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Clin Lab > Sodium > Flashcards

Sodium Flashcards

1
Q

What is the total body water for males?

A

60%

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2
Q

What is the total body water for females?

A

50%

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3
Q

What is the ratio of water found in the intracellular fluid?

A

2/3

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4
Q

What is the ratio of water found in the extracellular fluid?

A

1/3

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5
Q

What dictates the ECF volume?

A

The net gain/loss of Na

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6
Q

Describe the ECF when fluid loss is isotonic?

A

If fluid/blood loss is isotonic- the osmolality of the fluid is unchanges
-no change in ICF volume

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7
Q

Describe the ECF when fluid loss is hypotonic?

A

If fluid/blood loss is hypotonic- increases plasma osmolarity
-shifts ICF to ECF

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8
Q

What conditions commonly cause hyponatremia?

A
  • Hospitalized patients
  • Low total Na
  • Hypovolemic patients (dehydrated patients)
  • Elevated BUN:Cr ratio
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9
Q

Characteristics of Renal Sodium Loss (2)

A

Associated with…

  • High urinary Na excretion
  • High urinary osmolality (concentration)
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10
Q

What commonly causes renal Na loss?

A

Diuretics

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11
Q

This renal sodium loss is less common and its also called salt wasting nephritis

A

Renal Tubular Disease

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12
Q

What is typically associated with low urine Na excretion?

A
  • Diarrhea
  • Fever
  • Sweat/Exercise
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13
Q

Decreased Na intake is commonly seen in patients with…

A
  • Extremely poor diets (anorexia/alcoholics)

- Hospital patients that are on hypotonic IV fluids for a long time

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14
Q

Patients with hyponatremia commonly present with…

A
  • Hypovolumic
  • Low Na urine excretion
  • High urine osmolality (concentrated)
  • High BUN
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15
Q

How do people classify hyponatremia?

A
  • Volume Status

- Osmolality

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16
Q

What are some factors that you need to know before classifying a patient with hyponatremia?

A
  • History
  • Volume Status
  • BUN/Creatinine
  • Urine osmolality/electrolytes
  • Plasma osmolality
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17
Q

What is another phrase for hyponatremia with high plasma osmolality

A

Hypertonic hyponatremia

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18
Q

If a patient has elevated ECF osmolality, where does the water shift?

A

From ICF to ECF

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19
Q

If the fluid shifts from inside the cell to outside the cell, what would this do to the Na concentration?

A

Dilute the Na concentration

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20
Q

What is the most common cause of hypertonic hyponatremia?

A

Hyperglycemia

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21
Q

Describe hyperglycemias effect on hyponatremia?

A
  • Osmotic diuresis (increase in urine rate) causes renal Na and water loss
  • can further raise plasma osmolality (conc.)
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22
Q

If a patient has hyponatremia due to hyperglycemia, how do you treat?

A

Treat the hyperglycemia first

-Don’t give saline (causes the fluid to leave the ICF)

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23
Q

What is another name for hyponatremia with normal plasma osmolality?

A

Pseudohyponatremia

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24
Q

What causes Pseudohyponatremia?

A
  • Hyperlipidemia

- Hyperproteinemia (multiple myeloma)

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25
Q

What % of plasma is water?

A

93%

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26
Q

What is the remained 7% of plasma made of?

A
  • Proteins

- Lipids

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27
Q

How does hyperlipidemia and hyperproteinemia cause Pseudohyponatremia?

A

-The water content of a given volume of plasma is decreased
(the solids have pretty much displaced the water in the plasma)
-Causes plasma sodium to be falsely low

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28
Q

Is treatment required for Pseudohyponatremia?

A

Nopers

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29
Q

What is another name for hyponatremia with low plasma osmolality?

A

Hypotonic hyponatremia

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30
Q

Is the volume of the ECF in excess/deficient in hypotonic hyponatremia?

A

Excess (hypervolemic)

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31
Q

What are a patients urine Na levels if they have renal failure?

A

Urine Na is greater than 20 meq/L (the kidneys are failing so the volume levels stay high)

32
Q

What are a patients urine Na levels if they have CHF or hepatic cirrhosis?

A

Urine Na is less than 20 meq/L (they have increased venous pressure and this results in edema state)

33
Q

If a patient has edema, where is the edema fluid moving?

A

From plasma to the interstitial fluid

34
Q

What does the lose of plasma fluid result in?

A

Increase in the secretion of ADH and aldosterone

35
Q

What effect does ADH and aldosterone have?

A

Causes an increase in the total body water and that exceeds the rise in sodium

36
Q

What are treatment options for patients with hypotonic hyponatremia with ECF volume excess?

A
  • Judicious sodium (limit sodium to 1-3 grams/day)
  • Fluid Restriction (1-1.5 liters/day)
  • water intake must be less than urine output
37
Q

What are some signs of hypotonic hyponatremia with decreased ECF volume?

A

-Signs of dehydration because total sodium is depleted disproportionally to water losses

38
Q

What are 2 causes of hypotonic hyponatremia with decreased ECF volume?

