Hyper/Hyponatremia Paulson Flashcards
Hypernatremia is mc caused by ______ depletion
water
Who are at highest risk for hypernatremia?
Elderly patients with dec thirst and dec access to fluids
What are early clinical features of hypernatremia?
anorexia, restlessness, n/v
What are next (after early) clinical features of hypernatremia?
AMS**, lethargy
What are neurologic clinical features of hypernatremia?
twitching, hyperreflexia, ataxia, tremor & seizures
Acute or chronic hypernatremia?
-Has been present greater or equal to 2 days, less likely to provoke neurologic s/s
chronic
Acute or chronic hypernatremia?
-More likely to provoke neurologic s/s
acute bc the brain is unable to rapidly adapt
What diagnostic do we use to check for hypernatremia?
BMP
If etiology is unclear, what is the diagnostic test for hypernatremia?
Urine & plasma osmolality
What is the tx for chronic hypernatremia?
- Give dilute fluids
- D5W IV to lower serum sodium by 10 mEq/L over 24 hour period
- Recheck after 4-6 hrs
What is the tx for acute hypernatremia?
D5W IV at a rate of 3-6mL/kg per hr
- *watch out for hyperglycemia bc dextrose
- Goal is to reduce the sodium by 1-2 mEq/L each hour
This is the most common electrolyte disorder seen in hospitalized patients
hyponatremia
What med is a big culprit that can cause hyponatremia?
thiazides
Causes of euvolemic hyponatremia?
- Adrenal insufficiency
- Polydipsia
- Hypothyroidism
- SIADH
Hypotonic hyponatremia?
- Less concentrated than normal saline
- SIADH
- endocrine
- Renal failure
Isotonic hyponatremia?
same concentration as normal saline
-Pseudohyponatremia
Hypertonic hyponatremia?
More concentrated than normal saline
-Significant hyperglycemia (mannitol, maltose, sucrose) cause a shift of water out of the cells so sodium is diluted
Clinical features and sxs of hyponatremia?
weakness, agitation, hyporeflexia, orthostatic hypotension, delirium, coma, seizure, disorientation, HA
Diagnostics for hyponatremia?
BMP + serum osmolality (this helps you determine hypotonic, isotonic, hypertonic)
Hyponatremia classification:
developed in last 24 hrs
acute
Hyponatremia classification:
24-48 hrs
subacute
Hyponatremia classification:
>48 hrs
chronic
Hyponatremia classification:
Sodium < 120
Severe
Hyponatremia classification:
Sodium 121-129
Moderate
Hyponatremia classification:
Sodium 130-135
Mild
Treatment for hyponatremia?
Hypertonic saline
*Never want to raise by 8 in a given 24 hr period, do it SLOWLY
Treatment for hypovolemic?
Isotonic saline
Treatment for hypervolvemic?
CHF, cirrhosis: diuresis, fluid restriction, sodium restriction
Renal failure: fluid restriction, dialysis, sodium restriction
Treatment for euvolemic?
fluid restriction and salt tabs
Never give salt tabs to who?
Edematous patient
This med is used off-label for severe hyponatremia and for SIADH and patients who don’t respond to salt tabs?
Demeclocycline
s/e of Demeclocycline?
Renal toxicity
