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Clinical Therapeutics > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Hormones that mediate physiological adjustments in fluid and electrolyte balance

A

ADH
aldosterone
Naturestic hormone

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2
Q

Medical term for low sodium

A

Hyponatraemia

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3
Q

Normal serum na conc

A

135-145 mol/L

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4
Q

What is the plasma osmolarity usally mantained at

A

280-290 mOsmol/kg

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5
Q

How does adh/vasopressin

A

Senses low blood volume

ADH/vasopressin secreted by posterior lobe of pit gland

Travels to blood in kidney

Promotes reabs of water from Dct and cd into blood (conc urine produced)

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6
Q

RAAS function

A

Activated due to low or falling renal perfusion detected by juxtaglomerular app eg significant blood loss, dehydration cardiac failure.
Low renal perfusion causes release of renin➡️ag ➡️ag1

Ag1➡️ag2
Ag2:
Vasoconstriction (increased bp)
Stimulated adh release
Stimulates aldosterone from adrenal gland (promotes na reabsorption from nephron )

These changes promote retention of na in blood , increasing circulating volume and improved renal perfusion to kidneys and other organs.

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7
Q

What plasma osmolarity Is ADH released at

A

280mosmol/kg

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8
Q

What plasma osmolarity is theist stimulated

A

290 mosmol/ kg

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9
Q

Hyponatrameia blood serum ranges

A

Mild 125-135 mmol/L
Moderate 115-125 mmol/L
Severe less than 115 mmol/L

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10
Q

Rate of onset of hyponatramia

A

Acute - less than 48hrs
Chronic -48 hrs or more

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11
Q

Psuedohyponatraemia

A

Mesureded conc is low although actual volume is ok. May be due high serum proteins or lipid Levels

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12
Q

What to do if hyponatraemic pt presents with neurological symptoms

A

Need to maintenance for acute bc of risk of brain damage

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13
Q

Hyponatraemia symptoms

A

130-135 - a lot of patients may be asymptomatic . Mild ,may develop over time n
If the hyp is chronic there was be subtle absnormalities such as gait disturbances , decreased bone strength and muscle weaknesses , this may contribute to increased risk of falls and fractures.

120-130++ naseua , geenaksied weakness, c fusion and disoreination

<120 (rapid changes , more serious ) confusing and disorientation may worsen and be disabling.
Neurological signs such as seixures (risk! Medical emergency )

<110 impaired consciousness M neurological signs , seizures
Risk of severe mental impairment and death

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14
Q

Hyponatraemia acc with a decreased extracelluar volume

A

Meds (thiazide diuretics )
Primary adrenal insifficany
Severe v and d (GI na loss)
Sweating (eg severe exercise ) and extensive skin burns (extensive transdermal na loss)
Third space losses - sepsis , bowel obstruction l pancreastis , muscle trauma

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15
Q

Hyponatraemia ass with increased extracelluar volume

A

Congestive heart failure
Kidney and liver disease

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16
Q

Hyponatraemia ass with normal ec vol

A

Syndrome if inappropriate antidiuretic hormone (SIADH)
Endocrine disorders - secondary adrenal insufficiency , hypothyroidism
High water low solute intake eg primary poly dipsia - caused by defect in the central thirst regulation , reduced below ADH threshold so encourages to drink despite there being a low plasma osmolarity.

17
Q

SIADH

A

Syndrome of inappropriate release of ADH
excessive, uncontrollable release of ADH
Produces state of water xs without Marjorie na retention

18
Q

SIADH causes

A

Malignancy - tumours can produce ADH
CNS DISORDERS eg meningitidis
Pulmonary disease eg pneumonia
AIDS/HIV
NON SPECIFIC eg pains , meds. Naseua , stress

19
Q

SIADH diagnosis

A

Exclusion - confirmed in 2 nd care

20
Q

Most common drugs ass w Hyponatraemia

A

SSRIS eg citaplipram
Diuretics - thiazide diuretics , thiazide like diuretics ( inhibit na reabsorption) take tan days or yrs to present. Also loop Suivre ti s eg furosemide (more common if taken with other drugs like ace inhibitors )

Antipsychotics - haloperidol and phenothiazine’s
Carbamazepine (more freq in elderly)

21
Q

Drugs less commonly associated with Hyponatraemia

A

Drugs that increase the action of ADH - opioids , ace inhibitors , ag2ra, PPIS, anticonvulsants, MDMA

Drugs that cause a loss in ADH inhibition eg NSAIDS

Oxytcoin , desmopressin

22
Q

Others drugs used I. Hyponatraemia

A

Demeclocylcine
Tolvaptan

23
Q

Demeclocycline hydrochloride

A

Directly blocks the tubular effects on ADH
Treats Hyponatraemia caused by inappropriate renal effect of ADH
Shouldn’t be used in severe renal impairmenent

24
Q

Tolvaptan

A

Vasopressin v2 receptor antagonist
Treatment of Hn secondary to SIADH
rapid correction of hn during treatment with Tolvaptan therapy can cause osomotic demylentisiom

25
Q

What syndrome is caused by rapid over correction of Hyponatraemia

A

Osmotic dymlyeinstion syndrome

26
Q

Osmotic demyelination syndrome symptoms

A

Dufficulty speaking , swallowing , acute paralysis or other neurological symptoms

Clinical Therapeutics (5 decks)

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