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PHARM 343 > Conditions of Sodium Imbalance > Flashcards

Conditions of Sodium Imbalance Flashcards

1
Q

What is the role of sodium in fluid balance

A

The primary driver of osmolarity in Extracellular Fluid Compartment

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2
Q

Formula to calculate Serum Osmolarity

A

(2 x Na+) + (Glucose) + Blood Urea Nitrogen

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3
Q

Most common electrolyte abnormality?

A

Hypotonic Hyponatremia
- Low Electrolytes

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4
Q

Symptoms of Mild Hyponatremia (5)

A

Mild:
- Asymptomatic
- Impaired Attention
- Postural Changes
- Gait Changes
- Increased Fall Risk

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5
Q

Symptoms of Moderate/Severe Hyponatremia (8)

A
  • Nausea
  • Vomiting
  • Headache
  • Lethargy
  • Altered Mental Status
  • Seizures
  • Respiratory Arrest
  • Increased Risk of Death
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6
Q

How to assess Hyponatremia

A
  1. Patient is determined to have low sodium levels
  2. Measure Serum Osmolarity
  3. If Hypovolemic measure Volume Status
  4. If Hypovolemic measure Urine Osmolarity
  5. If Hypovolemic measure Urine Concentration
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7
Q
  1. Low Sodium
  2. Normal Serum Osmolarity
A

Isotonic Hyponatremia
- Pseudohyponatremia

Displacement in fluid volume from elevations in cholesterol/protein levels
- Sodium level is normal, but, when drawing blood sample sodium is low because other components in the blood is displacing it

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8
Q
  1. Low Sodium
  2. High Serum Osmolarity
A

Hypertonic Hyponatremia
- Hyperglycemia

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9
Q

Explain Hypotonic Hyponatremia (Dehydrated)

A
  1. Low Sodium level
  2. Low Serum Osmolarity
    –> Dehydrated
  3. Hypovolmic
  4. Urine is very concentrated
    5a. If Sodium concentration is less than 20 mEq/L sodium loss is from extra renal sources
    5b. If Sodium concentration is greater than 20 mEq/L sodium loss is from renal source
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10
Q

How does Hypotonic Hyponatremia (Hypovolemic) occur

A
  1. Excessive fluid loss (Diuretic, Diarrhea, Sweating)
  2. Body is in a hypernatremia state
  3. Body releases vasopressin
  4. Water is retained, sodium is excreted
  5. Very concentrated urine
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11
Q

What would be Extrarenal Losses

A

GI: Diarrhea
Skin: Sweating
Lungs: Hyperventilation

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12
Q

What would be Renal Losses

A

Adrenal Insufficiency: Not enough aldosterone
Diuretics: Too strong
Renal Losses

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13
Q

Explain Hypotonic Hyponatremia (Edema)

A
  1. Low Sodium Levels
  2. Low Serum Osmolarity
    –> Edema
  3. Hypervolemia
  4. Low Osmotic Pressure in Vasculature
  5. Water moves into interstitial spaces
  6. Urine Osmolarity will be low as blood volume is low
  7. Sodium Concentration in urine will be less than 20 mEq/L because it is not being released in kidneys
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14
Q

What causes Hypotonic Hyponatremia (Hypervolemic)

A

Heart Failure
Cirrhosis
Nephrosis

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15
Q

Explain Hypotonic Hyponatremia (Isovolumic and Low Urine Osmolarity)

A
  1. Low Sodium Levels
  2. Low Serum Osmolarity
  3. Isovolumic/Euvolemic
  4. Low Urine Osmolarity
  5. Low Sodium Concentration in Urine

Primary polydipsia causes excessive drinking of water because of high glucose levels
- Water dilutes urine

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16
Q

Explain Hypotonic Hyponatremia (Isovolumic and High Urine Osmolarity)

A
  1. Low Sodium Levels
  2. Low Serum Osmolarity
  3. Isovolumic/Euvolemic
  4. High Urine Osmolarity
  5. High Sodium Concentration in Urine

Caused by hypothyroidism, hypocortisolism, Kidney failure, SIADH

17
Q

What is SIADH, relation to hypoantremia

A

Can cause hypotonic hyponatremia (Euvolemic)
- Causes release of vasopressin
–> Water is retained, sodium is excreted

