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Clin Med II - Exam 4 > Paulson - Sodium > Flashcards

Paulson - Sodium Flashcards

1
Q

hypernatremia parameter

A

over 145 mEq/L

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2
Q

mc cause of hypernatremia

A

water depletion

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3
Q

main extracellular cation

A

Na

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4
Q

pt population at high risk for hypernatremia

A

elderly → decreased thirst and access to fluids

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5
Q

3 classifications of fluid volume

A

hypervolemia

hypovolemia

euvolemia

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6
Q

3 causes of water loss

A

skin

GI

urine

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7
Q

3 clinical/pathologic causes of urine water/sodium loss

A

osmotic diuresis

diabetes insipidus

diuretics

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8
Q

2 causes of hypervolemic hypernatremia

A

iatrogenic from hypertonic saline or dialysis

hyperaldosteronism

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9
Q

2 causes of hypovolemic hypernatremia

A

renal losses → renal dz or diuretics

extrarenal losses

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10
Q

2 types of euvolemic hypernatremia

A

hypodipsia

diabetes indipidus

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11
Q

early s/sx of hypernatremia

A

anorexia

restlessness

n/v

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12
Q

more advanced sign of hypernatremia

A

AMS

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13
Q

order of AMS progression in hypernatremia

A
  1. lethargy/irritability
  2. stupor or coma
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14
Q

neurologic sx of hypernatremia (5)

A

twitching

hyperreflexia

ataxia

tremor

sz

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15
Q

sx of dehydration (7)

A

dry mm

tenting/poor skin turgor

lack of tears

decreased salivation

tachycardia

hypotn

oliguria/anuria

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16
Q

definition of chronic hypernatremia

A

present 2 or more days

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17
Q

chronic hypernatremia is less likely to present w.

A

neurologic sx

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18
Q

what pt pop does chronic hypernatremia make you think about

A

underlying neuro dz → impaired thirst → brain adaptation to hypernatremia

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19
Q

acute hypernatremia is more likely to present w.

A

neurologic sz

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20
Q

lab to order to diagnose hypernatremia

A

bmp → > 145

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21
Q

cause of hypernatremia is usually obvious from hx; if not, test to order

A

urine and plasma osmolality

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22
Q

hypernatremic + plasma osmolality > 295

A

extrarenal cause

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23
Q

hypernatremic + urine osmolality < plasma

A

diabetes insipidus

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24
Q

tx for hypernatremia

A

dilute fluids → correct/replace losses

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25
Q

for chronic hypernatremia, tx must be

A

slow!

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26
Q

what can happen if Na replacement is too quick for chronic hypernatremia

A

cerebral edema → sz → coma

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27
Q

fluid tx for chronic hypernatremia

A

D5W 1.35 mL/hr x wt in kg

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28
Q

Na should not be lowered > __

over __

A

10 mEq/L

24 hr

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29
Q

when should you recheck Na and glucose after initiation of fluids

A

4-6 hr after initiation

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30
Q

poor outcomes are associated w. hypernatremia and (3)

A

perioperative

PNA

VTE

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31
Q

definition of acute hypernatremia

A

less than 2 days

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32
Q

acute hypernatremia should be corrected w.in __

A

24 hr

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33
Q

fluid tx for acute hypernatremia

A

D5W 3-6 mL/kg/hr

OR

½ NS

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34
Q

what fluid should NOT be used for hypernatremia

A

NS

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35
Q

Na and glucose monitoring for acute hypernatremia

A

q 1-2 hr until Na < 145

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36
Q

after Na reaches < 145 in acute hypernatremia you should

A

decrease rate to 1 mL/kg/hr until goal of 140

37
Q

steps in fluids for acute hypernatremia (3)

A
  1. D5W 3-6 mL/kg/hr OR ½ NS
  2. monitor Na and glucose q 1-2 hr until Na < 145
  3. decrease rate to 1 mL/kg/hr until goal of 140
38
Q

goal for Na reduction for acute hypernatremia

A

1-2 mEq/L each hour

39
Q

rate of correction for chronic hypernatremia

A

no more than 10 mEq/L/day

40
Q

rate of correction for acute hypernatremia

A

lower to near normal in first 24 hr

41
Q

hyponatremia definition

A

Na < 135 mEq/L

42
Q

mc lyte d.o seen in hospitalized pt’s

A

hyponatremia

43
Q

mc cause of hypervolemic hyponatremia

A

fluid overload

water is added or retained → amt of Na in serum is diluted

44
Q

4 ex of pathologic hypervolemic hyponatremia

A

CHF

cirrhosis

IVF

nephrotic syndrome

45
Q

cause of hypovolemic hyponatremia

A

both water and Na are lost → more Na than water

46
Q

water and Na losses in hypovolemic hyponatremia can be either (2)

