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5 Written questions

5 Matching questions

  1. the Main solutes of ECFV are?
  2. what is the treatment goal when Hypovolemic Hypotonic Hyponatremia is being treated?
  3. Hypervolemic Hypernatremia is caused by what?
  4. Treatment of Diabetes Insipidus central is done by giving what?
  5. how is Non-Emergent Euvolemic Hypotonic Hyponatremia treated in patients with SIADH?
  1. a -1.) Water restriction (< 1 to 1.2 L/day = from food and drinks)
    -NaCl tablets (1g tabs up to 9g/day)= increase Na load to kidney and forces the kidney to excrete Na and water
    -Demeclocycline 300 mg 2 - 4 times/day; antibiotic that antagonizes the Vasopressin receptors, allowing patients to increase peeing!
  2. b -Na+, glucose and urea
  3. c -Na+ gain > Water gain
    -Iatrogenic = if give the patient a Na+ overload, its medically induced over infusion
    -Hyperaldosteronism = conserves Na+ = conns syndrome
  4. d -avoid increase in serum Na+ > 12 mEq/L in 24 hrs, because patient already has low tonicity, water will start to move outside the cells and cells will shrink, major effect is in the brain:
    -Osmotic demyelination syndrome= altered mental status, seizures, permanent brain damage
  5. e -Desmopressin (vasopressin analog)
    -Intranasal formulation preferred (DDAVP) 5 - 20 mcg intranasally q12-24h
    -Goal: 1.5 - 2 L/day urine volume = normal urine output

5 Multiple choice questions

  1. -seizures, coma, permanent brain damage, respiratory arrest, brain herniation, death (severe <115)
  2. -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)
  3. 2/3 TBW
  4. -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
  5. -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

5 True/False questions

  1. tonicity can be defined as?-more solutes inside cells and less outside-more water outside and cell lysis-cerebral edema

          

  2. when treating Hypovolemic Hypotonic Hyponatremia with Diuretics, what has to be considered?-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

          

  3. if have Postural hypotension and have low BP the priority is to become hemodynamically stable, then address what?-volume
    -0.9% NaCl until hemodynamically stable
    -D5W or 0.45% NaCl, will effect IV-volume slower= give ½ normal saline is if it is due to hyperglycemia because it will only raise the sugar level-

          

  4. what are the two Vasopressin Antagonists (last line) used to TX?-Indicated for hypervolemic or euvolemic hyponatremia
    -Conivaptan (Vaprisol®): Non-selective V1A and V2 receptor antagonist; IV only
    -Tolvaptan (Samsca®): Selective V2 receptor antagonist; oral only also approved in patients with SIADH (but not first line option)

          

  5. how is Determining volume status done?-clinical assessment

          

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