5 Written Questions
5 Matching Questions
- ratio of water to Na+, are related to what abnormality?
- what is normal solute concentration?
- Signs and Symptoms of hyponatremia?
- Central diabetes insipidus (causes high Na+) can be defined as?
- what is the treatment goal when Hypovolemic Hypotonic Hyponatremia is being treated?
- a - (275 - 290 mOsm/kg)
- b -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
- c -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
- d -seizures, coma, permanent brain damage, respiratory arrest, brain herniation, death (severe <115)
- e -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
5 Multiple Choice Questions
- 3/4 ECFV
- -clinical assessment
- -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
- -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
5 True/False Questions
Hypovolemic Hypotonic Hyponatremia is caused by what? → -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)
Treatment of Diabetes Insipidus, Nephrogenic DI is done by giving what? → -Desmopressin (vasopressin analog)
-Intranasal formulation preferred (DDAVP) 5 - 20 mcg intranasally q12-24h
-Goal: 1.5 - 2 L/day urine volume = normal urine output
how is Na+ levels Monitor for Treatment of Hypovolemic Hypernatremia? → -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
Treatment of Hypovolemic Hypernatremia is done by treating how? → -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
when treating Hypovolemic Hypotonic Hyponatremia with Diuretics, what has to be considered? → -Loop diuretics: proportional loss of Na+ and water (don't become hyponatremic!)
-Thiazides: more Na+ loss than water (high chance of having a low serum Na)