Thus, increases urine osmolarity and sodium concentration in urine

18
Q

Hypotonic Hyponatremia
- Which conditions involve High Serum Osmolarity + High Urine Osmolarity

A

Dehydration From Renal Sources (Hypovolemic)
- Body losses water
- Body responds by retaining water
- Body excretes sodium
- Concentrated urine

SIADH (Euvolemic)
- Vasopressin is released
- Water is retained, sodium is excreted
- Concetrated Urine

19
Q

Hypotonic Hyponatremia
- Which conditions involve Low Serum Osmolarity + High Urine Osmolarity

A

None

20
Q

Hypotonic Hyponatremia
- Which conditions involve High Serum Osmolarity + Low Urine Osmolarity

A

Edema (Hypervolemic)
- Low Osmolarity Pressure in Vasculature
- Water moves into interstitial space
- Low Blood Volume and Low Blood Pressure

  1. Urine is more concentrated due to less blood volume
  2. Sodium is not excreted through kidneys
21
Q

Hypotonic Hyponatremia
- Which conditions involve Low Serum Osmolarity + Low Urine Osmolarity

A

Primary Polydipsia (Euvolemic)
- Excessive drinking of water
- Urine is very dilute

22
Q

Diseases that can induce SIADH

A
  • Tumours (Lungs, Pancreas)
  • CNS Disorders (Head trauma, stroke, meningitis, pituitary surgery)
  • Pulmonary Disease (TB, Pneumonia)
23
Q

Drugs that can induce SIADH

A
  • Tricyclic Antidepressants
  • Phenothiazines
  • Opioids
  • Nicotine
  • Carboplatin
  • Cisplatin
  • Bromocriptine
  • NSAIDs
  • Acetaminophen
24
Q

How to treat severe Hypotonic Hyponatremia

A

3% NaCl (Hypertonic Saline)
0.9% NaCl (Normal Saline)

Do not exceed 6 to 12 mmol/L during the first 24 hours

25
Q

How to treat Hypovolemic Hyponatremia
- Mechanism?

A

Treat the underlying cause

0.9% NaCl / Oral Replacement: Water, WHO-ORS, Water+Salt, Sports Drinks
- Once infused it remains in extracellular / intravascular fluid compartment
–> Restores intravascular fluid volume thus, reducing elevated vasopressin release

26
Q

How to treat Hypervolemic Hyponatremia

A
  • Treat underlying cause: Heart failure, Nephrosis, Cirrhosis
  • Fluid Restriction: Creates a negative water balance, fluids are moves out of interstitial spaces into the intravascular spaces
  • Sodium Restriction: Moves fluids out of the interstitial spaces into the intravascular spaces
  • Vasopressin Receptor Antagonists (Tolvaptan, Conivaptan): Prevents reabsorption of water, more water is excreted creating less concentrated urine. Urine osmolarity decreases, Serum Sodium Concentration increases
27
Q

How to treat Euvolemic Hyponatremia

A
  • Correct the underlying cause: Stop the cause of SIADH
  • Fluid Restriction: Creates a negative water balance
  • For chronic SIADH may need to increase NaCl intake or add/remove loop diuretic
  • Vasopressin Receptor Antagonist: Prevents water reabsorption, more water excreted
28
Q

Symptoms of Hypernatremia Mild to Moderate (6)

A
  • Weakness
  • Restlessness
  • Lethargy
  • Irritability
  • Twitching
  • Confusion
29
Q

Symptoms of Hypernatremia Severe (3)

A

Seizures, Coma, Increased chances of death

30
Q

Hypovolemic Hypernatremia
- Cause

A

Water loss faster than sodium loss

31
Q

Hypervolemic Hypernatremia
- Cause

A

Sodium overload
- Too much salt, water follows salt

32
Q

Euvolemic Hypernatremia
- Cause

A

Water loss with little to no sodium loss
- Diabetes Insipidus is the most common cause

33
Q

Causes of Diabetes Insipidus

A
  • Lots of Water being lost through urine
  • Central (Low levels of Vasopressin)
  • Renal tubules not responding to Vasopressin (Nephrogenic)
34
Q
A

PHARM 343 (23 decks)

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