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Renal Medi > 3-4 > Flashcards

3-4 Flashcards

1
Q

Hyponatremia is when serum Na is less than ___

A

135 mEq/L

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2
Q

Severe symptoms of hyponatremia

A

Vomiting
Cardiorespiratory arrest
Seizures
Reduced consciousness/coma (Glasgow <8)

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3
Q

ADH/vasopressin is synthesized in the ___

A

Hypothalamus

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4
Q

Normal serum osmolality is ___

A

280-295

2Na + glucose/18 + BUN/2.8

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5
Q
  1. Hypertonic hyponatremia
  2. Isotonic
  3. Hypotonic
A
  1. Hyperglycemia, glucose, mannitol, maltose
  2. Pseudo, hyperlipidemia, hyperproteinemia
  3. Most common
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6
Q 
[Na] =
Hypotonic hyponatremia: volume assessment:
1. Hypovolemia
2. Hypervolemia
3. Iso/Euvolemia
A

Na/TBW

  1. ⬇️⬇️Na, ⬇️H2O
  2. ⬆️Na, ⬆️⬆️H2O
  3. ⬆️H2O
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7
Q

Hypotonic hyponatremia: volume assessment:

  1. Hypovolemia with urine Na:
    a. >20
    b. <20
  2. Euvolemia ALWAYS has urine Na >20
  3. Hypervolemia with urine Na:
    a. >20
    b. <20
A
  1. a. Renal solute loss
    b. Extrarenal solute loss
  2. SIADH, Endocrinopathies (glucocorticoid deficiency), or K depletion (ex: from diuretic use)
  3. a. Renal failure
    b. Edematous disorders (HF, cirrhosis, nephrotic syndrome)
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8
Q

SIADH causes:

A 
CNS disorders
Pulmonary disease
Small cell lung cancer 
Drugs
Hypothyroidism
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9
Q

SIADH vs Psychogenic polydipsia

A

-not dilute urine vs. dilute urine

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10
Q

Hyponatremia:
Acute
Subacute
Chronic

A

<24 hrs
24-48
>48

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11
Q

Fluid replacement options for hyponatremia:

A
  1. Normal Saline (9%, 154 mEq of Na)
  2. Lactate ringers (130 mEq)
  3. Hypertonic saline (3%, 513 mEq) *used for severe cases
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12
Q

Goal of treatment for hyponatremia is to raise Na by ___, not to exceed ____. Measure serum Na every ____

A

4-6 mmol/L/24 hours
8 mEq in 24 hours
2 hours

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13
Q

Rapid correction of hyponatremia can lead to ___

A

Osmotic demyelination syndrome (ODS)

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14
Q

ODS presentation:

A 
Paresis
Dysphagia
Dysarthria
Diplopia
Loss of consciousness
Ataxia
Parkinsonism
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15
Q

Tx of choice for

  1. Euvolemia hyponatremia
  2. Hypovolemic hyponatremia
  3. Hypervolemic hyponatremia
A
  1. Free water restriction
  2. Isotonic/hypertonic saline
  3. Na and fluid restriction
    - if CHF: add loop diuretics and ACEI/ARB
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16
Q

Furosemide

  1. What is it?
  2. Indication?
  3. Where does it act?
  4. MOA?
  5. Cautions?
  6. Onset?
  7. Duration?
A
  1. Loop diuretics
  2. Hypervolemia
  3. Ascending loop of Henle
  4. Inhibits Na-K-Cl transport system
  5. Hypokalemia
  6. PO 30-60 min, IV 5 min
  7. PO 6-8 hrs, IV 2 hrs
17
Q

Desmopressin

  1. What is it?
  2. MOA?
  3. Should avoid in ___
A
  1. Synthetic analogue of ADH
  2. Increases cAMP in renal tubular cells which increases H2O permeability = decreased urine volume, increased urine osmolality
  3. Psychogenic polydipsia, CHF, cirrhosis
18
Q

Tolvaptan

  1. MOA
  2. Uses
  3. Do not use for more than ___
  4. Black box warning
  5. Contraindications
A
  1. Selective V2 receptor antagonist
    - increases urine output, decreases urine osmolality, normalizes serum Na
  2. Hypervolemic or Euvolemia hyponatremia
  3. 30 days
  4. Only use in a hospital with serum Na monitoring
  5. Liver disease
19
Q

Conivaptan

  1. MOA
  2. Uses
  3. Route
A
  1. Blocks V1a and V2 receptors
  2. Euvolemia and hypervolemic hyponatremia in hospital pts
  3. IV
20
Q

V2 receptors are predominantly located in the ___

A

Distal tubule and collecting ducts

21
Q

Things that may cause isosmotic volume contraction:

A

Diarrhea
Vomiting
Burns

22
Q

How would you treat isosmotic volume contraction?

A

Isotonic fluids

23
Q

Things that may cause hyperosmotic volume contraction:

A

Severe dehydration
Drinking cessation
Severe exercising
Diabetes insipidus

24
Q

How would you treat hyperosmotic volume contraction?

A

hyposmolar or isosmolar IV fluids

Dextrose 5

25
Q

Things that may cause hyposmotic volume contraction:

A

Adrenal insufficiency
-Decrease in aldosterone
excess Na loss in the urine

26
Q

How would you treat hyposmotic volume contraction?

A

Corticosteroids (allow reabsorption of free water and Na)

27
Q

Things that may cause isosmotic volume expansion:

A

Isotonic saline infusion

Too high fluids running while in the hospital

28
Q

How would you treat isosmotic volume expansion?

A

Fluid restriction

29
Q

Things that may cause hyperosmotic volume expansion:

A

Eating high Na foods

30
Q

How would you treat hyperosmotic volume expansion?

A

Cut back on salty foods

31
Q

Things that may cause hyposmotic volume expansion:

A

SIADH

32
Q

How would you treat hyposmotic volume expansion?

A

Fluid restriction
Vapton drugs
DO NOT GIVE HYPEROSMOTIC FLUIDS OR GIVE RAPID Na REPLACEMENT! You could give them ODS

33
Q

ECFV ⬇️
Osmolarity -
ICFV -

A

Isosmotic volume contraction

34
Q

ECFV ⬇️
Osmolarity ⬆️
ICFV ⬇️

A

Hyperosmotic volume contraction

35
Q

ECFV ⬇️
Osmolarity ⬇️
ICFV ⬆️

A

Hyposmotic volume contraction

36
Q

ECFV ⬆️
Osmolarity -
ICFV -

A

Isosmotic volume expansion

37
Q

ECFV ⬆️
Osmolarity ⬆️
ICFV ⬇️

A

Hyperosmotic volume expansion

38
Q

ECFV ⬆️
Osmolarity ⬇️
ICFV ⬆️

A

Hyposmotic volume expansion

Renal Medi (11 decks)

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