5 Written questions
5 Matching questions
- how is Na+ levels Monitor for Treatment of Hypovolemic Hypernatremia?
- Primary or psychogenic polydipsia (drinking a lot of water= psychological condition); Intake of more water than kidneys can excrete (> 20L/day) what does this cause?
- total ECF sodium, are related to what abnormality?
- Treatment of Acute Symptomatic Hypotonic Hyponatremia, is treated how?
- if have Postural hypotension and have low BP the priority is to become hemodynamically stable, then address what?
- a -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-
- b -ADH is suppressed: UOsm < 100 mOsm/kg VERY DILUTE URINE
-Euvolemic Hypotonic Hyponatremia
- c -Cases of abnormal ECFV size (hypervolemia vs. hypovolemia) are due to problems with the sodium control mechanism
- d -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
- e -3% NaCl (preferred, only in severely symptomatic patients)
-Goal: serum Na+ > 120 mEq/L; No greater than 12 mEq/day increase in serum Na+
5 Multiple choice questions
- -↓ serum Na+ concentration, ↑ measured ECF osmolality & tonicity
-Severe hyperglycemia in uncontrolled diabetes mellitus
- -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)
- -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"
- -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!
5 True/False questions
Signs and symptoms of hypernatremia include? → -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
Extracellular fluid volume (ECFV= outside cells) ? → 2/3 TBW
IVNa = sodium concentration of infusate 3% is how much mEq? → 154mEq
Treatment of Diabetes Insipidus central 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
IVNa = sodium concentration of infusate 0.9% is how much mEq? → 154mEq