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Sodium Disorders Flashcards

1
Q

Which two electrolytes often have to be ordered separately/not part of CMP?

A

Mg and PO4

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2
Q

TBW = x% of body weight

A

60%

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3
Q

ICF makes up ____ of body water

A

2/3

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4
Q

In infants, water is ___ % of body weight. In elderly, water is _____%

A

infants: 80%

Elderly: 45%

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5
Q

Obesity has what effect on total body water?

A

decreased

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6
Q

TIE 60, 40, 20 means…

A

Total body fluid: 60%

Intracellular: 40%

Extracellular: 20%

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7
Q

This is the total solute concentration in a fluid compartment as determined by sodium, glucose and urea

A

Osmolality

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8
Q

How is osmolality calculated?

A

(2*sodium) + (Glucose/18) + (BUN/2.8)

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9
Q

Symptoms occur when osmolality is greater than ____ or less than ____

A

> 320

< 265

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10
Q

The below substances (are/aren’t) included in lab calculated osmolarity…

mannitol, protein, ethanol, methanol, ethylene glycol

A

aren’t

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11
Q

High amounts of osmotically active substances can lead to an elevated…

A

osmolar gap

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12
Q

This is the ability of solutes to drive water from one compartment to another…

A

tonicity

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13
Q

Tonicity has major effects on …

A

size of cells

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14
Q

decreased sodium results in shift of water from ECF to ICF. This can cause what severe manifestation?

A

swelling of brain cells

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15
Q

The total amount of which electrolyte in the ECF is the major determinant of the extracellular fluid volume…

A

sodium

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16
Q

This is the amount of water relative to sodium in ECF, not total body sodium

A

Serum sodium

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17
Q

Abnormal serum sodium is a sign of a disorder in what?

A

water regulation

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18
Q

The ECFV is determined by…

A

overall volume status of patient

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19
Q

An abnormality in the size of the ECFV is a marker of what?

A

abnormal sodium control

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20
Q

high ECFV indicates…

A

too much sodium

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21
Q

high serum sodium indicates

A

too little water relative to sodium

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22
Q

With sodium disorders, a patients volume status must be determined. What are the three volume statuses?

A

hypovolemic
euvolemic
hypervolemic

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23
Q

Volume losses or sequestration via intestinal obstruction, pancreatitis, rhabdo can cause what volume status?

A

hypovolemia

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24
Q

Patient presents with the following, making you concerned for what volume status?

increased thirst
decreased turgor
dry mucous membranes
oliguria
CNS depression
muscle cramps/weakness
hypotension
increased pulse
A

