5 Written questions
5 Matching questions
- if the Osmolal gap (OSM GAP) = OSM(measured) - OSM (calculated), is greater than 10 what does this indicate?
- when treating Hypovolemic Hypotonic Hyponatremia with Diuretics, what has to be considered?
- Serum sodium concentration [Na+] is indicative of the amount of water relative to sodium. T/F?
- Treatment of Diabetes Insipidus, Nephrogenic DI is done by giving what?
- ratio of water to Na+, are related to what abnormality?
- a -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)
- b -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
- c -true, Total amount of sodium in ECF is major determinant of size of ECFV
-Amount of Na+ in ECF (& ECFV size) determined by balance between Na+ intake and Na+ excretion by kidneys
- d -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)
- e -Loop diuretics: proportional loss of Na+ and water (don't become hyponatremic!)
-Thiazides: more Na+ loss than water (high chance of having a low serum Na)
5 Multiple choice questions
- -Tubular unresponsiveness to ADH --> renal concentrating defect --> excessive renal losses of water -->hypernatremia
- -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!
- 3/4 ECFV
- -Head trauma
5 True/False questions
hypotonic, can be defined as? → -solutes outside-more water inside cells and cells shrink-brain can shrink and cause damage
IVNa = sodium concentration of infusate 0.9% is how much mEq? → 154mEq
what are the two Vasopressin Antagonists (last line) used to TX? → -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"
the Main solutes of ECFV are? → -Na+, glucose and urea
Hypervolemic Hypernatremia is caused by what? → -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