IM

Question 1

Calculated osmolality=

Answer 1

(Na x 2) + glucose/18 + BUN/2.8

Question 2

Osmolar gap is the difference between the ___ and the ___ and is normally less than ___.

Answer 2

Measured and calculated osmolality…less than 10 mOsm/L

Question 3

Osmolality refers to ___ where as tonicity describes ___

Answer 3

Osmolality refers to all particles, where as tonicity describes whether the particles are effective or ineffective osmoles. Effective osmoles (ex. Na, glucose) cannot penetrate cell membranes and thus can lead to changes in cell volume. Ineffective osmoles (ex. urea and alcohols) are ineffective osmoles because they pass freely into and out of cells and are unable to effect changes in cell volume.

Question 4

Three causes of hyponatremia not associated with a hypo-osmolar state

Answer 4

1) Psydohyponatremia: Occurs in hyperglobulinemia or hypertryglyceridemia (plasma water relative to solids is decreased in blood leading to less Na in a given volume of blood)
2) True hyponatremia with elevations in [ ] of an effective osmole: Hyperglycemia (increased plasma glucose pulls water out of cells and dilutes serume Na)
3) Addition of an isosmotic non-Na containing fluid to the extracellular space: typically occurs during a TURP or laproscopic surgery

Question 5

Hypotonic Hyponatremia implies that water intake ___ the abilit of the kidney to excrete water

Answer 5

Excedes

Question 6

Hypotonic Hypatremia with dilute urine (Uosm <100), Ddx:

Answer 6

1. Primary Polydipsia (consuming >20-30L per day)
2. Beer potomania (mod fluid intake with extremely low solute intake)
3. “Tea and Toaster” (mod fluid intake with extremely low solute intake)

Question 7

Most common cause of drug induced hyponatremia

Answer 7

Thiazide diuretics

Question 8

Symptoms of hyponatremia

Answer 8

Nausea, malaise, headache, lethargy muscle cramps, disorientation, restlessness, obtundation

Question 9

General approach to hypernatremia

Answer 9

1. Why has there been inadequate intake of water? (ex. altered LoC)
2. Search for presence of accelerated water loss or increased Na gain (incensible losses from respiratory tract or skin result in concentrated urine, where as inappropriate water loss from DI results in dilute urine)

Question 10

Urine osmolality >300 in the polyuric patient patient is suggestive of ____

Answer 10

Solute or osmotic diuresis

Question 11

Central and nephrogenic DI often have this symptoms

Answer 11

Frequent nocturia

Question 12

Central and nephrogenic Di are distinguished by

Answer 12

Change in urine osmolality following subcutaneous administration of AVP (increased in central no change in nephrogenic)

Question 13

Signs and symptoms of hypernatremia include

Answer 13

Lethargy, weakness, fasciculations, seizures, coma

Question 14

Water deficit can be calculated with this equation

Answer 14

Current body water (0.6 in med and 0.5 in women x body weight) x [( [Na plasma]/140) - 1]

Question 15

Tx of uncomplicated hospital acquired pneumonia

Answer 15

Ceftriaxone 1g IV step down to Amox Clav PO

Question 16

Examples of counterregulatory hormones released in catabolic and critical illnesses

Answer 16

Cortisol, Catecholamines, glucagon

Question 17

Tb involving the spine is called…

Answer 17

Pott’s

Question 18

Individuals who are likely to be malnourished include

Answer 18

Involuntary body weight loss 5% or more within weeks-months, weight less than 90% of ideal body weight, BMI <18.5

Question 19

Equation to estimate energy requirements is called

Answer 19

Harris-Benedict equation

Question 20

Adequate energy goal for most patients is estimated at ____ (using most recent prehospital clinic dry body weight)

Answer 20

20-25kcal/kg/day

Question 21

When it comes to nutrition, if the ____ works use it!

Answer 21

When it comes to nutrition, if the gut works use it!

Question 22

Complications of enteral tube feeding include

Answer 22

Diarrhea, aspiration, mechanical tube issues if placed in nose, leakage/skin issues if percutaneously placed, metabolic complications (fluid imbalances, hyperglycemia, lyte abnormalities, azotemia, refeeding syndrome)

Question 23

Indications for parenteral nutrition include:

Answer 23

1. Short bowel syndrome or other conditions causing intestinal failure
2. Patient is stable, unlikely to get sufficient enteral feeding for 7-10 days
3. Severe catabolic stress in ICU, enteral intake unlikely for 3-5 days