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*OldPharm > Sodium and Water Disorders > Flashcards

Sodium and Water Disorders Flashcards

1
Q

Normal adults are considered to have a minimal obligatory water intake of ________ mL/ day

A

1600 mL/day

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2
Q

what is the breakdown of water needs per day

A

Ingested water- 500mL
Water in food- 800mL
Water from oxidation – 300mL

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3
Q

what is the normal water loss per day

A

2.5-3 Liters per 24 hours

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4
Q

what is the breakdown of water losses

A

Loss from urine 500mL
Skin- 500mL
Respiratory Tract- 400mL
Stool- 200mL

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5
Q

what conditions require increased fluid needs

A

burns, diarrhea, dehydration, fever

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6
Q

what conditions require decreased fluid needs

A

CHF, renal failure, iatrogenic fluid overload, mechanical ventilation

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7
Q

where does most of the water go?

A

intracellular fluid

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8
Q

what is determined by the concentrations of effective osmoles in the ECF.

A

tonicity

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9
Q

_________ osmoles are solutes that can not move freely across cell membranes.

A

Effective

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10
Q

what is the main effective osmole in the ECF?

A

Sodium

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11
Q

when there is decreased wall stress in the atria and pulmonary vasculature the hypothalamus is stimulated to release what? This is the low pressure system

A

ADH

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12
Q

what stimulated the reinin-angiotensin-aldosterone system

A

Baroreceptors in aortic arch, carotid sinus, and juxtaglomerular apparatus
(high pressure system)

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13
Q

________ cleaves angiotensin to generate Angiotensin I

A

Renin

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14
Q

Angiotensin I is then cleaved by _______________ to Angiotensin II

A

angiotensin converting enzyme (ACE)

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15
Q

what does angiotensin II lead to

A

Stimulation of Aldosterone secretion by adrenal gland
Increased reabsorption of NaCl from proximal tubule
Central stimulation of thirst and secretion of ADH
Arteriolar vasoconstriction

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16
Q

What solutions are hypotonic

A

D5W

1/2 NS

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17
Q

what is an isotonic solution

A

Normal Saline

lactated ringers

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18
Q

what is a hypertonic solution

A

3% saline

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19
Q

is dextrose a good volume replacement

A

no, good for patients who need calories

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20
Q

where does dextrose distribute?

A

to all compartment

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21
Q

what types of saline are hypotonic? where are they distributed

A

1/4 NS and 1/2 NS

distributed to intracellular (mainly), plasma, interstitial

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22
Q

where is 0.9% NS (isotonic) distributed

A

ECF only

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23
Q

problem w/ 0.9% NS in large volumes

A

acidosis

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24
Q

when is 0.9% NS useful

A

dehydration/ hypovolemic state

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25
Q

Is 3% saline commonly used?

A

No, hypertonic and high solute in extracellular compartment draws water from intracellular compartment

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26
Q

More physiologic isotonic solution than NS

Confined to extracellular compartment

A

Lactated Ringers

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27
Q

Is NS or lactated ringers safer in large volumes

A

Lactated ringers

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28
Q

when is a fluid imbalance desirable?

A

correction for dehydration

fluid overload in CHF patients

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29
Q

what is the major determinant of ECF osmolality?

A

Sodium

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30
Q

what 2 other things contribute to ECF osmolality?

A

chloride

bicarbonate

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31
Q

what is the normal range for serum sodium

A

135-145 mEq/L

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32
Q

do serum sodium concentrations always reflect total body sodium concentrations

A

No

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33
Q

If a patient is hypernatremic what must you look at next?

A

volume status (Hypervolemia, isovolemic, hypovolemic)

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34
Q

If a patient is hyponatremic, what must you assess next?

A

Tonicity

can be hypertonic, isotonic, hypotonic (3 different fluid levels)

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35
Q

what antiepileptic can cause SiADH?

A

carbamazepine

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36
Q

what antiepileptic can cause diabetes insipidus?

A

phenytoin

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37
Q

a count of the number of particles in a fluid sample

A

osmolality

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38
Q

what regulates osmolality

A

ADH

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39
Q

ADH is also secreted in response to hypovolaemia and this stimulus will over-ride any response to _________________ .

