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5 Written questions

5 Matching questions

  1. what are the two Vasopressin Antagonists (last line) used to TX?
  2. Body weight normal is ____ Body weight current before patient was volume depleted
  3. Diabetes Insipidus is defined as having what SX?
  4. Treatment of Acute Symptomatic Hypotonic Hyponatremia, is treated how?
  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 -3% NaCl (preferred, only in severely symptomatic patients)
    -Goal: serum Na+ > 120 mEq/L; No greater than 12 mEq/day increase in serum Na+
  3. c 15%
  4. 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!
  5. 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

  1. -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)
  2. -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)
  3. -Weakness, lethargy, restlessness, irritability, confusion
    -More severe or rapidly developing: twitching, seizures, coma, death
  4. -Restriction of water < 1 - 1.2 L/day
    -Restrict Na+ < 1 - 2 g/day
    -Improve circulating blood volume: to ↓ ADH release
  5. - (275 - 290 mOsm/kg)

5 True/False questions

  1. Hypertonic, can be defined as?-solutes outside-more water inside cells and cells shrink-brain can shrink and cause damage


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


  3. hypotonic, can be defined as?-more solutes inside cells and less outside-more water outside and cell lysis-cerebral edema


  4. 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


  5. 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"


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