Sodium Balance

Question 1

Hyponatremia - Value?

Answer 1

135

Question 2

Hyponatremia - Types (2)

Answer 2

1. Pseudo - Does not cause HypoOsmollalilty (Asymptomatic)

2. True - Cause HypoOsmollality (Symtpomatic or Asymptomatic)

Question 3

Water in Body?

Answer 3

TBW - 60% of BW

1. ICF - Intra Cellular Fluid 60%
2. ECF - Extra Cellular Fluid 40%:
   
   1. Interstititum - 80% of ECF
   2. Plasma - 20% ECF

Question 4

Plasma Osmollality Calculation

Answer 4

POsm = 2 x P[Na+] + [Glu]/18 + BUN/2.8

Normal - 275-290

Question 5

Plasma Tonicity Calculation

Answer 5

PTonicity = Effective Posm = 2 x P [Na+] + [Glu]/18

Question 6

Hyponatremia clinical signs

Answer 6

Asymptomatic
Symptomatic - Mostly Neurological:
1. nausea, malaise
2. headache
3. lethargy
4. irratability
5. supor
6. comma

Question 7

Pseudohyponatremia - Ethologies (3)

Answer 7

1. Hyperglicemia (HyperTonic)
2. Hyperlipidemia (IsoTonic)
3. HyperProteinemia (IsoTonic)

Question 8

Sodium correction for HyperGlycemia?

Answer 8

1.4 for every 100 above 100mg/dl glucose

Question 9

Pseudohyponatremia - Types (2)

Answer 9

1. Isotonic - Hyperlipidemia + Hyperproteinemia

2. Hypertonic - Hyperglycemia / IV Manitol

Question 10

True-Hyponatremia - Types (3):

Answer 10

1. Hypovolemia - Decreased TBNa
2. Hypervolemia - Increased TBNa
3. Normovolemia - Normal TBNa

Question 11

Hypovolemia - Decreased TBN - Casuses(2)?

Answer 11

Tachycardia, Hypotension

1. Renal / Diuretics - Una>20meq/L (Disothiazide > Fusid )
2. Extra renal - Skin / GIT - UNa<20meq/L

Question 12

Hypovolemia - Decreased TBN - Clinics

Answer 12

1. Hypotension
2. Tachycardia
3. Dry mucos

Question 13

Hypovolemia - Decreased TBN - TX?

Answer 13

1. Cause

2. Normal Saline - isotonic - 0.9%

Question 14

Hypervolemia - Increased TBNa - Casuses (4)?

Answer 14

Clinics: Edema, Ascitis
1. CHF
2. Cirrhosis 
3. Nephrotic synd
UNa < 20meq/

Question 15

True-Hyponatremia - Hypervolemia - Urinary Sodium level?

Answer 15

א”ס לב, צרוזיס : מתחת 20meq/L
תסמונת נפרוטית: מתחת 20meq/L
באיבוד בכליות: מעל 20meq/L

Question 16

True-Hyponatremia - Hypervolemia - TX?

Answer 16

1. Limit Water intake
2. Limit Sodium intake
3. Loop Diuretic
4. Treat main cause (should be 1st)

Question 17

True-Hyponatremia - Normovolemia

Normal TBN

Answer 17

1. Normal BP
2. No Tachycardia
3. No Edema/Ascitis

SIADH
Una>40meq/L
Uosmol>100mosmol/L

Question 18

True-Hyponatremia - Normovolemia

Normal TBN - Urinary Sodium?

Answer 18

U(na)>40meq/L

Question 19

True-Hyponatremia - Normovolemia

Normal TBN - Urinary Sodium?

Answer 19

1. Find Cause

2. Water Limit

Question 20

When to use Hypertonic Saline?

Answer 20

Only for Symptomatic Hyponatremia

Max rate - 0.5mEq/L/h

Question 21

Na Deficit (Male) ?

Answer 21

0.6 X Body Weight X (120 – Current Na)

Question 22

Na Deficit (Female) ?

Answer 22

0.5 X Body Weight X (120 – Current Na)

Question 23

Hypovolemia - Decreased TBN - Clinics

Answer 23

1. Hypotension
2. Tachycardia
3. Dry mucos

Question 24

Hypovolemia - Decreased TBN - TX?

Answer 24

1. Cause

2. Normal Saline - isotonic - 0.9%

Question 25

Hypervolemia - Increased TBNa - Casuses (4)?

Answer 25

``` Clinics: Edema, Ascitis 1. CHF 2. Cirrhosis 3. Nephrotic synd UNa < 20meq/ ```

Question 26

True-Hyponatremia - Hypervolemia - Urinary Sodium level?

Answer 26

א"ס לב, צרוזיס : מתחת 20meq/L תסמונת נפרוטית: מתחת 20meq/L באיבוד בכליות: מעל 20meq/L

Question 27

True-Hyponatremia - Hypervolemia - TX?

Answer 27

1. Limit Water intake 2. Limit Sodium intake 3. Loop Diuretic 4. Treat main cause (should be 1st)

Question 28

True-Hyponatremia - Normovolemia | Normal TBN

Answer 28

1. Normal BP 2. No Tachycardia 3. No Edema/Ascitis SIADH Una>40meq/L Uosmol>100mosmol/L

Question 29

True-Hyponatremia - Normovolemia | Normal TBN - Urinary Sodium?

Answer 29

U(na)>40meq/L

Question 30

True-Hyponatremia - Normovolemia | Normal TBN - Urinary Sodium?

Answer 30

1. Find Cause | 2. Water Limit

Question 31

When to use Hypertonic Saline?

Answer 31

Only for Symptomatic Hyponatremia | Max rate - 0.5mEq/L/h

Question 32

Na Deficit (Male) ?

Answer 32

0.6 X Body Weight X (120 – Current Na)

Question 33

Na Deficit (Female) ?

Answer 33

0.5 X Body Weight X (120 – Current Na)