[PHARMA] NA+ DISTURBANCES Flashcards
Normal Na+ level
135-145 mEq/L
A.isotonic hyponatremia caused by?
B. TTT?
A. hyperlipidemia
B. Treat cause
A. hypertonic hyponatremia caused by?
B. TTT?
A. hyperglycemia
B. Treat cause
SIADHs
euvolemic
severe symptomatic hyponatremia Na+ level
<120 mEq/L
for <24-48h
symptoms when Na<120 mEq/L (acute symptomatic hyponatremia)
mental changes
coma
seizures
delay in TTT of symptomatic hyponatremia can lead to (4)
1-irreversible neurological damage
2-brain stem herniation
3-Respiratory arrest
4-Death
severe symptomatic hyponatremia TTT
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
symptoms of symptomatic hyponatremia usually improve after
4-6 mEq/L increase in 1st hour
when to stop infusion in symptomatic hyponatremia
-symptoms improve
-reach 130 mEq/L
-increase Na+ by 10mmol/L
what to do once symptoms of symptomatic hyponatremia improve
stop infusion
switch to isotonic solution
rate of correction in symptomatic hyponatremia
6-10mEq/L in 1st 24h & ≤18 mEq/L in 48h
what should be added to patients w/ concurrent volume overload
loop diuretics
rapid correction of hyponatremia leads to
osmotic dyemyelination
osmotic demyelination symptoms (4)
ataxia
tremors
dystonia
parkinsonism
osmotic demyelination RF
1-liver disease & malnutrition
2- Na+ <120 mEq/L for more than 48h
3-hypernatremia
management of hypotonic hypovolemic chronic hyponatremia
0.9% NaCl
management of hypotonic euvolemic chronic hyponatremia
1-free water restriction
2-Demeclocycline
3-Vaptans
management of hypotonic hypervolemic chronic hyponatremia
1-free water & salt restriction
2- Vaptans
3-Loop diuretics
low serum Na+
high urine Na+
=?
SIADHs
demeclocycline onset
2-3d
demeclocycline adv effects
Skin photosensitivity
nephrotoxicity
most potent ADH inhibitor
demeclocycline
off label tetracycline derivative
demeclocycline
conivaptan
V1 & V2
IV
Tolvivaptan
V2
Oral
conivaptan side effect
injection site reaction
Vaptans indications
Euvolemic + hypervolemic ONLY
SIADHS
CHF w/ hyponatremia
vaptans adv effects
polyuria
thirst
hypernatremia
vaptans are CI in
hepatic cirrhosis
isovolemic hypernatremia causes
diabetes insipidus
hypervolemic hypernatremia cause
conn $ (inc aldosterone)
major symptom of hypernatremia
thirst
what happens with serum Na+ levels >153 mmol//L
brain cell shrinkage—> confusion, msc twitching, coma, seizures, death
suitable postmortem specimen in case of hypernatremia
vitreous humor
correction of acute hypernatremia
1-2mEq/L for 2-3h
maximum increase= 12 mEq/L
correction of chronic hypernatremia
<0.5 mEq/L
total increase= 8-10 mEq/L
for fear of brain edema
target Na+ in chronic hypernatremia
145 mEq/L
target Na+ in hyponatremia
130 mEq/L
hypovolemic hypernatremia management
isotonic saline
euvolemic hypernatremia management
D5W + 0.25/0.5 isotonic NaCl
hypervolemic hypernatremia management
D5W + diuretics
patients w/ ARF may require
dialysis
Na in hypernatremia should be monitored
every 1-2h
