5 Written questions
5 Matching questions
- how is Na+ levels Monitor for Treatment of Hypovolemic Hypernatremia?
- Serum osmolality (calculated) (serum=blood in vessels) is calculated using what equation?
- a Colloids can be defined as?
- Interstitial fluid volume = in between cells?
- 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 -2 x [Na+ concentration] + [glucose concentration]/18 + [Blood Urea Nitrogen]/2.8 = solutes used to calculate serum osmolality
- c 3/4 ECFV
- d -Packed red blood cells, albumin 5%, albumin 25%, dextrans and hetastarch
-Saved for certain things, typical hydration correction is done before colloids are initiated, more expensive only used with a compelling indication
- e -q2-3 hours over first 24 hrs, then q6-12h (when serum Na+ < 148 mEq/L and asymptomatic; fluid status q8-24h)
5 Multiple choice questions
-0.9% NaCl until hemodynamically stable
-D5W or 0.45% NaCl, will effect IV-volume slower= give ½ normal saline is if it is due to hyperglycemia because it will only raise the sugar level-
- -ADH is suppressed: UOsm < 100 mOsm/kg VERY DILUTE URINE
-Euvolemic Hypotonic Hyponatremia
- -3% NaCl (preferred, only in severely symptomatic patients)
-Goal: serum Na+ > 120 mEq/L; No greater than 12 mEq/day increase in serum Na+
- -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)
- -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
Signs and Symptoms of hyponatremia? → -Weakness, lethargy, restlessness, irritability, confusion
-More severe or rapidly developing: twitching, seizures, coma, death
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"
ratio of water to Na+, are related to what abnormality? → -ECF sodium concentration (hypernatremia vs. hyponatremia) are due to problems with water control mechanisms
total ECF sodium, are related to what abnormality? → -Cases of abnormal ECFV size (hypervolemia vs. hypovolemia) are due to problems with the sodium control mechanism
Treatment of Diabetes Insipidus, Nephrogenic DI is done by giving what? → -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)