A
  • Renal Losses

- Extra Renal Losses

39
Q

What are examples of renal losses?

A
  • Diuretic Therapy
  • Adrenal Insufficiency
  • ACE inhibitors
40
Q

What effect does diuretic therapy have?

A

Pulls of volume and Na

41
Q

What effect does adrenal insufficiency have?

A
  • Low aldosterone

- Inability to retain Na and water

42
Q

What effect do ACE inhibitors have?

A
  • Low Aldosterone

- Inability to retain salt and water

43
Q

What are examples of extra renal losses?

A
  • Vomiting
  • Diarrhea
  • Sweat
44
Q

What are clinical signs of hypotonic hyponatremia with hypovolemia?

A

Usually notice the depletion of water before the hyponatremia

45
Q

What is treatment for hypotonic hyponatremia with hypovolemia?

A
  • Reexpansion of ECF

- Use isotonic saline and correct any underlying disorders

46
Q

What causes hypotonic hyponatremia with normal ECF volume?

A
  • Primary Polydipsia

- Syndrome of inappropriate anti-diuretic hormone

47
Q

What patients express primary polydipsia?

A

Psych patients

-Due to excess water intake

48
Q

Describe urine sodium and urine concentration in primary polydipsia

A
  • Urine sodium is less than 20 meq/L

- Urine osmolality is less than 100 mOsm/kg

49
Q

What is the treatment for primary polydipsia?

A
  • Water restriction
  • Monitor plasma Na levels
  • Don’t want to increase Na too quickly
50
Q

This is the most common cause of hyponatremia and is the diagnosis of exclusion

A

Syndrome of inappropriate anti-diuretic hormone

51
Q

What causes the fluid and electrolyte balance in SIADH?

A
  • Inability to excrete dilute urine
  • Water retention in the body
  • Low Sodium levels
  • Often caused by Small Cell Lung cancer which secretes excess ADH
52
Q

What are characteristics of SIADH?

A
  • Low Na and osmolarity
  • Adequate urine sodium excretion with high urine osmolality
  • No edema
  • No evidence of dehydration
53
Q

What diseases/disorders is SIADH commonly seen in?

A
  • Lung disease
  • Malignancies
  • CNS abnormalities
  • Cortisol deficiency
54
Q

What are 2 clinical signs of hyponatremia?

A
  • Observed sodium concentrations are less than 120 meq/L

- Rate of fall in Na is rapid

55
Q

What are initial symptoms of hyponatremia?

A
  • Headache
  • Nausea
  • Cramps
  • Malaise
  • Lethargy
56
Q

What are progressive symptoms of hyponatremia?

A
  • Delirium
  • Psychosis
  • Seizures
  • Coma
57
Q

When is treatment of hyponatremia urgent?

A

-If Na is less than 110 meq/L or the patient is symptomatic

58
Q

Asymptomatic patients should not exceed over _____ per hour

A

.5 meq/L per hour

59
Q

Severe patients should not exceed over ______ per hour

A

1-1.5 meq/L per hour

60
Q

Patients should never exceed _____ per day

A

12 meq/L per day

61
Q

What is the major cause of hypernatremia?

A

Lack of free water access

62
Q

What patients commonly present with hypoernatremia?

A
  • Babies
  • Psych patients
  • Elderly patients
  • Patients that have neurological problems that don’t have thirst signals
63
Q

The loss of volume leads to _______ BUN:Cr levels?

A

Elevated (because the kidneys aren’t getting perfused and they cant filter)

64
Q

The loss of volume leads to ______ urine osmolality?

A

High (because it is more concentrated)

65
Q

_______ is the best indicator for following volume status

66
Q

What are the 2 types of Diabetes Insipitus?

A
  • Central DI

- Nephrogenic DI

67
Q

Describe ADH in central DI

A

-ADH is absent

68
Q

Do your thirst signals remain in central DI?

A

Yes they do man

69
Q

What are 2 S and S for central DI?

A
  • Polydipsia

- Polyuria

70
Q

Central DI is associated with…

A
  • Encephalopathy
  • Head trauma
  • Pituitary surgery
  • Tumor
71
Q

What is the treatment for Central DI?

A
  • dDAVP (artificial ADH)

- Stimulates water and Na uptake

72
Q

How do you confirm Central DI diagnosis?

A

-If the patient can concentrate the urine after receiving dDAVP

73
Q

Describe ADH in nephrogenic DI?

A

-Kidneys are resistant to ADH (so they don’t retain Na and water)

74
Q

What are characteristics/ S&S for nephrogenic DI?

A
  • Patients excrete large volumes of really dilute urine
  • Low Na in urine
  • Patients still have thirst signals
  • If they are unable to get water they will become dehydrated quickly
75
Q

What people tend to present with nephrogenic DI?

A

-3rd trimester pregnant patients

76
Q

How do you diagnose Nephrogenic DI?

A
  • Trial of water deprivation (if the patients fail to concentrate their urine they have nephrogenic DI)
  • Lack of response to dDAVP

Clin Lab (23 decks)

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