[PHARMA] NA+ DISTURBANCES

Question 1

Normal Na+ level

Answer 1

135-145 mEq/L

Question 2

A.isotonic hyponatremia caused by?
B. TTT?

Answer 2

A. hyperlipidemia
B. Treat cause

Question 3

A. hypertonic hyponatremia caused by?
B. TTT?

Answer 3

A. hyperglycemia
B. Treat cause

Question 4

SIADHs

Answer 4

euvolemic

Question 5

severe symptomatic hyponatremia Na+ level

Answer 5

<120 mEq/L
for <24-48h

Question 6

symptoms when Na<120 mEq/L (acute symptomatic hyponatremia)

Answer 6

mental changes
coma
seizures

Question 7

delay in TTT of symptomatic hyponatremia can lead to (4)

Answer 7

1-irreversible neurological damage
2-brain stem herniation
3-Respiratory arrest
4-Death

Question 8

severe symptomatic hyponatremia TTT

Answer 8

3% saline
infused 1-2mL/kg/hour till u reach 6-8mEq/L increase

3% saline
IV bolus 100-150mL every 20 minutes till u reach 2-3mEq/L increase

Question 9

symptoms of symptomatic hyponatremia usually improve after

Answer 9

4-6 mEq/L increase in 1st hour

Question 10

when to stop infusion in symptomatic hyponatremia

Answer 10

-symptoms improve
-reach 130 mEq/L
-increase Na+ by 10mmol/L

Question 11

what to do once symptoms of symptomatic hyponatremia improve

Answer 11

stop infusion
switch to isotonic solution

Question 12

rate of correction in symptomatic hyponatremia

Answer 12

6-10mEq/L in 1st 24h & ≤18 mEq/L in 48h

Question 13

what should be added to patients w/ concurrent volume overload

Answer 13

loop diuretics

Question 14

rapid correction of hyponatremia leads to

Answer 14

osmotic dyemyelination

Question 15

osmotic demyelination symptoms (4)

Answer 15

ataxia
tremors
dystonia
parkinsonism

Question 16

osmotic demyelination RF

Answer 16

1-liver disease & malnutrition
2- Na+ <120 mEq/L for more than 48h
3-hypernatremia

Question 17

management of hypotonic hypovolemic chronic hyponatremia

Answer 17

0.9% NaCl

Question 18

management of hypotonic euvolemic chronic hyponatremia

Answer 18

1-free water restriction
2-Demeclocycline
3-Vaptans

Question 19

management of hypotonic hypervolemic chronic hyponatremia

Answer 19

1-free water & salt restriction
2- Vaptans
3-Loop diuretics

Question 20

low serum Na+
high urine Na+
=?

Answer 20

SIADHs

Question 21

demeclocycline onset

Answer 21

2-3d

Question 22

demeclocycline adv effects

Answer 22

Skin photosensitivity
nephrotoxicity

Question 23

most potent ADH inhibitor

Answer 23

demeclocycline

Question 24

off label tetracycline derivative

Answer 24

demeclocycline

Question 25

conivaptan

Answer 25

V1 & V2 IV

Question 26

Tolvivaptan

Answer 26

V2 Oral

Question 27

conivaptan side effect

Answer 27

injection site reaction

Question 28

Vaptans indications

Answer 28

Euvolemic + hypervolemic ONLY SIADHS CHF w/ hyponatremia

Question 29

vaptans adv effects

Answer 29

polyuria thirst hypernatremia

Question 30

vaptans are CI in

Answer 30

hepatic cirrhosis

Question 31

isovolemic hypernatremia causes

Answer 31

diabetes insipidus

Question 32

hypervolemic hypernatremia cause

Answer 32

conn $ (inc aldosterone)

Question 33

major symptom of hypernatremia

Answer 33

thirst

Question 34

what happens with serum Na+ levels >153 mmol//L

Answer 34

brain cell shrinkage---> confusion, msc twitching, coma, seizures, death

Question 35

suitable postmortem specimen in case of hypernatremia

Answer 35

vitreous humor

Question 36

correction of acute hypernatremia

Answer 36

1-2mEq/L for 2-3h maximum increase= 12 mEq/L

Question 37

correction of chronic hypernatremia

Answer 37

<0.5 mEq/L total increase= 8-10 mEq/L for fear of brain edema

Question 38

target Na+ in chronic hypernatremia

Answer 38

145 mEq/L

Question 39

target Na+ in hyponatremia

Answer 39

130 mEq/L

Question 40

hypovolemic hypernatremia management

Answer 40

isotonic saline

Question 41

euvolemic hypernatremia management

Answer 41

D5W + 0.25/0.5 isotonic NaCl

Question 42

hypervolemic hypernatremia management

Answer 42

D5W + diuretics

Question 43

patients w/ ARF may require

Answer 43

dialysis

Question 44

Na in hypernatremia should be monitored

Answer 44

every 1-2h