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503 (Renal) > Sodium Disorders > Flashcards

Sodium Disorders Flashcards

1
Q

What is the normal value for Na+ in the body

A

135-145

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2
Q

T/F: Sodium is the major determinant of osmolarity in the body

A

True

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3
Q

Hyponatremia

A

low sodium level in the blood, most commonly an excess of water in relation to sodium

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4
Q

T/F: Hyponatremia can only occur in hypertonic states

A

False: Hyponatremia can occur in low, normal, or high tonicity states

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5
Q

What is moderate hyponatremia levels, severe

A

120, 110

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6
Q

What is an adaption the brain utilizes in hyponatremia

A

Brain Swelling

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7
Q

To prevent brain swelling in response to chronic hyponatremia how will the brain adapt , what are the consequences

A

Transport solutes extracellularly (NaCl, K, organic solutes), lowers brain osmolarity and induces water loss (hemorrhages)

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8
Q

What is a cause for high osmolarity hypertonic hyponatremia

A

Hyperglycemia, mannitol

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9
Q

What are causes of hypervolemic hypotonic hyponatremia

A

congestive heart failure, Liver failure, acute/chronic renal failure, nephrotic syndrome

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10
Q

What are causes of euvolemic hypotonic hyponatremia

A

Hypothyroidism, Addison’s disease, Syndrome of inappropriate ADH (SIADH)

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11
Q

Causes of SIADH

A

Central nervous system disorders (strokes, mass lesions, trauma acute psychosis), Malignancy (lung), medications (carbamazepine)

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12
Q

What are the causes of hypovolemic hypotonic hyponatremia

A

Renal loss (cerebral salt wasting, excessive diuresis, adrenal insufficiency), Non renal loss (bleeding, vomiting, diarrhea, burns/wounds, sweating)

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13
Q

In hypervolemic hypotonic hyponatremia what is the status of TBW, TBNa

A

high TBW, elevated TBNa

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14
Q

In euvolemic hypotonic hyponatremia what is the status of TBW, TBNa

A

elevated TBW, TBNa has little to no change

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15
Q

In hypovolemic hypotonic hyponatremia what is the status of TBW, TBNa

A

low TBW, Low TBNa

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16
Q

In treating hyponatremia what will be used

A

3%NaCl

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17
Q

In treating hyponatremia when is it appropriate to use 3%NaCl

A

Must have severe/ significant symptoms

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18
Q

What is the equation to calculate the change in serum Na+ per 1 liter of infusate

A

(infusate Na+- serum Na+)/(TBW+1)

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19
Q

What is the infusate Na+ of 3% NaCl

A

513

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20
Q

What is the infusate Na+ of 0.9% NaCl

A

154

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21
Q

What is the infusate Na+ of Lactated Ringers

A

130

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22
Q

What is the maximum correction rate for acute (< 48 hours) hyponatremia

A

1-2 mEq/L/hr

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23
Q

What is the maximum correction rate for chronic (> 48 hours) hyponatremia

A

0.5mEq/L/hr

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24
Q

What is the maximum correction rate for Na+ in serum for the entire day in patients who are hyponatremic

A

8mEq/L

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25
Q

What is the goal Na+ in serum after treatment for hyponatremia

A

125-130 or lower

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26
Q

What is the time frame to monitor Na+ in serum after treatment

27
Q

Why is the correction rate smaller for patients who have chronic hyponatremia

A

Their brain is already adapting to the brain swelling and releasing solutes, raising the Na+ too much could cause brain shrinkage

