5 Written questions
5 Matching questions
- the Main solutes of ECFV are?
- how is Determining volume status done?
- ratio of water to Na+, are related to what abnormality?
- tonicity can be defined as?
- if have Postural hypotension and have low BP the priority is to become hemodynamically stable, then address what?
- a -Na+, glucose and urea
- b -Ability of combined effect of all solutes to generate osmotic driving force that causes H2O movement from one compartment to another (if osmolality is high in EC-compartment, compared to what's inside cells, will be hypertonic)
- c -clinical assessment
- d -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
- e -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-
5 Multiple choice questions
- -Water loss > Na+ loss
-Insensible water loss in patients deprived of water, fever, mechanical ventilation, Diarrhea, vomiting,
-Osmotic diuresis = have high serum glucose pulls water with it
- -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)
- 1/3 TBW
- -SIADH (UOsm > 100 mOsm/kg) = [ADH] is high, and hang on to water and this dilutes Na+
-Diseases: Tumors, CNS disorders, pulmonary disease
Medications: desmopressin = vasopressin analog, carbamazepine, cyclophosphamide, SSRI's, TCA's, NSAIDs, "ecstasy"
5 True/False questions
Plasma/intravascular volume (vessels where blood is) → 1/4 ECFV
if the Osmolal gap (OSM GAP) = OSM(measured) - OSM (calculated), is greater than 10 what does this indicate? → -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)
total ECF sodium, are related to what abnormality? → -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
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 Hypervolemic Hypernatremia due to Na excess is done 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