Electrolytes and Vitamins

Question 1

Name 4 causes of hypovolemic hyponatermia. What other causes of hyponatremia that can cause hypernatremia and why?

Answer 1

1. GI loss (diarrhea and vomitting) 2. Renal loss 3. Volume loss from bleeding. 4. Primary Adrenal Insufficiency. ( Sweating, Burns, Fever and Pneumonia can cause hyponatremia if there is chronic free water replacement.

Question 2

Name 2 causes of euvolemic hyponatremia.

Answer 2

1. SIADH (Serum < 280 and Urine >100 - inappropriately concentrated) 2. Psycogenic polydipsia <100 - appropritately diluted.

Question 3

Name 3 causes hypervolemic hyponatremia.

Answer 3

1. CHF 2. Cirrhosis 3. Kidney disease/Nephrotic Syndrome.

Question 4

Poor night vision and hypoparathyroidism. Pt can develop Measles.

Answer 4

Vitamin A deficiency

Question 5

Beriberi, Wernicke Encephlopathy

Answer 5

Vitamin B1 (Thiamine) deficiency

Question 6

Angular chelosis, stomatatisis, red large tongue, glossitis

Answer 6

Vitamin B2 (Riboflavin) deficiency

Question 7

Dermatitis, Demntia, Death, Diarrhea

Answer 7

Vitamin B3 (Niacin) deficiency

Question 8

Burning Feet syndrome

Answer 8

Vitamin B5 (Panthothenic acid) deficiency

Question 9

Echymoses, bleeding gums and petechiae

Answer 9

Vitamin C deficiency

Question 10

Hypercalcemia, polyuria, polydipsia.

Answer 10

Vitamin D toxicity

Question 11

Increased prothrombin time/INR, Mild to severe bleeding.

Answer 11

Vitamin K deficiency

Question 12

Pseudotumor cerebri, hyperparathyroidism, hyperkertinosis.

Answer 12

Vitamin A toxicity.

Question 13

Management of Hypercalcemia Acute and Chronic?

Answer 13

1. Saline IV hydration, calcitonin (acute) and bisphosphenates (chronic.)

Question 14

After a pt receives multiple blood transfusions she develops HYPERACTIVE deep tendon reflexes. Cause?

Answer 14

Hypocalcemia due to the transfused blood being hypoalbuminc and contains a lot of citrate which binds to the calcium and decreases it.

Question 15

Treatment of 1. Hyponatremic Hypervolemic (Cirrhosis)? 2. Hyponatremic Evuolemic (SIADH) 3. Hyponatremic Hypovolemic (GI, Renal and Diuretics.) 4. What if pt presents with seizure like activity.

Answer 15

1. Water restriction 2. Water restriction 3. Normal Saline. 4. Pt pt presents with seizure like activity then hypertonic saline.

Question 16

3 main causes of Hypernatremia? Best inital Test? 2nd Test? Rx?

Answer 16

1. Sweating, Pneumonia and DI 2. Water Deprivation test to determine the cause Sweating vs DI. Once positive then give ADH. Respnse then central. No response the peripheral. Rx: Correct the underlying cause. Give ADH in CDI. NSAIDs + Diuretics in Nephorgenic DI.

Question 17

1. Causes of Hypernatremic Hypervolemic (2)? 2. Causes of Hypernatremic Hypolvolemic (4) ?

Answer 17

1. Cushing Dz or Hyperaldosteronism. 2. Sweating, Pneumonia, GI and Renal

Question 18

For Hyponatremic Hypovolemia, How can you tell the difference between Renal or GI losses ( Seen with chronic replacement of free water without replacing Sodium when water is loss)?

Answer 18

UNa < 25 in GI and UNa>25 in Kidney (the kidney is not concentrating well.)