A

renal losses

extrarenal losses

47
Q

renal losses of water and Na

A

diuretics → esp thiazides

48
Q

extrarenal water and Na losses (4)

A

diarrhea

sweating

blood loss

fluid shifts

49
Q

5 causes of euvolemic hyponatremia

A

adrenal insufficiency

polydipsia

hypothyroidism

syndrome of inappropriate antidiuretic hormone (SIADH)

reset osmostat

50
Q

4 causes of SIADH

A

intracranial

paraneoplastic syndrome

pulmonary dz

meds

51
Q

2 meds that cause SIADH

A

SSRI

cyclophosphamide

52
Q

classification of hyponatremia by tonicity

A

hypotonic

isotonic

hypertonic

53
Q

4 causes of hypotonic hyponatremia

A

SIADH

CHF, cirrhosis, diuretics → blood volume depletion

endocrine d.o

advanced renal failure

54
Q

endocrine d.o that cause hypotonic hyponatremia (3)

A

hypothyroid

adrenal insufficiency

55
Q

ex of isotonic hyponatremia

A

pseudohyponatremia

56
Q

increased serum lipids or proteins cause erroneous measurement of Na levels

A

pseudohyponatremia

57
Q

2 causes of hypertonic hyponatremia

A

significant hyperglycemia

mannitol, maltose sucrose retention

58
Q

hyponatremia usually becomes symptomatic when Na is

A

125-130

59
Q

possible sx of hyponatremia (6)

A

anorexia

n.v

lethargy

disorientation

ha

sz

60
Q

possible clinical sx of hyponatremia (9)

A

weakness

agitation

hyporeflexia

orthostatic hypotn

delirium

coma

sz

resp arrest

brainstem herniation

61
Q

1st diagnostic steps for hyponatremia

A

BMP + serum osmolality

62
Q

which diagnostic test gives you info regarding tonicity cause of hyponatremia

A

serum osmolality

63
Q

other helpful tests for hyponatremia

A

urine osmolality

lytes

TSH

plasma cortisol

ACTH stimulation

brain/lung imaging

64
Q

hyponatremia flow chart

A
65
Q

in euvolemic hyponatremia, urinary Na is usually

A

Na > 20 mEq/L

66
Q

euvolemic hyponatremia plus urine osmolality >100 suggests

A

SIADH

hypothyroid

adrenal insufficiency

stress

drug use

67
Q

euvolemic hyponatremia plus urine osmolality < 100 suggests

A

primary polydipsia → low Na intake

beer potomania syndrome

68
Q

4 meds to know that cause hyponatremia

A

thazides

antipsychotics

SSRIs

contrast agents

69
Q

classification of hyponatremia

A

acute

subacute

chronic

severe

moderate

mild

70
Q

acute hyponatremia

A

w.in last 24 hr

71
Q

subacute hyponatremia

A

w.in last 24-48 hr

72
Q

chronic hyponatremia

A

w.in > 48 hr

73
Q

severe hyponatremia

A

120 or lower

74
Q

moderate hyponatremia

A

121-129

75
Q

mild hyponatremia

A

130-135

76
Q

pt w. any symptoms of hyponatremia needs

A

emergency therapy

even mild sx

77
Q

emergency fluid for symptomatic hyponatremia

A

hypertonic saline

78
Q

goal and monitoring for Na replacement for emergent tx (symptomatic pt)

A

raise NA by 4-6 over a couple hours

check Na q 2 hr

79
Q

goal for non-emergency Na replacement

A

bring Na up slowly

80
Q

overly rapid correction of hyponatremia can cause

A

osmotic demyelination syndrome (same-same central pontine myelinolysis)

81
Q

tx for hypovolemic hyponatremia

A

isotonic saline

82
Q

tx for hypervolemic hyponatremia: CHF, cirrhosis (3)

A

diuresis

fluid restriction

Na restriction

83
Q

tx for hypervolemic hyponatremia: renal failure

A

fluid restriction

dialysis

Na restriction

84
Q

tx for euvolemic hyponatremia

A

fluid restriction

if SIADH → +/- salt tabs and/or loop diuretic

85
Q

what is demeclocycline used off label for

A

SIADH

86
Q

indication for demeclocycline

A

SIADH pt who do not respond to salt tabs/loop diuretics

87
Q

s.e of demeclocycline (3)

A

renal toxicity → esp cirrhosis pt

nephrogenic DI

intracranial htn

88
Q

salt tabs should NEVER be given to

A

edematous pt

Clin Med II - Exam 4 (20 decks)

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