Sodium and fluid balance

Question 1

what is the normal sodium level

Answer 1

135-145

Question 2

how should you assess hyponat

Answer 2

do a vol assessment

Question 3

what will be the findings in hypovolaemic hyponat

Answer 3

low urine Na (<20)
tachycardia
postural hypotension

Question 4

causes of hypovol hyponat

Answer 4

D&V, diuretics

Question 5

3 causes of eurovol hyponat and the investigations you would do

Answer 5

hypothy - do thy func test
adrenal insuff - short synACTHen test
SIADH - plasma and urine osmolarity (plasma = low, urine = >100)

Question 6

causes of hypervolaemic hyponat

Answer 6

cardiac F, cirrhosis, renal F

Question 7

management of hyponat

Answer 7

hypovol - vol rep with 0.9% saline

euro/hypervol - fluid res + treat cause

Question 8

how do you treat SIADH

Answer 8

fluid res

if insuff - demeclocycline, Tolvaptan

Question 9

what is the danger in rapidly correctly serum Na

Answer 9

osmotic demyelination

central pontine demyelinosis/osmotic demyelination syndrome

Question 10

causes of hypernatraemia

Answer 10

inc Na - high intake, Conn’s syndro, renal a stenosis, cushings syndro
dec water - renal loss (DI, osmotic diuresis), GI loss, sweat

Question 11

management of hypernat

Answer 11

5% dextrose (if hypovol) then 0.9% saline and dextrose water

serum Na checks every 4-6 hrs

Question 12

hyponat sympto

Answer 12

headache, lethargy, dizziness, confusion, psychosis