hyponatremia/hypernatremia

Question 1

hyperosmolality can be caused by what 3 things?

Answer 1

hypernatremia, high glucose, high BUN (renal failure)

Question 2

What are stimuli for ADH

Answer 2

high serum osmol, low blood volume, angiotensin II, pain, nausea

Question 3

What are the symptoms of hypernatremia

Answer 3

thirst, altered mental status (irritability, stupor, coma), SEIZURES, focal neuro deficits

Question 4

what are the extrarenal losses that cause hypernatremia

Answer 4

GI- NGT, vomit, diarrhea

Insensible- fever, sweating, burns, respirations

Question 5

What are the renal causes of hypernatremia?

Answer 5

diabetes insipidus, osmotic diuresis, loop diuretics

Question 6

What are the causes of nephrogenic diabetes insipidus,

Answer 6

lithium
amphotericin
hypercalcemia,
severe hypokalemia
post-obstruction
ATN recovery phase

Question 7

What other causs of hypernatremia should we be aware of>

Answer 7

hypertonic IVF and hyperaldosteronism

Question 8

hypernatremia, Uosm >700, Una

Answer 8

Extrarenal loss, GI or insensible

Question 9

hypernatremia, Uosm >700, Una >25

Answer 9

Na overload IVF hyperosmolar

mineralcorticoids

Question 10

hypernatremia, Uosm

Answer 10

renal H2O loss, complete DI

Question 11

hypernatremia U osm 300-600

Answer 11

partial DI
osmotic diuresis (mannitol, glucose, urea)
loop diuretics

Question 12

how do we calculate free water deficit

Answer 12

.6 x weight x (sodium concentration-ideal/ideal)

Question 13

3 basic steps for hypernatremia treatment?

Answer 13

• calculate free water deficit
• estimate ongoing losses
• restore water over 2-3 days- access free water or replace water with IV fluids

Question 14

what do we treat central DI with?

Answer 14

desmopressin

Question 15

what are the symptoms of overcorrecting hypernatremia

Answer 15

cerebral edema- nausea, malaise, stupor coma

Question 16

what is the hyperglycemia correction for Na?

Answer 16

every 100 in glucose then Na drops by 2.4

Question 17

isotonic hyponatremia

Answer 17

pseudo hyponatremia caused by hyperlipidemia or hyperproteinemia

Question 18

hypertonic hyponatremia is often caused by what?

Answer 18

hyperglycemia, mannitol (dilutional hypernatremia0

Question 19

what do we check in hypotonic hyponatremia

Answer 19

check volume status

Question 20

hypotonic hyponatremia, hypovolemia, urine sodium >20 >1%

Answer 20

diuretics

aldosterone deficiency

Question 21

hypotonic hyponatremia, hypovolemia, urine sodium

Answer 21

diarrhea
vomiting
thirdspacing
hypovolemia

Question 22

hypotonic hyponatremai, euvolemia, causes?

Answer 22

SIADH
Hypothyroid
cortisol deficiency (CRH and ADH secreted together)
primary polydipsia, beer potomania, tea and toast

Question 23

hypotonic hyponatremia, hypervolemia urine sodium >20 >1%

Answer 23

renal failure

Question 24

hypotonic hyponatremia, hypervolemia urine sodium

Answer 24

heart failure
cirrhosis
nephrotic syndrome

Question 25

what are hyponatremia general treamtment options

Answer 25

asymptomatic- water restrict

symptomatic +acute- hypertonic saline

Question 26

how do we treat hypovolemic hyponatremia>

Answer 26

volume replete–>ADH will normalize–> hyponatremia will normalize

Question 27

how do we correct hypervolemic hyponatremia?

Answer 27

1. loop diuretic
2. increase EABV- vasodilators in CHF, colloids in cirrhosis and nephrosis
3. water restrict

Question 28

how do we treat SIADH

Answer 28

• mild- water restriction
• severe- hypertonic saline
• other- salt tabs, conivaptan, demeclocycline

Question 29

What symptoms should we look for in hypernatremia?

Answer 29

restessness, weakness, focal neuro deficits- confustion seizure, coma

tissues and mucous membranes are dry,

SALVATION DECREASES (as opposed to hyponatremia)

Question 30

What are clinical manifestations of hyponatremia?

Answer 30

headache, delirium
muscle twitching
hyperactive deep tendon reflexes
Nausea, Vomit, ileus, watery diarrhea,
INCREASED SALVATION AND LACRIMATION
Oliguria progressing to anuria