Fluid And Electrolytes

Question 1

5 y/o male brought in due to fever, vomiting and frequent watery stools for 3 days. On physical. Exam, he is irritable with poor oral intake due to persistent vomiting, sunken eyeballs, poor skin turgor but with stable vital signs and normal CRT. Which of the following statements is true?
(ch 68 p393-395)

A. The patient is in a state of hypovolemic hyponatremia even without intake of fluid.
B. Hyponatremia will only occur if the child will be given hypotonic fluids
C. He is in a state of hypernatremia with normal intravascular volume
D. Viral diarrhea are always hypertonic resulting to hyponatremia

Answer 1

A. The patient is in a state of hypovolemic hyponatremia even without intake of fluid

Question 2

A 3 y/o female with TB meningitis stage 3, currently on the 2nd month of treatment was referred to you due to hypernatremia (Na 150). Which of the following is true regarding treatment of hypernatremia?

A. Sodium can be corrected rapidly with D5W
B. Check for serum glucose and treat with insulin if elevated
C. Slow correction of sodium by <10meqs/L/day should be done
D. Treat with hypertonic saline if seizure occurs

Answer 2

C. Slow correction of sodium by <10meqs/L/day should be done

Question 3

Which of the following can cause euvolemic hyponatremia?
(ch 68 p395)

A. Nephrotic syndrome
B. PSGN
C. Urinary tract infection
D. SIADH

Answer 3

D. SIADH

Question 4

A 3 month old male was brought in due to a breif seizure episode of approx. 15 secs. On further history, he was formula fed but the caregiver decided to change the milk preparation using 2 oz of water mixed with every scoop of formula milk from the recommended 1:1 dilution. The seizure in this case can be explained by:

A. Hypoglycemia due to inadequate glucose concentration in the milk preparation
B. Hyponatremia because of inadequate Na and protein in the milk prevents adequate water excretion
C. Hypovolemia because diluted milk can cause diarrhea
D. Hyponatremia because of poor sodium content of formula milk

Answer 4

B. Hyponatremia because of inadequate Na and protein in the milk prevents adequate water excretion