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Clin Med Lab Med > Exam #2: Sodium Disorders > Flashcards

Exam #2: Sodium Disorders Flashcards

1
Q

What does “TIE 60, 40, 20” refer to?

A
  • TBW = 60% of total body weight
  • ICF = 40% of total body weight
  • ECF = 20% of total body weight
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2
Q

What is the primary ECF ion, and is it a cation or anion?

A

Na+ (cation)

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3
Q

If fluid is moved from ECF → ICF, what happens to cells?

A

Cells SWELL

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4
Q

If fluid is moved from ICF → ECF, what happens to cells?

A

Cells SHRINK

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5
Q

If there is an abnormal serum [Na+], what does this indicate?

A

Water regulation disorder

- Serum [Na+] refers to amount of water relative to Na+ in ECF

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6
Q

What is the major determinant of ECF volume?

A

Total amount of Na+ in ECF

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7
Q

If Na+ is LOW, what does this mean for ECF volume, and what is another name for this?

How does this present clinically?

A

Low Na+ → low ECFV = hypovolemia

- Presents as poor skin turgor, dry mucous membranes (dehydration)

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8
Q

If Na+ is HIGH, what does this mean for ECF volume, and what is another name for this?

How does this present clinically?

A

High Na+ → high ECFV = hypervolemia

- Presents as edema/fluid retention

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9
Q

What general condition is associated with etiologies of GI loss, renal loss, skin loss, sequestration without loss?

A

Hypovolemia

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10
Q

What general condition is associated with etiologies of liver disease, HF, acute/chronic renal failure, nephrotic syndrome, primary hyperaldosteronism, Cushing’s, pregnancy?

A

Hypervolemia

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11
Q

What are the three major causes of Hypervolemia?

A
  • Liver disease
  • HF
  • Renal failure (acute/chronic)
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12
Q

What general condition is associated with increased thirst, decreased sweating; poor skin turgor, dry mucous membranes; oliguria, CNS depression; weakness and muscle cramps; low BP with postural dizziness; high pulse?

A

Hypovolemia

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13
Q

What general condition is associated with edema, SOB, orthopnea, PND, JVD, hepatojugular reflux, crackles?

A

Hypervolemia

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14
Q

What two factors influence water retention?

A
  • Thirst

- ADH

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15
Q

What is the primary factor that influences salt retention, and what are the two main results?

A

RAAS

  • Na+ retention
  • K+ excretion
  • Also ANP and general renal function (GFR, RBF)
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16
Q

What is the most common electrolyte abnormality in hospitalized patients?

A

Hyponatremia

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17
Q

What constitutes Hyponatremia? With what two populations is it more common in?

A

Serum [Na+] below 125 (or symptomatic)

- More common in very young or very old

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18
Q

What condition involves falsely low serum [Na+] BUT normal osmolality (isoosmolar)?

A

Pseudohyponatremia

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19
Q

What two causes are often associated with Pseudohyponatremia?

A
  • Hyperlipidemia

- Hyperproteinemia

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20
Q

What condition involves hyperosmolar state due to increased solute in ECF causing shift of water from ICF to ECF → lower serum [Na+]?

A

Redistributive/Hyperosmolar hyponatremia

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21
Q

What is often the cause of Redistributive/Hyperosmolar hyponatremia, and why?

A

Hyperglycemia

- High glucose in ECF causes shift of water from ICF → ECF = lowers serum Na

22
Q

What are the three primary causes of Hypervolemic Hyponatremia?

How do you treat it?

A
  • Liver failure
  • HF
  • Renal failure

Treat underlying cause (diuretics, dialysis, fluid restrictions)

23
Q

What are the five possible causes of Hyponatremia?

A
  • Pseudohyponatremia
  • Redistributive/Hyperosmolar hyponatremia
  • Hypovolemic Hyponatremia
  • Euvolemic Hyponatremia
  • Hypervolemic Hyponatremia
24
Q

What condition is considered a laboratory artifact?

A

Pseudohyponatremia

25
Q

With Hypovolemic Hyponatremia, if urine Na+ >20, what is the primary cause?

