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Renal > Disorders of Sodium and H2O balance > Flashcards

Disorders of Sodium and H2O balance Flashcards

1
Q

What is the normal value of Sodium?

A

135-145 mmol/L

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2
Q

What is the normal value of Sodium?

A

135-145 mmol/L

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3
Q

What is the most common cause of Na balance?

A

Disorders of WATER balance!

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4
Q

What defines hyponatremia?

A
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5
Q

What are the symptoms of Hyponatremia?

A

CNS related- Edema in brina
N/V headache, fatigue, WEAKNESS, seizure, coma, death
Severity related to RAPIDITY and SEVERITY of hyponatremia

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6
Q

What defines SEVERE Hyponatremia?

A
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7
Q

What is osmotic adaptation?

A

Brain cells can produce or excrete osmols in order to protect against dehydration or over hydration

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8
Q

What are the symptoms of Osmotic Demyelination syndrome?

A

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

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9
Q

What are the symptoms of Osmotic Demyelination syndrome?

A

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

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10
Q

What is the most common cause of Na balance?

A

Disorders of WATER balance!

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11
Q

What defines hyponatremia?

A

less than 135 mmol/L

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12
Q

WHat are rhe EU-VOLEMIC Causes of Hyopnatremia?

A

Hypoadrenalism, hypothyroidism - INC ADH
Hypothyroidism
SIAD
-inappropriate elevation of ADH DESPITE hyponatremia and euvolemic state

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13
Q

What defines SEVERE Hyponatremia?

A
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14
Q

What is osmotic adaptation?

A

Brain cells can produce or excrete osmols in order to protect against dehydration or over hydration

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15
Q

What is Osmotic Demyelination syndrome?

A

Demyelination of CNS(pons)

Occurs with RAPID correction of severe hyponatremia

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16
Q

What are the symptoms of Osmotic Demyelination syndrome?

A

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

17
Q

What is the Tx of True Hyponatremia?

A 
Tx underlying etiology 
Take into account Os Adaptation
Severe HypoNa? Consider hypertonic Saline
Demeclocycline-increase H2O loss
Vasopressin antagonist- Urinary H2O loss
18
Q

WHat are rhe HYPO-VOLEMIC Causes of Hyopnatremia?

A

Renal losses: Diuretics Especially HYDROCHLORATHIAZIDE. osmotic diuresis(hyperglycemia)
Inc U Na+
Extra renal Losses: blood loss, diarrhea or vomiting
Dec U Na+ (Volume Depletion)
Inc U Osm

19
Q

WHat are rhe HYPER-VOLEMIC Causes of Hyponatremia?

A

Renal Failure- Inc U Na+

CHF, Cirrhosis, nephrotic synd

20
Q

WHat are rhe EU-VOLEMIC Causes of Hyopnatremia?

A

Hypoadrenalism, hypothyroidism - INC ADH
Hypothyroidism
SIAD

21
Q

What is SIAD/Hyponatremia?

A

Non-physiologic release of ADH
leading to impaired H2O excretion
No Edema

22
Q

What is the Etiology of SIAD?

A

CNS Disease- Meningitis, cancer, stroke
Drugs- CNS related, psychotropic, narcotics
Pulmonary Disease- pneumonia
Pain, Stress- post op state

23
Q

What are Diagnostic Charicteristics of SIAD?

A

HypoNa HypoOs
Innap elevated U. osm
Normovolemic on clin exam
Normal renal, adrenal and Thyroid funct

24
Q

What is Tx of Pseudohyponatremia?

A

Treat Cause: Hyperlipidemia

Myeloma

25
Q

What is the Tx of True Hyponatremia?

A 
Tx underlying etiology 
Take into account Os Adaptation
Severe HypoNa? Consider hypertonic Saline
Demeclocycline-increase H2O loss
Vasopressin antagonist- Urinary H2O loss
26
Q

What is the cause of Hypernatremia?

A

Water loss
Na Retention
Water loss > Na loss

27
Q

What are causes of Water loss?

A 
Insensible
Renal
GI
Hypothalmic Dis
Water redist into cells
28
Q

What are causes of Na+ Retention?

A

Admin of Hypertonic NaCl, NaHCO3

Salt pills

29
Q

What are defenses against Hypernatremia?

A

Stim of ADH production

30
Q

What is Diabetes Insipidus?

A

Dec ADH production or secretion

Dec Renal response to ADH

31
Q

What are causes of Central DI-CDI?

A 
Idiopathic 75%
Neurosurgery
Head Trauma
Hypoxic/Ischemic Encephalopathy
Cancer
32
Q

What are the Symptoms of Central Diabetes Insipidus?

A 
Polyuria
Polydipsia
Low U. Osm
Undetectable Plasma ADH
improvement and inc U. osm with Admin of ADH
33
Q

What are the causes of Nephrogenic Diabetes insipidus?

A 
Congenital 
Hypercalcemia, Hypokalemia
Lithium, demeclocycline
Renal Parencymal Dis
AI dis
Osmotic Diuresis
34
Q

What causes Primary Polydipsia?

A

Psychiatric or Hypothalamic Dys

35
Q

What is the DDx of Polyuria/Polydipsia?

A

NDI and CDI => Hypernatremia
1^ Polydipsia => Hyponatremia
Water deprivation test- Overnight Fast from H2O

36
Q

When is Tx of Hypernatremia indicated?

A

Symptomatic
Volume Depleted
Hypernatremia Severe (>155)

37
Q

What is the Tx of Hypernatremia?

A

Correct Cause
Correct Hypernatremia with fluids
CDI => Give ADH
NDI => Adequate H2O

Renal (21 decks)

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