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5 Written Questions

5 Matching Questions

  1. ratio of water to Na+, are related to what abnormality?
  2. what is normal solute concentration?
  3. Signs and Symptoms of hyponatremia?
  4. Central diabetes insipidus (causes high Na+) can be defined as?
  5. what is the treatment goal when Hypovolemic Hypotonic Hyponatremia is being treated?
  1. a - (275 - 290 mOsm/kg)
  2. 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
  3. 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
  4. d -seizures, coma, permanent brain damage, respiratory arrest, brain herniation, death (severe <115)
  5. e -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms

5 Multiple Choice Questions

  1. 3/4 ECFV
  2. -clinical assessment
  3. 15%
  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. -Weakness, lethargy, restlessness, irritability, confusion
    -More severe or rapidly developing: twitching, seizures, coma, death

5 True/False Questions

  1. 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)


  2. 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


  3. 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)


  4. 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


  5. 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)


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