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Nephrology Board Review > Hyponatremia > Flashcards

Hyponatremia Flashcards

1
Q

what is osmolarity?

A

measure of water balance

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2
Q

calculation for serum osmolarity

A

2[Na+] + [glucose]/18 + [urea]/2.8 + [EtOH]/4.6 = calculated

osm

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3
Q

what is the main determinant of serum osmolarity?

A

serum Na+

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4
Q

what is serum [Na+] a surrogate of?

A

water

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5
Q

what is serum [Na+] NOT a surrogate of?

A

Na+ content

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6
Q

what is an osmole?

A

amound of a substance that dissociate in solution to form one mole of osmotically ACTIVE particles

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7
Q

dysnatremias are a disorder of

A

WATER metabolism

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8
Q

volume regulation clinically defined by

A

effective arterial blood volume

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9
Q

water regulation clinically defined by

A

plasma osmolality

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10
Q

volume regulation clinically measured by

A

physical exam

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11
Q

water regulation clinically measured by

A

serum [Na+]

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12
Q

volume regulation regulated by

A

baroreceptors

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13
Q

water regulation regulated by

A

osmoreceptors

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14
Q

volume regulation hormones activated

A

renin, angiotensin, aldosterone, catecholamines, atrial natriuretic peptide, ADH

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15
Q

water regulation hormones activated

A

ADH

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16
Q

volume regulation evaluated by

A

urine Na+

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17
Q

water regulation evaluated by

A

urine osmolality

18
Q

volume regulation treated by

A

giving or restricting SALT or VOLUME

19
Q

water regulation treated by

A

giving or restricting WATER

20
Q

how much water, how much volume in 1 liter of: 0.9% saline

A
  • water 0 L

- volume 1 L

21
Q

how much water, how much volume in 1 liter of: d5w

A
  • water 1 L

- volume 0 L

22
Q

how much water, how much volume in 1 liter of: 0.45% saline

A
  • water 500 ml

- volume 500 ml

23
Q

how much water, how much volume in 1 liter of: d5w w/ 3 amps NaHCO3

A
  • water 0 L

- volume 1 L

24
Q

how much water, how much volume in 1 liter of: 1/4% saline (39 meq NaCl)

A
  • water 750 ml

- volume 250 ml

25
Q

TBW equals?

A

60% weight

26
Q

ICF = how much of TBW?

A

2/3

27
Q

ECF = how much of TBW?

A

1/3

28
Q

ISF = how much of ECF?

A

3/4

29
Q

IVF = how much of ECF?

A

1/4

30
Q

movement of fluid between ECF and ICF is determined by

A

Starling forces (hydrostatic, oncotic)

31
Q

what % of plasma is protein and lipids?

A

7%

32
Q

why does pseudohyponatremia occur?

A

indirect ion-selective electrode measurements (sample is diluted prior)

33
Q

MCC of iso/hypertonic hyponatremia

A

hyperglycemia

34
Q

causes of hyponatremia w/ low urine osmolality

A
  • primary polydipsia
  • beer potomania
  • tea and toast diet
35
Q

what drives urine output?

A

solute intake

36
Q

impaired renal dilution d/t

A
  • diminished GFR
  • older age
  • thiazide diuretic
  • ADH (SIADH, volume depletion, nausea, pain)
  • abnormal ADH receptor in cortical collecting duct
37
Q

stimuli for ADH

A
  • increased tonicity
  • volume depletion (true OR ineffective arterial volume 2/2 CHF or cirrhosis)
  • pain
  • nausea
  • medications (antidepressants, antieplieptics, antipsychotics, MDMA)
  • cancer (paraneoplastic ADH release)
38
Q

uric acid level in SIADH

A

LOW

39
Q

main consequence of hyponatremia

A

ODS

40
Q

organic osmolytes released from brain cells as defense against water (takes several days)

A
  • glutamate
  • taurine
  • myoinositol
41
Q

signs/symtpoms of cerebral edema from hyponatremia

A
  • lethargy
  • seizures
  • fatal herniation
  • noncardiogenic pulmonary edema
42
Q

treatment of hyponatremia

A
  • fluid restriction for ALL pts
  • correct ADH stimulus
  • 3% saline, aquaporin antagonists, loop diuretics

Nephrology Board Review (4 decks)

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