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5 Written questions

5 Matching questions

  1. a Crystalloids can be defined as?
  2. when treating Hypovolemic Hypotonic Hyponatremia with Diuretics, what has to be considered?
  3. tonicity can be defined as?
  4. Hypervolemic Hypernatremia is caused by what?
  5. Hypovolemic Hypernatremia results in what?
  1. a -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
  2. b -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)
  3. c -Na+ gain > Water gain
    -Iatrogenic = if give the patient a Na+ overload, its medically induced over infusion
    -Hyperaldosteronism = conserves Na+ = conns syndrome
  4. d -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)
  5. 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

  1. -2 x [Na+ concentration] + [glucose concentration]/18 + [Blood Urea Nitrogen]/2.8 = solutes used to calculate serum osmolality
  2. -clinical assessment
  3. -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
  4. -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. -more solutes inside cells and less outside-more water outside and cell lysis-cerebral edema

5 True/False questions

  1. Central diabetes insipidus (causes high Na+) can be defined as?-Desmopressin (vasopressin analog)
    -Intranasal formulation preferred (DDAVP) 5 - 20 mcg intranasally q12-24h
    -Goal: 1.5 - 2 L/day urine volume = normal urine output

          

  2. Hypertonic Hyponatremia, can be defined as?-↓ serum Na+ concentration, ↑ measured ECF osmolality & tonicity
    -Severe hyperglycemia in uncontrolled diabetes mellitus

          

  3. Diabetes Insipidus is defined as having what SX?-Desmopressin (vasopressin analog)
    -Intranasal formulation preferred (DDAVP) 5 - 20 mcg intranasally q12-24h
    -Goal: 1.5 - 2 L/day urine volume = normal urine output

          

  4. how is Non-Emergent Euvolemic Hypotonic Hyponatremia treated in patients with SIADH?-Restriction of water < 1 - 1.2 L/day
    -Restrict Na+ < 1 - 2 g/day
    -Improve circulating blood volume: to ↓ ADH release

          

  5. Treatment of Acute Symptomatic 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