A

serum osmolality

40
Q

what is the normal range of urine osmolality

A

50-1200 mmol/kg

41
Q

what is the best measure of urine concentration

A

urine osmolality

42
Q

The main factor determining urine concentration is the amount of water which is resorbed in ______ and ________ in response to ADH.

A

the distal tubules and collecting ducts

43
Q

In a dehydrated patient with normally functioning pituitary and kidneys, a small volume of highly _____________ urine will be produced.

A

concentrated

44
Q

when is serum osmolality used?

A

investigation of hyponatraemia and identificaiton of an osmolar gap

45
Q

when does hypernatremia usually occur?

A

hospitalized patients (elderly and breastfed infants more common)

46
Q

what is the serum level of Na in hypernatremia?

A

Na > 145 mEq/L

always associated w/ hypertonicity- serum > 295 mOsm

47
Q

IF a person is hypernatremic what do you classify them according to?

A

ECF status

48
Q

what can lead to hypervolemic hypernatremia?

A

Sodium overload
sodium bicarb therapy
albumin therapy
mineralcorticoid excess

49
Q

what can cause isovolemic hypernatremia?

A

diabetes insipidus
osmotic diuretic
hyperglycemia
no access to water

50
Q

what can cause hypovolemic hypernatremia (losing both water and Na but losing water to greater extend than sodium)

A 
renal disorders
diuretics
diarrhea
laxative abuse
excess sweating
51
Q

what is a Disorder of antidiuretic hormone (ADH) release that causes isovolemic hypernatremia.

A

diabetes insipidus

52
Q

what are the 2 types of diabetes insipidus

A

central

nephrogenic

53
Q

what is the clinical presentation of diabetes insipidus?

A

dehydration
volume depletion
increase in urine output

54
Q

causes of central DI?

A

CNS tumors
cerebral clots of bleed
head trauma
TB, syyphilis

55
Q

what are nephrogenic causes of DI?

A

renal diseases

56
Q

what drugs can induce DI?

A

lithium, phenytoin, foscarnet, demeclocycline

57
Q

what can decrease in brain volume in DI cause?

A

Decrease in brain volume can cause rupture of cerebral vein, hemorrhages, and irreversible neurological damage

58
Q

symptoms of DI?

A

lethargy, weakness, confusion, restlessness, irritability

59
Q

what would a patient w/ hypervolemic hypernatremia look like?

A

edematous

pulmonary congestion

60
Q

how do you treat hypervolemic hypernatremia?

A

need to dilute sodium and remove excess sodium and fluid
administer a hypotonic solution (D5W)
and add a loop diuretic (furosemide)

61
Q

what can happen if serum Na is decreased too quickly

A

cerebral edema, seizures, permanent neurological damage

62
Q

how do you treat isovolemic hypernatremia?

A

replace water deficit
give D5W at 1.3-2 mL/kg/hour
ADH (vasopressin) analgoue/ DDAVP
adjunct- HCTZ, carbamazepine, chlorpropamide

63
Q

how do you treat nephrogenic diabetes insipidus

A

thiazide diuretic and dietary sodium restriction

64
Q

what is the problem w/ hypovolemic hypernatremia

A

losing more fluid than Na, but losing both of them

65
Q

Tx for hypovolemic hypernatremia

A

restore intravascular volume w/ NS
replace free water deficit
can switch to more hypotonic solution once fluid is replaced

66
Q

what is hyponatremia

A

Serum sodium < 135 mEq/L

67
Q

what is the most common electrolyte abnoramlity in hospitalized patients?

A

hyponatremia

68
Q

do all patient w/ hyponatermia need Na?

A

No

69
Q

what can cause high plasma osmolaity hyponatremia?

A

hyperglycemia

Mannitol

70
Q

What can cause normal plasma osmolality hyponatremia?

A

hyperproteinemia
hyperlipidemia
bladder irrigation

71
Q

what can cause low plasma osmolality hyponatremia

A

figure out if urine is dilute, it yes then primary polydipsia, recent osmostat
If urine isn’t dilute need to access fluid status

72
Q

If a patient is hyponatremic w/ hypertonic what is usually the cause?

