Hyponatremia

Question 1

Evaluation

Answer 1

urine Na
serum Na
clinical staus

Question 2

Nml urine Na

Answer 2

10-20 mEq/L

Question 3

Nml serum Na

Answer 3

~ 280

2 X Na = 2 X 140 = 280

Question 4

Urine Na distinguishes between?

Answer 4

renal from non-renal causes

Question 5

Urine Na < 10 mEq/L

Answer 5

renal retention to compensate for extrarenal fluid loss

Question 6

Urine Na > 20

Answer 6

renal salt wasting

problem with kidneys

Question 7

Serum osmo 284-295 mosm/kg

Answer 7

isotonic hyponatremia / Pseudohyponatremia

Question 8

Mgmt of isotonic hyponatremia / Pseudohyponatremia

Answer 8

cut down fat (d/t hyperlipidemia or hyperproteinemia)

no fluid restriction

Question 9

Serum osmo <280

Answer 9

Hypertonic hyponatremia
‘state of water excess’
Assess if hypervolemic or hypovolemic

Question 10

Serum osmo < 10 mEq/L

hypovolemic

Answer 10

1. diarrhea
2. dehydration
3. emesis

Question 11

Serum osmo 20

hypovolemic

Answer 11

Low volume, kidneys cannot conserve Na

1. diuretics
2. ACE inhibitors
3. Mineralocorticoid deficiency

Question 12

Hypervolemic, hypotonic hyponatremia

Answer 12

need to restrict water

1. Edematous state
2. CHF
3. Liver disease
4. Adv renal failure

Question 13

Serum osmo > 290

Answer 13

Hypertonic Hyponatremia

Question 14

Hypertonic Hyponatremia d/t:

Answer 14

1. Hyperglycemia, usu. HHNK

Question 15

Mgmt of hyponatremia

Answer 15

tx bases on cause
If hypovolemic: NS IV
Urine Na > 20, treat cause
If hypervolemic, restrict water
If symptomatic (n/v, ha, malaise): NS IV with loop diuretic
If CNS symptoms present, 3% NS IV with loop diuretics