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Guru Flashcards

1
Q

hyponatremia defined

A

135 mEq/L <

  1. Excess extracellular water relative to sodium.
  2. ECF volume can be high, normal, or low. In most cases, it is either due to sodium depletion or dilution.
  3. Dilutional hyponatremia frequently results from excess extracellular water, and hence excess extracellular volume status. E.g. Excess oral water intake or iatrogenic I.V.
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2
Q

Causes of Hyponatremia (eight)

A

1. Dilutional hyponatremia frequently results from excess extracellular water, and hence excess extracellular volume status. E.g. Excess oral water intake or iatrogenic I.V.

2. Drugs: Antipsychotics, TCA, ACE inhibitors cause water retention. Elderly are particularly susceptible to drug induced hyponatremia.

3. Depletional: either decreased intake or increased loss of sodium containing fluids–>concomitant ECF volume deficit. Causes of depletional hyponatremia: Low intake, GI loss from vomiting, NG suctioning, or diarrhea, Renal losses due to diuretics use.

  1. Excess solute relative to the free water (hypertonic hyponatremia): Untreated hyperglycemia or Mannitol administration
  2. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  3. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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3
Q

Dilutional hyponatremia

A

Dilutional hyponatremia frequently results from excess extracellular water, and hence excess extracellular volume status. E.g. Excess oral water intake or iatrogenic I.V.

  1. Drugs: Antipsychotics, TCA, ACE inhibitors cause water retention. Elderly are particularly susceptible to drug induced hyponatremia.
  2. Depletional: either decreased intake or increased loss of sodium containing fluids–>concomitant ECF volume deficit. Causes of depletional hyponatremia: Low intake, GI loss from vomiting, NG suctioning, or diarrhea, Renal losses due to diuretics use.
  3. Excess solute relative to the free water (hypertonic hyponatremia): Untreated hyperglycemia or Mannitol administration
  4. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  5. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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4
Q

hyponatremia: Drugs:

A

Dilutional hyponatremia frequently results from excess extracellular water, and hence excess extracellular volume status. E.g. Excess oral water intake or iatrogenic I.V.

  1. Drugs: Antipsychotics, TCA, ACE inhibitors cause water retention. Elderly are particularly susceptible to drug induced hyponatremia.
  2. Depletional: either decreased intake or increased loss of sodium containing fluids–>concomitant ECF volume deficit. Causes of depletional hyponatremia: Low intake, GI loss from vomiting, NG suctioning, or diarrhea, Renal losses due to diuretics use.
  3. Excess solute relative to the free water (hypertonic hyponatremia): Untreated hyperglycemia or Mannitol administration
  4. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  5. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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5
Q

hyponatremia: depletional

A

Dilutional hyponatremia frequently results from excess extracellular water, and hence excess extracellular volume status. E.g. Excess oral water intake or iatrogenic I.V.

  1. Drugs: Antipsychotics, TCA, ACE inhibitors cause water retention. Elderly are particularly susceptible to drug induced hyponatremia.
  2. Depletional: either decreased intake or increased loss of sodium containing fluids–>concomitant ECF volume deficit. Causes of depletional hyponatremia: Low intake, GI loss from vomiting, NG suctioning, or diarrhea, Renal losses due to diuretics use.
  3. Excess solute relative to the free water (hypertonic hyponatremia): Untreated hyperglycemia or Mannitol administration
  4. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  5. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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6
Q

hyponatremia: Excess solute

A
  1. Excess solute relative to the free water (hypertonic hyponatremia): Untreated hyperglycemia or Mannitol administration
  2. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  3. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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7
Q

hyponatremia: lipids

A

  1. Hyperlipidemia/ Hyperproteinemia: Extreme elevation of plasma proteins and plasma lipids can cause pseudohyponatremia.
  2. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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8
Q

hyponatremia: Most common cause of normovolemic hyponatremia.

A

6. SIADH: Most common cause of normovolemic hyponatremia. Increased ADH secretion causes impaired water excretion while the regulation of sodium balance is unaffected.

➢Common causes of SIADH: neuropsychiatric and pulmonary diseases, malignant tumors, major surgery (postoperative Pain)

  1. Primary Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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9
Q

hyponatremia: Primary Na+ gain exceeded by….

A
  1. Na+ gain exceeded by secondary water gain: Heart failure, cirrhosis, nephrotic syndrome
  2. Hormonal deficiency: Adrenal insufficiency, Hypothyroidism
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10
Q

hyponatremia: Hormonal deficiency

A

Hormonal deficiency: Adrenal insufficiency, Hypothyroidism

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11
Q

hypovolemic hyponatremia: > 20 mEq/L, defined causes

A

Urinary sodium > 20 mE/L

Plasma sodium < 135 mEw/L

both water and salt loss but salt is worse

causes:

  1. renal disease
  2. diruetic excess
  3. osmotic diuresis
  4. ketonuria
  5. salt losing deficiency
  6. mineral corticoid deficiency
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12
Q

hypovolemic hyponatremia: : < 20 mEq/L, defined causes

A

Urinary sodium > 20 mE/L

Plasma sodium < 135 mEw/L

both water and salt loss but salt is worse

causes:

  1. vomiting
  2. dirrhea
  3. third spacing:
    1. burn patients
    2. pancreatitis
    3. cirrhosis
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13
Q

characterizes most cases of euvolemic hyponatremia

A

SIADH

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14
Q

Hypernatremia Defined, and causes

A

Defined as a plasma Na+ concentration >145 mmol/L.

Results from either loss of free water or gain of sodium in excess of water.

Like hyponatremia, it can be associated with increased, normal, or decreased extracellular volume.

1) Hypervolemic hypernatremia:

Causes:

  1. Iatrogenic
  2. Mineralocorticoid excess such as hypercortisolism
  3. Cushing’s syndrome
  4. Congenital adrenal hyperplasia
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15
Q

Hypervolemic hypernatremia Labs, causes

A

Urine sodium concentration >20 mEq/L

Urine osmolality >300 mosm/L

causes:

  • mineral corticoid excess- hypercortisolism, cushings
  • congenital adrenal hyperplasia
  • iatrogenic
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16
Q
A
17
Q

Normovolemic hypernatremia

A

Normovolemic hypernatremia

➢Causes:

✓Renal disease

✓Diuretics

✓Diabetes insipidus

✓Non-renal water loss such as GIT and skin.

18
Q

Hypovolemic hypernatremia causes and labs

A

3) Hypovolemic hypernatremia

➢Causes: same as normovolemic hypernatremia

✓Renal disease

✓Diuretics

✓Diabetes insipidus

✓Non-renal water loss such as GIT and skin.

Lab: Urine sodium concentration <20 mmol/L

Urine osmolarity <300 – 400 mosm/L

In case of non-renal water loss, Urine Na concentration <15 mmol/L and Urine osmolarity >400 mosm/L

19
Q
A

Electrolytes (1 decks)

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