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renal > hypo/hypernatremia > Flashcards

hypo/hypernatremia Flashcards

1
Q

osmolality

A

concentration of particles in a solution

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2
Q

tonicity

A

osmotic agents that cannot freely cross the cell membrane will result in water movement into or out of the cell

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3
Q

serum osmolarity formula

A

2[Na] + BUN /2.8 + glucose/18

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4
Q

hyponatremia serum sodium

A

<135 mEq/L

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5
Q

hyponatremia is due to

A

increased free water

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6
Q

appropriate response to hyponatremia should be ______ urine

A

dilute

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7
Q

appropriate response to hypernatremia should be ______ urine

A

concentrated

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8
Q

pseudohyponatremia

A

lab error due to hyperproteinemia or hypertriglyceridemia altering the plasma water concentration

isotonic

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9
Q

isotonic hyponatremia

A

low measured serum Na and normal serum osmolarity

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10
Q

hypotonic hyponatremia has ____serum Na and ____ serum osmolarity

A

low

low

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11
Q

hypertonic hyponatremia has ____serum Na and ____ serum osmolarity

A

low
high

(translocational hyponatremia)

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12
Q

translocational hyponatremia

A

reflects a movement of water from ICF to ECF due to hyperglycemia
(hypertonic hyponatremia)

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13
Q

after determining serum osmolarity, what is the next step in determining the cause of hyponatremia?

A

determine the patient’s volume status

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14
Q

the type of hyponatremia is determined by ____ and _____

A

serum osmolarity

volume status

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15
Q

clinically significant/true hyponatremia

A

hypotonic hyponatremia

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16
Q

hypotonic hyponatremia pathophys

A

excess of water compared to sodium in the ECF due to either dilution or depletion

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17
Q

hypovolemic hypotonic hyponatremia has ____ ECF volume

A

low

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18
Q

euvolemic hypotonic hyponatremia has ____ ECF volume

A

normal

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19
Q

hypervolemic hypotonic hyponatremia has ____ ECF volume

A

high

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20
Q

renal causes of hypovolemic hypotonic hyponatremia

A

diuretics

mineralocorticoid deficiency

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21
Q

extrarenal causes of hypovolemic hypotonic hyponatremia

A 
diarrhea
vomiting
burns
fever
bleeding
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22
Q

renal causes of euvolemic hypotonic hyponatremia

A 
SIADH
post-op
stress
drugs
glucocorticoid deficiency
polydipsia
tea and toast/beer potomania
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23
Q

tea and toast/beer potomania

A

reduced solute intake in the setting of normal or elevated free water intake

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24
Q

renal causes of hypervolemic hypotonic hyponatremia

A

acute or chronic kidney injury with low urine output

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25
Q

extrarenal causes of hypervolemic hypotonic hyponatremia

A

CHF
cirrhosis
nephrotic syndrome

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26
Q

urinary sodium concentration due to renal losses

A

> 20 mmol/L

27
Q

urinary sodium concentration due to extra renal causes

A

< 20 mmol/L

28
Q

hypovolemic hypotonic hyponatremia treatment

A

volume replacement with normal saline

29
Q

euvolemic hypotonic hyponatremia treatment

A

water restriction

30
Q

hypervolemic hypotonic hyponatremia treatment

A

volume removal with diuretics or water and Na restriction

31
Q

most common cause of hyponatremia in hospitalized pts

A

SIADH

32
Q

causes of SIADH

A

drugs
CNS lesions
pulmonary lesions

33
Q

treatment for hyponatremia without symptoms

A

limit water intake to 1-1.5 L / day`

34
Q

hypervolemia symptoms

A

peripheral and presacral edema
pulmonary edema
JVD
HTN

35
Q

hypovolemia symptoms

A

poor skin turgor
dry mucous membranes
flat neck veins
hypotension

36
Q

severe hyponatremia treatment

A

for Na <115

IV hypertonic saline

37
Q

general clinical features of hyponatremia

A 
confusion
lethargy
fatigue
N/V
cramps
38
Q

symptoms of severe hyponatremia

A

*develops acutely
seizures
coma
respiratory failure

39
Q

what is osmotic demyelination

A

damage to the myelin sheath due to a rapid correction of hyponatremia, typically involves the pons region

40
Q

how much should sodium be raised per hour

A

0.5 mEq/L

41
Q

possible severe sx of demyelination

A

nerve palsies
quadriplegia
locked in syndrome

42
Q

hypernatremia definition based on sodium

A

increased serum sodium >145 mEq/L

43
Q

hypernatremia is due to (general)

A

increased free water loss

hypertonic sodium gain

44
Q

hypernatremia serum osmolality is always ______

A

increased resulting in a hypertonic state

45
Q

in hypovolemic hypernatremia Na is ____ and ECF is _____

A

high

low

46
Q

in euvolemic hypernatremia Na is ____ and ECF is _____

A

high

normal

47
Q

in hypervolemic hypernatremia Na is ____ and ECF is _____

A

high

high

48
Q

renal causes of hypovolemic hypernatremia

A

diuretics
postobstruction
intrinsic renal disease

49
Q

when the cause of volume change is renal the serum Na is _____

A

> 20 mmol

50
Q

extrarenal causes of hypovolemic hypernatremia

A

excess sweating
diarrhea
burns
fistulas

51
Q

renal causes of euvolemic hypernatremia

A

diabetes insipidus

hypodipsia

52
Q

renal causes of euvolemic hypernatremia

A

lack of access to/intake of water leads to oliguria

53
Q

renal causes of hypervolemic hypernatremia

A

primary hyperaldosteronism

Cushings

54
Q

hypernatremia symptoms

A 
dehydration on PE
thirst
confusion
lethargy
muscle twitching
vomiting
55
Q

severe hypernatremia sx

A

seizures
coma
neuro defects
respiratory arrest

56
Q

diabetes insipidus is due to

A

decreased or inefficient ADH = polyuria

57
Q

when the cause of volume change is renal, the urinary Na is _____

A

<600 mOsm/kg

58
Q

hypervolemic hypernatremia treatment

A

loop diuretics and free water replacement so that hypernatremia does not get worse

59
Q

hypovolemic hypernatremia treatment

A

isotonic fluids to replete volume and then hypotonic fluids (D5W) to correct hypernatremia

60
Q

diabetes insipidus treatment

A

desmopressin (synthetic ADH)

61
Q

urine osmolality is ___ if extra renal loss , and urine is ___

A

increased, concentrated

62
Q

urine osmolality is ___ if renal loss , and urine is ___

A

decreased

dilute

63
Q

pure water and 5% dextrose in water are both

A

hypotonic fluids

renal (17 decks)

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