Hyponatremia and Electrolyte disorders Flashcards

1
Q

Why would you have hyponatremia with dehydration?

A

Replacing blood volume > replacing sodium

ADH > aldosterone

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2
Q

Isotonic hyponatremia

A

Extra protein: myeloma

Extra fat: hyperlipidemia

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3
Q

Hypertonic hyponatremia

A

Extra carb:

1) hyperglycemia
2) mannitol, other sugars
3) radiocontrast
4) ethylene glycol, methanol

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4
Q

Hypotonic hyponatremia

A

Look at volume status

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5
Q

Hypovolemia

A

UNa 20 = renal salt loss

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6
Q

Euvolemia

A
UNa > 20
SIADH
Cortisol
Drug interactions (NSAIDs, SSRIs)
Polydipsia
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7
Q

Hypervolemia

A

UNa 20 = Advanced kidney disease

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8
Q

Increased salt retention

A

Hypokalemia and alkalosis

Bicarb high - secondary aldosteronism, contraction alkalosis

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9
Q

Hypokalemia on EKG

A

Inverted T and U waves

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10
Q

BUN and dehydration

A

Elevated

Moves down conc gradient in to blood, ADH increase reabsorption

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11
Q

Elevated BUN/Creatinine ratio

A
High protein intake or breakdown:
         Catabolic state 
         Catabolic drugs, ie tetracycline, steroids
         GI bleed
 Pre renal disease: 
         Dehydration
         CHF
         Shock
         Glomerulonephritis
Post renal disease:
         Prostatic obstruction
         Ureteral obstruction
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12
Q

Ratio of 10

A

Normal or intrarenal

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13
Q

Ratio less than 10

A

Low BUN

liver failure, malnutrition, overhydration, pregnancy, SIADH

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14
Q

Intrinsic renal failure with an anion gap acidosis

A

Decreased organic acid excretion

Increase UNa - no reabsorption
Decrease bicarb - no reabsorption

Ratio decreased - intrarenal failure

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15
Q

Hypotonic hypervolemia

A

No effective plasma volume

Low UNa - RAS

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16
Q

Classic example of Hypotonic Euvolemic

Hyponatremia

A

SIADH

17
Q

Positive dipstick for hemoglobin

A

Blood OR myoglobin (no RBCs)

18
Q

Prolonger PR interval with peaked T waves

A

Hyperkalemia

19
Q

Causes of ATN

A
Ischemic causes of ATN: 
     post op
     shock, sepsis
     pancreatitis 
     hypophosphatemia
Toxic causes of ATN:
     aminoglycosides
     vancomycin
     cyclosporine
     radiographic contrast media
     myoglobinuria
     hemoglobin
     hyperuricemia
     Bence Jones protein
20
Q

Phosphate replacement

A

Must be slow to avoid hypocalcemia

21
Q

Classic crush injury rhabdomyolysis

A

Rapid increase in phosphate, uric acid and potassium
CaxP precipitates into tissue
Do NOT replace decreased Ca

22
Q

ATN recovery

A

Polyuria until brush border recovered

23
Q

Lung and brain cancer

A

SIADH