28
Q

What is the danger in using 3%NaCl to treat hyponatremia

A

Central Pontine Myelinolysis (CPM)/osmotic demyleniation syndrome

29
Q

What is CPM/ osmotic demyleniation syndrome

A

Loss of oligodendrocytes and myelin in the pons

30
Q

What is the treatment options for hypervolemic hypotonic hyponatremia

A

Treat the underlying cause, Na restriction, Loop diuretics, conivaptan/tolvaptan

31
Q

What drugs are vasopressin receptor antagonist

A

Conivaptan/tolvaptan

32
Q

What is the treatment options form euvovolemic hypotonic hyponatremia

A

fluid restriction, convipatan/tolvaptan, furosemide with NaCl tablet or 0.9%NaCl

33
Q

What are medications that treat chronic SIADH

A

demeclocyline, lithium, phenytoin

34
Q

What is the treatment options for hypovolemic hypotonic hyponatremia

A

NaCl tablet, 0.9% NaCl

35
Q

T/F: Hypernatremia can occur in low,mid and high osmolarity

A

False: Hypernatremia can only occur in a hypertonic state

36
Q

What is is moderate hypernatremia levels. severe

37
Q

In hypervolemic hypertonic hypernatremia what is the status of TBW, TBNa

A

elevated TBW, high TBNa

38
Q

In euvolemic hypertonic hypernatremia what is the status of TBW, TBNa

A

Low TBW, No change in TBNa

39
Q

In hypovolemic hypertonic hypernatremia what is the status of TBW, TBNa

A

Low TBW, Low Na

40
Q

What causes hypervolemic hypertonic hypernatremia

A

Latrogenic (3% NaCl, excessive Na ingerstion, antibiotic containing Na, Hypertonic dialysis), Hyperaldosteronism, Cushing’s syndrome

41
Q

What causes euvolemic hypertonic hypernatremia

A

Renal loss (diabetes insipidus), Non-renal loss (Fever, hyperventilation)

42
Q

If urine specific gravity is less that what there is a chance euvolemic hypernatremia is present

A

less than 1.005

43
Q

What causes hypovolemic hypertonic hypernatremia

A

Renal loss (osmotic diuresis, loop diuretic, acute/chronic renal disease), non-renal loss ( diarrhea, vomiting, fistulas. excessive sweating, burns)

44
Q

What is an adaption the brain utilizes in hypernatremia

A

Brain shrinkage

45
Q

To prevent brain shrinkage in the presence of hypernatremia how will the brain adapt, what are the consequences

A

The brain will accumulate organic osmolytes and electrolytes, cerebral edema

46
Q

What is the maximum correction rate for acute (less than 48 hours) hypernatremia

A

1-2 mEq/L/hr

47
Q

What is the maximum correction rate for chronic (more than 48 hours) hypernatremia

A

0.5 mEq/L/hr

48
Q

What is the maximum correction rate for hypernatremia for a day

49
Q

How often should Na+ be monitored

A

every 2-4 hours

50
Q

What is the goal serum sodium in hypernatremia treatment

A

145- 150 mEq/L

51
Q

What is the infusate Na+ of .45%NaCl

52
Q

What is the infusate Na+ of D5W

53
Q

What is the equation to calculate free water deficit

A

normal TBW- Current TBW

54
Q

What is the equation to find current TBW

A

(140/serum Na) x normal TBW

55
Q

How should the TBW be replaced

A

(1/2) the deficit the first 24 hours, replace the rest over a 24-72 hour period

56
Q

What is the treatment options for hypervolemic hypertonic hypernatremia

A

Discontinue offending agent, diuretics to eliminate Na/H20 excess, hemodialysis if renal failure, replace free water deficit

57
Q

What are the treatment options for euvolemic hypertonic hypernatremia

A

replace free water defecit, if Central Diabetic insipidus: vassopressin, desmopressin, if nephrogenic diabetic insipidus: hydrochlorothiazide, amiloride, indomethacin

58
Q

What are the treatment options for CDI

A

vasopressin, desmopressin

59
Q

What is the best option for CDI, why

A

desmopressin, higher potency/longer duration/lower smooth muscle and pressor effects

60
Q

What are doses, instructions and dosage forms of desmopressin

A

nasal spray (1 spray=10mcg)/Instill in one nostril once a day, IV (2-4 mcg)/ sc=BID, Oral tablet (.1mg or .2mg)/everyday BID or TID

61
Q

What the treatment options for NDI

A

HCTZ, amiloride, Indomethacin

62
Q

What are the treatment options for hypovolemic hypertonic hypernatremia

A

replace free water, if severe 500-1000ml of .9%NaCl over 30-60 min, then replace free water deficit with D5W

63
Q

What is the equation to calculate the change in Na+ serum per liter of infusate

A

(infusate Na+ - serum Na+)/(TBW+1)

503 (Renal) (6 decks)

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