5 Written questions
5 Matching questions
- how is Non-Emergent Euvolemic Hypotonic Hyponatremia treated in patients with SIADH?
- what is the treatment goal when Hypovolemic Hypotonic Hyponatremia is being treated?
- a Crystalloids can be defined as?
- Syndrome of inappropriate ADH release (SIADH) can be defined as?
- Extracellular fluid volume (ECFV= outside cells) ?
- a -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)
- b -Nonosmotic ADH release leading to water retention & hyponatremia (go down because hanging on to more water diluting [Na+]
-Hanging on to more water than Na+, serum Na goes down!
- 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 -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!
- e 1/3 TBW
5 Multiple choice questions
- -Correct hypercalcemia and hypokalemia
-Create mild ECFVd with thiazide diuretic and dietary Na+ restriction ↓ urine volume
-Indomethacin 50 mg po tid (increase sensitivity to ADH)
-Amiloride 5 - 10 mg po daily (lithium induced DI, antagonizes Li effects on kidney tubules)
- -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)
- -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
- -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 True/False questions
Plasma/intravascular volume (vessels where blood is) → 3/4 ECFV
Signs and symptoms of hypernatremia include? → -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
Non-Emergent Hypervolemic Hypotonic Hyponatremia is treated how? → -Restriction of water < 1 - 1.2 L/day
-Restrict Na+ < 1 - 2 g/day
-Improve circulating blood volume: to ↓ ADH release
how is Determining volume status done? → - (275 - 290 mOsm/kg)
Diabetes Insipidus is defined as having what SX? → -Uvol > 3 L/day, Uosm < 250 mOsm/kg = high urine volume and low osmolality
-Response to Desmopressin determines if central or Nephrogenic
-central-yes, DI (urine volume will go down)
-nephrogenic-no, DI (urine volume remains high)-give thiazide instead!