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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

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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
What is the goal Na+ in serum after treatment for hyponatremia
125-130 or lower
26
What is the time frame to monitor Na+ in serum after treatment
2-4 hours
27
Why is the correction rate smaller for patients who have chronic hyponatremia
Their brain is already adapting to the brain swelling and releasing solutes, raising the Na+ too much could cause brain shrinkage
28
What is the danger in using 3%NaCl to treat hyponatremia
Central Pontine Myelinolysis (CPM)/osmotic demyleniation syndrome
29
What is CPM/ osmotic demyleniation syndrome
Loss of oligodendrocytes and myelin in the pons
30
What is the treatment options for hypervolemic hypotonic hyponatremia
Treat the underlying cause, Na restriction, Loop diuretics, conivaptan/tolvaptan
31
What drugs are vasopressin receptor antagonist
Conivaptan/tolvaptan
32
What is the treatment options form euvovolemic hypotonic hyponatremia
fluid restriction, convipatan/tolvaptan, furosemide with NaCl tablet or 0.9%NaCl
33
What are medications that treat chronic SIADH
demeclocyline, lithium, phenytoin
34
What is the treatment options for hypovolemic hypotonic hyponatremia
NaCl tablet, 0.9% NaCl
35
T/F: Hypernatremia can occur in low,mid and high osmolarity
False: Hypernatremia can only occur in a hypertonic state
36
What is is moderate hypernatremia levels. severe
150,160
37
In hypervolemic hypertonic hypernatremia what is the status of TBW, TBNa
elevated TBW, high TBNa
38
In euvolemic hypertonic hypernatremia what is the status of TBW, TBNa
Low TBW, No change in TBNa
39
In hypovolemic hypertonic hypernatremia what is the status of TBW, TBNa
Low TBW, Low Na
40
What causes hypervolemic hypertonic hypernatremia
Latrogenic (3% NaCl, excessive Na ingerstion, antibiotic containing Na, Hypertonic dialysis), Hyperaldosteronism, Cushing's syndrome
41
What causes euvolemic hypertonic hypernatremia
Renal loss (diabetes insipidus), Non-renal loss (Fever, hyperventilation)
42
If urine specific gravity is less that what there is a chance euvolemic hypernatremia is present
less than 1.005
43
What causes hypovolemic hypertonic hypernatremia
Renal loss (osmotic diuresis, loop diuretic, acute/chronic renal disease), non-renal loss ( diarrhea, vomiting, fistulas. excessive sweating, burns)
44
What is an adaption the brain utilizes in hypernatremia
Brain shrinkage
45
To prevent brain shrinkage in the presence of hypernatremia how will the brain adapt, what are the consequences
The brain will accumulate organic osmolytes and electrolytes, cerebral edema
46
What is the maximum correction rate for acute (less than 48 hours) hypernatremia
1-2 mEq/L/hr
47
What is the maximum correction rate for chronic (more than 48 hours) hypernatremia
0.5 mEq/L/hr
48
What is the maximum correction rate for hypernatremia for a day
10 mEq/L
49
How often should Na+ be monitored
every 2-4 hours
50
What is the goal serum sodium in hypernatremia treatment
145- 150 mEq/L
51
What is the infusate Na+ of .45%NaCl
77
52
What is the infusate Na+ of D5W
0
53
What is the equation to calculate free water deficit
normal TBW- Current TBW
54
What is the equation to find current TBW
(140/serum Na) x normal TBW
55
How should the TBW be replaced
(1/2) the deficit the first 24 hours, replace the rest over a 24-72 hour period
56
What is the treatment options for hypervolemic hypertonic hypernatremia
Discontinue offending agent, diuretics to eliminate Na/H20 excess, hemodialysis if renal failure, replace free water deficit
57
What are the treatment options for euvolemic hypertonic hypernatremia
replace free water defecit, if Central Diabetic insipidus: vassopressin, desmopressin, if nephrogenic diabetic insipidus: hydrochlorothiazide, amiloride, indomethacin
58
What are the treatment options for CDI
vasopressin, desmopressin
59
What is the best option for CDI, why
desmopressin, higher potency/longer duration/lower smooth muscle and pressor effects
60
What are doses, instructions and dosage forms of desmopressin
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
What the treatment options for NDI
HCTZ, amiloride, Indomethacin
62
What are the treatment options for hypovolemic hypertonic hypernatremia
replace free water, if severe 500-1000ml of .9%NaCl over 30-60 min, then replace free water deficit with D5W
63
What is the equation to calculate the change in Na+ serum per liter of infusate
(infusate Na+ - serum Na+)/(TBW+1)

Phar 503 (25 decks)

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