Hyper/Hyponatremia Paulson

Question 1

Hypernatremia is mc caused by ______ depletion

Answer 1

water

Question 2

Who are at highest risk for hypernatremia?

Answer 2

Elderly patients with dec thirst and dec access to fluids

Question 3

What are early clinical features of hypernatremia?

Answer 3

anorexia, restlessness, n/v

Question 4

What are next (after early) clinical features of hypernatremia?

Answer 4

AMS**, lethargy

Question 5

What are neurologic clinical features of hypernatremia?

Answer 5

twitching, hyperreflexia, ataxia, tremor & seizures

Question 6

Acute or chronic hypernatremia?

-Has been present greater or equal to 2 days, less likely to provoke neurologic s/s

Answer 6

chronic

Question 7

Acute or chronic hypernatremia?

-More likely to provoke neurologic s/s

Answer 7

acute bc the brain is unable to rapidly adapt

Question 8

What diagnostic do we use to check for hypernatremia?

Answer 8

BMP

Question 9

If etiology is unclear, what is the diagnostic test for hypernatremia?

Answer 9

Urine & plasma osmolality

Question 10

What is the tx for chronic hypernatremia?

Answer 10

• Give dilute fluids
• D5W IV to lower serum sodium by 10 mEq/L over 24 hour period
• Recheck after 4-6 hrs

Question 11

What is the tx for acute hypernatremia?

Answer 11

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

Question 12

This is the most common electrolyte disorder seen in hospitalized patients

Answer 12

hyponatremia

Question 13

What med is a big culprit that can cause hyponatremia?

Answer 13

thiazides

Question 14

Causes of euvolemic hyponatremia?

Answer 14

• Adrenal insufficiency
• Polydipsia
• Hypothyroidism
• SIADH

Question 15

Hypotonic hyponatremia?

Answer 15

• Less concentrated than normal saline
• SIADH
• endocrine
• Renal failure

Question 16

Isotonic hyponatremia?

Answer 16

same concentration as normal saline

-Pseudohyponatremia

Question 17

Hypertonic hyponatremia?

Answer 17

More concentrated than normal saline

-Significant hyperglycemia (mannitol, maltose, sucrose) cause a shift of water out of the cells so sodium is diluted

Question 18

Clinical features and sxs of hyponatremia?

Answer 18

weakness, agitation, hyporeflexia, orthostatic hypotension, delirium, coma, seizure, disorientation, HA

Question 19

Diagnostics for hyponatremia?

Answer 19

BMP + serum osmolality (this helps you determine hypotonic, isotonic, hypertonic)

Question 20

Hyponatremia classification:

developed in last 24 hrs

Answer 20

acute

Question 21

Hyponatremia classification:

24-48 hrs

Answer 21

subacute

Question 22

Hyponatremia classification:

>48 hrs

Answer 22

chronic

Question 23

Hyponatremia classification:

Sodium < 120

Answer 23

Severe

Question 24

Hyponatremia classification:

Sodium 121-129

Answer 24

Moderate

Question 25

Hyponatremia classification:

Sodium 130-135

Answer 25

Mild

Question 26

Treatment for hyponatremia?

Answer 26

Hypertonic saline

*Never want to raise by 8 in a given 24 hr period, do it SLOWLY

Question 27

Treatment for hypovolemic?

Answer 27

Isotonic saline

Question 28

Treatment for hypervolvemic?

Answer 28

CHF, cirrhosis: diuresis, fluid restriction, sodium restriction
Renal failure: fluid restriction, dialysis, sodium restriction

Question 29

Treatment for euvolemic?

Answer 29

fluid restriction and salt tabs

Question 30

Never give salt tabs to who?

Answer 30

Edematous patient

Question 31

This med is used off-label for severe hyponatremia and for SIADH and patients who don’t respond to salt tabs?

Answer 31

Demeclocycline

Question 32

s/e of Demeclocycline?

Answer 32

Renal toxicity