[PHARMA] NA+ DISTURBANCES Flashcards

1
Q

Normal Na+ level

A

135-145 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A.isotonic hyponatremia caused by?
B. TTT?

A

A. hyperlipidemia
B. Treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A. hypertonic hyponatremia caused by?
B. TTT?

A

A. hyperglycemia
B. Treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SIADHs

A

euvolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

severe symptomatic hyponatremia Na+ level

A

<120 mEq/L
for <24-48h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

mental changes
coma
seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

severe symptomatic hyponatremia TTT

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

symptoms of symptomatic hyponatremia usually improve after

A

4-6 mEq/L increase in 1st hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when to stop infusion in symptomatic hyponatremia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what to do once symptoms of symptomatic hyponatremia improve

A

stop infusion
switch to isotonic solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

rate of correction in symptomatic hyponatremia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what should be added to patients w/ concurrent volume overload

A

loop diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

rapid correction of hyponatremia leads to

A

osmotic dyemyelination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

osmotic demyelination symptoms (4)

A

ataxia
tremors
dystonia
parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

osmotic demyelination RF

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

management of hypotonic hypovolemic chronic hyponatremia

A

0.9% NaCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

management of hypotonic euvolemic chronic hyponatremia

A

1-free water restriction
2-Demeclocycline
3-Vaptans

19
Q

management of hypotonic hypervolemic chronic hyponatremia

A

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

20
Q

low serum Na+
high urine Na+
=?

A

SIADHs

21
Q

demeclocycline onset

A

2-3d

22
Q

demeclocycline adv effects

A

Skin photosensitivity
nephrotoxicity

23
Q

most potent ADH inhibitor

A

demeclocycline

24
Q

off label tetracycline derivative

A

demeclocycline

25
Q

conivaptan

A

V1 & V2
IV

26
Q

Tolvivaptan

A

V2
Oral

27
Q

conivaptan side effect

A

injection site reaction

28
Q

Vaptans indications

A

Euvolemic + hypervolemic ONLY
SIADHS
CHF w/ hyponatremia

29
Q

vaptans adv effects

A

polyuria
thirst
hypernatremia

30
Q

vaptans are CI in

A

hepatic cirrhosis

31
Q

isovolemic hypernatremia causes

A

diabetes insipidus

32
Q

hypervolemic hypernatremia cause

A

conn $ (inc aldosterone)

33
Q

major symptom of hypernatremia

A

thirst

34
Q

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

A

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

35
Q

suitable postmortem specimen in case of hypernatremia

A

vitreous humor

36
Q

correction of acute hypernatremia

A

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

37
Q

correction of chronic hypernatremia

A

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

38
Q

target Na+ in chronic hypernatremia

A

145 mEq/L

39
Q

target Na+ in hyponatremia

A

130 mEq/L

40
Q

hypovolemic hypernatremia management

A

isotonic saline

41
Q

euvolemic hypernatremia management

A

D5W + 0.25/0.5 isotonic NaCl

42
Q

hypervolemic hypernatremia management

A

D5W + diuretics

43
Q

patients w/ ARF may require

A

dialysis

44
Q

Na in hypernatremia should be monitored

A

every 1-2h