5 Written questions
5 Matching questions
- what are the two Vasopressin Antagonists (last line) used to TX?
- Body weight normal is ____ Body weight current before patient was volume depleted
- Diabetes Insipidus is defined as having what SX?
- Treatment of Acute Symptomatic Hypotonic Hyponatremia, is treated how?
- a Crystalloids can be defined as?
- 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)
- b -3% NaCl (preferred, only in severely symptomatic patients)
-Goal: serum Na+ > 120 mEq/L; No greater than 12 mEq/day increase in serum Na+
- c 15%
- d -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!
- e -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)
5 Multiple choice questions
- -Initial: 200 - 300 ml/h of 0.9% NaCl until stable, regardless of what Na+ is (posterial hypotension).
-Water deficit = Present TBW x [(SNa / 140) - 1] (140 is the goal) O-5 - 1.0 mEq/L/hr, no > 10 mEq/L/day, because tonicity outside the cells is less and water would move inside the cells and they can swell and cause edema (make sure Na is corrected b/f correct! 1.7)
- -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)
- -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
- -Restriction of water < 1 - 1.2 L/day
-Restrict Na+ < 1 - 2 g/day
-Improve circulating blood volume: to ↓ ADH release
- - (275 - 290 mOsm/kg)
5 True/False questions
Hypertonic, can be defined as? → -solutes outside-more water inside cells and cells shrink-brain can shrink and cause damage
Hypertonic Hyponatremia, can be defined as? → -↓ serum Na+ concentration, ↑ measured ECF osmolality & tonicity
-Severe hyperglycemia in uncontrolled diabetes mellitus
hypotonic, can be defined as? → -more solutes inside cells and less outside-more water outside and cell lysis-cerebral edema
Hypervolemic Hypernatremia is caused by what? → -Na+ gain > Water gain
-Iatrogenic = if give the patient a Na+ overload, its medically induced over infusion
-Hyperaldosteronism = conserves Na+ = conns syndrome
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"