A

excess osmols in ECF (including serum)

usually caused by excess glucose

73
Q

how do you treat hyponatremic w/ isotonic fluid

A

tx underlying cause of hyperproteinemia
hyperlipidemia
bladder irrigation

74
Q

have excess water in relation to existing fluid stores.

A

hypotonic hyponatremia

75
Q

have excess total body Na with excess of ECF

A

hypervolemic hypotonic hyponatremia

76
Q

causes of hypervolemic hypotonic hyponatremia

A

CHF
cirrhosis
hypoalbuminemia

77
Q

patient has normal total body Na, but there is a small increase in ECF.

A

isovolemic hyptonic hyponatermia

78
Q

causes of isovolemic hyptonic hyponatermia

A 
imbalance of ins and out
SIADH
excessive ADH activity (SSRI, Ecstasy)
defective renal diluting mechanism
altered thirst
psychiatric disorder
79
Q

Release of ADH when not needed or increased response to ADH

opposite of diabetes insipidus

A

SiADH

80
Q

what are non-drug causes of SiADH?

A

CNS tumors, cerebral thrombosis or bleed, head trauma

meningitis, pneumonias, TB

81
Q

What can cause drug induced SiADH

A

NSAIds, carbamazepine, vincristine
opioids, phenobarbital, thiazide diuretics
TCAs, ecstasy

82
Q

what is due to a loss of sodium and ECF, but more Na

A

Hypovolemic Hypotonic Hyponatremia

83
Q

causes of Hypovolemic Hypotonic Hyponatremia

A

GI losses (V/D)
renal lsoses (diuretic)
weating
iatrogenic

84
Q

for Hypovolemic Hypotonic Hyponatremia if loss of sodium is from an extrarenal cause, the urine sodium concentration will be ____?

A

low (<20mEq/L)

85
Q

for Hypovolemic Hypotonic Hyponatremia if loss of sodium is from an renal cause, the urine sodium concentration will be ____?

A

high (>20 mEq/L)

86
Q

if Na is <120 mEq/L what can happen??

A

Seizures
coma
death

87
Q

is serious and can develop one to several days after aggressive treatment of hyponatremia by any method, including water restriction alone. Shrinkage of the brain triggers demyelination of pontine and extrapontine neurons that can cause neurologic dysfunction, including quadriplegia, pseudobulbar palsy, seizures, coma, and even death.

A

osmotic demyelination

88
Q

what increase the risk of the complication of osmotic demyelination?

A

Hepatic failure, potassium depletion, and malnutrition

89
Q

what is Hypervolemic Hypotonic Hyponatremia Treatment

A

restrict salt and water
restrict fluids to 1 to 1.2 L/day
restrict dietary sotium to 1-2 grams per day
may need to administer loop diuretics to remove water
may consider hypertonic saline if rapid onset (<48 hours)

90
Q

Hypovolemic Hypotonic Hyponatremia Treatment

A

replace sodium and volume loss w/ NS
don’t correctly too quickly (avoid demyelination)
if rapid onset can use 3% saline infusion

91
Q

Tx for Severe Euvolemic Hypotonic Hyponatremia

A

Hypertonic saline
fluid restriction
loop diuretic

92
Q

Isovolemic Hypotonic Hyponatremia Treatment

A

need to correct cause (hypothyroidism, glucocorticoid deficiency)
induce negative water bounce (want outs to exceed ins)
fluid restrict to 1 to 1.2 L/day

93
Q

Isovolemic Hypotonic Hyponatremia – Treatment of SiADH

A

treat underlyign cause
restrict fluid intake
may need hypertonic saline

94
Q

pharmacotherapy for SiADH

A

demeclocycline (abx) (inhibits ADH)
lithium (stops ADH at collecting tubules)
phenytoin (inhibit ADH release)

95
Q

Severe Euvolemic Hypotonic Hyponatremia Treatment

A

Hypertonic saline
Fluid restriction
Loop diuretic

*OldPharm (12 decks)

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