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5 Written questions

5 Matching questions

  1. how is Non-Emergent Euvolemic Hypotonic Hyponatremia treated in patients with SIADH?
  2. what is the treatment goal when Hypovolemic Hypotonic Hyponatremia is being treated?
  3. a Crystalloids can be defined as?
  4. Syndrome of inappropriate ADH release (SIADH) can be defined as?
  5. Extracellular fluid volume (ECFV= outside cells) ?
  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 -Nonosmotic ADH release leading to water retention & hyponatremia (go down because hanging on to more water diluting [Na+]
    -Hanging on to more water than Na+, serum Na goes down!
  3. c -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. d -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!
  5. e 1/3 TBW

5 Multiple choice questions

  1. -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)
  2. 154mEq
  3. -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)
  4. -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
  5. -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 True/False questions

  1. Plasma/intravascular volume (vessels where blood is)3/4 ECFV


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


  3. Non-Emergent Hypervolemic 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


  4. how is Determining volume status done?- (275 - 290 mOsm/kg)


  5. Diabetes Insipidus is defined as having what SX?-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!


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