Electrolytes (Na) Flashcards
Electrolyte concentrations in body fluids
-sodium outside (ECF)
-potassium inside (ICF)
Goals of electrolyte therapy
-prevent/treat serious complications
-normalize serum concentration
-identify and correct underlying causes
-avoid overcorrection
Sodium 135-145 mEq/L
-primary extracellular cation
-needed to maintain cellular integrity
-maintains osmolar gradient = regulate fluid homeostasis
HYPOnatremia
-most common electrolyte disturbance in hospital
-brain injury (seizure/death)
-too rapid correction of sodium (demyelination)
-acute effects of HYPO-osmolality
-big time morbidity and mortality
Classification of HYPOnatremia
-Na+ < 135 mEq/L
-what’s tonicity?
-what’s volume status
Osmolality
-275-290 mOsm/L
-number of particles per liter of water
-measure or estimate
Serum Osmolality calculation
Osm = (2*Na) + (BUN/2.8) + (Glucose/18)
ISOtonic hyponatremia (pseudohyponatremia)
-extreme elevations of lipid and proteins increase total plasma volume
-seen with hypertriglyceridemia or hyperproteinemia
-leads to dilution effect
-sodium appears low (just displaced)
-measured Osm not really affected
-Calculated Osm is low due to low sodium
=osmolality gap
Hypertonic Hyponatremia
-often seen with elevated Blood glucose (>120-140)
->290mOsm
Corrected Serum Sodium
-serum sodium falls by 1.6 mEq/L per 100mg/dL increase in BG over 100mg/dL
Corrected Serum sodium equation
Serum Na + 1.6((BG-100)/100))
Hypotonic Hyponatremia classification
-must check volume status to classify
->90% of all hyponatremia
HYPOvolemic Hypotonic hyponatremia
-TBW and Na+ dec
-RENAL causes (urine Na+ > 20mEq/L)
-NON-Renal causes (urine <20 mEq/L)
Renal Causes of HYPOvolemic hypotonic hyponatremia
-lots of Na+ in urine (>20mEq/L)
-diuretics
-adrenal insufficiency (mineralcorticoid deficiency)
-salt losing nephropathy
-cerebral salt wasting
Non-renal Causes of HYPOcvolemic hypotonic hyponatremia
-blood loss/ hemorrhage
-skin losses (burn/sweat/wound)
-GI losses (vomit, diarrhea, suction)
Isovolemic hypotonic hyponatremia
-TBW inc
-Na+ normal or slight inc
-slight excess of ECF
-no peripheral or pulmonary edema
-appears euvolemic
Isovolemic Hypotonic hyponatremia causes
-adrenal insufficiency (glucocorticoid defic)
-HYPOthyroidism
-psychogenic polydipsia
-SIADH
Syndrome of Inappropriate AntiDiuretic Hormone release (SIADH)
-most common cause of isotonic hypo hyponatremia
-water intake exceeds kidney ability to excrete water
causes of SIADH
-tumors
-CNS disorders
-DRUGS
Possible Drug-Induced SIADH
-antineoplastics (cyclophosphamide and vincristine)
-antipsyc**
-bromocriptine
-carbamazepine*
-chlorpropamide
-desmopressin
-meperidine/morphine
-nictoine
-NSAIDs (ibuprofen)
-oxytocin
-fluoxetine/sertraline**
-TCAs (amitryptyline)
-Imipramine
-Tolbutamide
Treatment of SIADH
-remove underlying cause
1. free water restrivtion
2. Vaptans if 24-48 hours of free water restriction fails (conivaptan and tolvaptan)
Hypervolemic Hypotonic hyponatremia
-TBW and Na+ inc
-expanded ECF volume and edema
Hypervolemic Hypotonic Hyponatremia seen in
-Cirrhosis
-Heart failure
-Kidney Failure (acute/chronic)
-nephrotic syndromes
Clinical presentation of hypotonic hyponatremia
-mostly asymptomatic (Na+> 125 mEq/L
-HYPO = dehydration
-Hyper = Edema
Hypovolemic hypotonic hyponatremia presentation
-dehydration
-dec skin turgor
-orthostatic HTN
-tachycardia
-dry membranes