A

Diuretics (Thiazides)

- Also cerebral salt wasting or RTA

26
Q

With Hypovolemic Hyponatremia, if urine Na+ <20, what is the primary cause?

A

Gastroenteritis (V/D)

- Also, third space losses (burns, pancreatitis)

27
Q

What is the primary treatment for Hypovolemic Hyponatremia?

A

Replace fluids lost

28
Q

What are the four primary causes of Euvolemic Hyponatremia?

A
  • SIADH
  • Hypothyroidism
  • Adrenal insufficiency
  • Psychogenic polydipsia
29
Q

What is the primary treatment for Euvolemic Hyponatremia?

A

Fluid restriction

30
Q

What general condition involves HA, dizziness, N/V, lethargy, weakness, confusion, hypoventilation, seizures, coma, death?

A

HYPOnatremia

31
Q

Severity of symptoms of Hyponatremia depends on level of…

A

Cerebral edema

- If ECF → ICF = brain cells swell

32
Q

What should always be considered in the diagnosis of Hyponatremia?

A

FLUID STATUS (hyper vs. eu vs. hypo)

33
Q

What condition involves concentrated urine with low serum osmolality and euvolemia?

A

SIADH

- Possible cause of Euvolemic Hyponatremia

34
Q

What condition is diagnosed as high urine osmolality and low serum osmolality?

A

SIADH

- Possible cause of Euvolemic Hyponatremia

35
Q

What condition involves too much ADH but has normal cortisol and thyroid levels?

A

SIADH

- Possible cause of Euvolemic Hyponatremia

36
Q

What is a possible cause of SIADH?

A

Pulmonary disease (SCLC)

37
Q

What is the recommended treatment for Hyponatremia (if serum [Na+] <125 OR symptomatic)?

A

Hospitalize

38
Q

What is a possible complication of Hyponatremia if Na+ is not corrected slowly (especially chronic)?

A

Cerebral Pontine Myelinolysis (CPM)

- Focal demyelination in pons and extra-pontine areas that is NOT reversible

39
Q

What is the recommended rate of correction for Hyponatremia?

A

Less than 8 mEq/L in first 24 hours

- Should be about 4-6 mEq/L in first 24 hours

40
Q

What constitutes Hypernatremia?

A

Serum [Na+] above 145

41
Q

What is the general etiology of Hypernatremia? What are two other possible causes?

A

Excessive water loss from body

- Also too little dietary water or too much dietary salt

42
Q

Is Cerebral Pontine Myelinolysis (CPM) reversible? How and when would this present?

A

NOT reversible

  • Dysarthria, dysphagia, seizures, AMS
  • Begins 1-3 DAYS after over-correction
43
Q

What general condition is often asymptomatic… Thirst/signs of volume depletion; AMS, weakness; NM irritability; focal neuro deficits; seizures, coma?

A

HYPERnatremia

44
Q

What are three possible causes of Hypernatremia?

A
  • Osmotic diuresis = hyperglycemia, Mannitol

- Diuretics (Loops)

45
Q

What is the body’s normal response to Hypernatremia (2 steps)?

A
  1. Create thirst to increase fluid intake

2. Concentrate urine to prevent further water loss

46
Q

What condition involves urinary water loss but high serum [Na+] = urine dilute but should be concentrated, and what type of natremia is it associated with?

A 
Diabetes Insipidus (DI)
- Associated with HYPERnatremia
47
Q

What are the two types of Diabetes Insipidus (DI), and what is the cause of each?

A
  • Neurogenic/Central DI: due to impaired ADH secretion

- Nephrogenic DI: lack of kidney response to ADH (sufficient ADH present though)

48
Q

How do you treat Neurogenic/Central DI?

A

Desmopressin

49
Q

How do you treat Nephrogenic DI (2)?

A

Thiazides, Amiloride

- CANNOT be treated with Desmopressin

50
Q

What is the general treatment of Hypernatremia (2)?

A
  • STOP water loss

- REPLACE water loss (but not too rapidly - should take days)

Clin Med Lab Med (13 decks)

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