficit = Present TBW x [(SNa / 140) - 1] (140 is the goal) O-5 - 1.0 mEq/L/hr, no > 10 mEq/L/day, because tonicity outside the cells is less and water would move inside the cells and they can swell and cause edema (make sure Na is corrected b/f correct! 1.7)