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5 Written questions

5 Matching questions

  1. how is Na+ levels Monitor for Treatment of Hypovolemic Hypernatremia?
  2. Serum osmolality (calculated) (serum=blood in vessels) is calculated using what equation?
  3. a Colloids can be defined as?
  4. Interstitial fluid volume = in between cells?
  5. a Crystalloids can be defined as?
  1. 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)
  2. b -2 x [Na+ concentration] + [glucose concentration]/18 + [Blood Urea Nitrogen]/2.8 = solutes used to calculate serum osmolality
  3. c 3/4 ECFV
  4. d -Packed red blood cells, albumin 5%, albumin 25%, dextrans and hetastarch
    -Saved for certain things, typical hydration correction is done before colloids are initiated, more expensive only used with a compelling indication
  5. e -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)

5 Multiple choice questions

  1. -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-
  2. -ADH is suppressed: UOsm < 100 mOsm/kg VERY DILUTE URINE
    -Euvolemic Hypotonic Hyponatremia
  3. -3% NaCl (preferred, only in severely symptomatic patients)
    -Goal: serum Na+ > 120 mEq/L; No greater than 12 mEq/day increase in serum Na+
  4. -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)
  5. -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

  1. Signs and Symptoms of hyponatremia?-Weakness, lethargy, restlessness, irritability, confusion
    -More severe or rapidly developing: twitching, seizures, coma, death

          

  2. what are potential causes of Euvolemic Hypotonic Hyponatremia?-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"

          

  3. ratio of water to Na+, are related to what abnormality?-ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms

          

  4. total ECF sodium, are related to what abnormality?-Cases of abnormal ECFV size (hypervolemia vs. hypovolemia) are due to problems with the sodium control mechanism

          

  5. Treatment of Diabetes Insipidus, Nephrogenic DI is done by giving what?-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)