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5 Written questions

5 Matching questions

  1. how is Na+ levels Monitor for Treatment of Hypovolemic Hypernatremia?
  2. 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?
  3. total ECF sodium, are related to what abnormality?
  4. Treatment of Acute Symptomatic Hypotonic Hyponatremia, is treated how?
  5. if have Postural hypotension and have low BP the priority is to become hemodynamically stable, then address what?
  1. 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-
  2. b -ADH is suppressed: UOsm < 100 mOsm/kg VERY DILUTE URINE
    -Euvolemic Hypotonic Hyponatremia
  3. c -Cases of abnormal ECFV size (hypervolemia vs. hypovolemia) are due to problems with the sodium control mechanism
  4. d -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
  5. 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

  1. -↓ serum Na+ concentration, ↑ measured ECF osmolality & tonicity
    -Severe hyperglycemia in uncontrolled diabetes mellitus
  2. 15%
  3. -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)
  4. -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. -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

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

          

  2. Extracellular fluid volume (ECFV= outside cells) ?2/3 TBW

          

  3. IVNa = sodium concentration of infusate 3% is how much mEq?154mEq

          

  4. 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

          

  5. IVNa = sodium concentration of infusate 0.9% is how much mEq?154mEq