Hypovolemia

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25
The following are causes of what fluid status? ``` liver disease CHF renal failure nephrotic syndrome primary hyperaldosteronism cushings pregnancy ```
hypervolemia
26
A patient presents with the following sxs, making you concerned for what volume status? ``` edema SOB orthopnea/PND JVD hepatojugular reflux crackles ```
hypervolemia
27
Thirst and ADH influence...
water retention
28
RAAS, ANP, catecholamines influence
salt retention
29
This hormone... increases renal sodium reabsorption increases renal potassium secretion
aldosterone
30
Hyponatremia becomes dangerous when it drops below...
125
31
What is the most common electrolyte abnormality in hospitalized patients?
hyponatremia
32
Serum sodium under what value indicates hyponatremia?
< 135
33
Presence of sxs in hyponatremia depend on what?
level of cerebral edema
34
``` HA NV Lethargy Weakness Confusion respiratory distress Seizures ``` these all indicate...
hyponatremia
35
What are three general types of hyponatremia?
pseudo redistributive hypovolemic/hypervolemic/euvolemic
36
What type of hyponatremia? Serum sodium < 135, but normal osmolality occurs with hyperlipidemia and hyperproteinemia laboratory artifact
pseudohyponatremia
37
What type of hyponatremia? hyperosmolar state caused by osmotically active substances in ECF MC cause by hyperglycemia
redistributive hyponatremia
38
How do you correct sodium in redistributive hyponatremia?
add 1.5 mEq/L to sodium for every 100mg/dl serum glucose over 100mg/dl
39
The following are causes of what type of hyponatremia? liver, heart, renal failure
hypervolemic hyponatremia
40
What tx is indicated for hypervolemic hyponatremia?
diuretics, dialysis, fluid restriction
41
What type of hyponatremia? Caused by: cerebral salt wasting renal tubular acidosis diuretics
hypovolemic hyponatremia urine sodium > 20
42
what type of hyponatremia? caused by: gastroenteritis third space losses (burns, pancreatitis, etc)
hypovolemic hyponatremia | urine sodium < 20
43
What type of hyponatremia? caused by: - SIADH - Psychogenic polydipsia - hypothyroidism - adrenal insufficiency
euvolemic hyponatremia
44
How do you treat euvolemic hyponatremia?
fluid restriction, tx of underlying cause
45
A patient presents with: concentrated urine (> 100) with low serum osmolality and euvolemia
SIADH
46
This disease occurs with impaired free water excretion, but normal sodium excretion
SIADH
47
What labs should be ordered to determine the underlying cause of SIADH?
CT/MRI (CNS) CXR (lung) medication list
48
The below Bartter and Shwartz Criteria diagnoses what condition? 1. decreased plasma osmolality 2. concentrated urine 3. elevated urine sodium 4. euvolemia 5. normal cortisol and thyroid, no diuretics
SIADH
49
How do you treat SIADH?
fluid restriction
50
What are the first look labs when evaluating hyponatremia?
serum sodium, osmolarity urine sodium, osmolarity
51
what are the second look labs when evaluating hyponatremia?
TSH, cortisol
52
What must be evaluated from the very start in hyponatremia?
fluid status
53
Hospitalization of a hyponatremic patient should occur if one of what two factors is present?
sodium < 125 symptomatic
54
rapid increase in serum sodium can lead to what condition?
cerebral pontine myelinolysis (CPM)
55
The rate of sodium correction should be ____ in the first 24 hours, not to exceed _____
4-6 mEq/L not to exceed 8 mEq/L
56
Is a daily or hourly change associated with CPM?
daily
57
How often should you check serum sodium when you are replacing it to ensure you are not overcorrecting?
q 2hrs
58
A patient presents with the following, concerning for what irreversible condition 1-3 days after hospitalization ``` dysarthria, dysphagia seizures AMS quadriparesis hypotension ```
CPM
59
Hyponatremia with high osm. often indicates...
hyperglycemia
60
hyponatremia with normal osm. often indicates
pseudohyponatremia
61
hyponatremia with normal/low urine osmolality often indicates...
water intoxication
62
Hyponatremia with the following often indicates... - low serum osmolality - high urine osmolality - hypervolemia
CHF | Liver/renal failure
63
Hyponatremia with the following often indicates... - low serum osmolality - high urine osmolality - euvolemia
SIADH hypothyroid adrenal insufficiency
64
Hyponatremia with the following often indicates... - low serum osmolality - high urine osmolality - hypovolemia - urine sodium < 10
vomiting, diarrhea
65
Hyponatremia with the following often indicates... - low serum osmolality - high urine osmolality - hypovolemia - urine sodium > 20
diuretics
66
Serum sodium > 145 indicates...
hypernatremia
67
What causes the clinical features in hypernatremia?
brain shrinkage
68
The following can cause... too little water too much dietary salt excess water loss
hypernatremia
69
Hyperglycemia, increased mannitol can cause _____ which contributes to hypernatremia
osmotic diuresis
70
A patient presents with: ``` asymptomatic thirst AMS weakness neuromuscular irritability focal neurologic deficit seizure ```
hypernatremia
71
sxs of hypernatremia are related to...
rate of onset
72
The vast majority of cases of hypernatremia are due to...
GI, skin, renal water loss
73
how does the body usually compensate for water loss?
increase thirst maximally concentrate urine
74
This disorder... nonosmotic urinary water loss elevated serum sodium dilute urine when should be concentrated
Diabetes insipidus
75
Diabetes insipidus is a problem with what hormone, leading to collecting ducts being impermeable to water, and therefore not reabsorbed?
ADH
76
impaired secretion of ADH indicates what type of diabetes insipidus
central
77
lack of kidney response to ADH despite adequate presence of ADH indicates what type of diabetes insipidus?
nephrogenic
78
The following are acquired causes of what? - chronic renal insufficiency - tubulointerstitial renal dz - amyloidosis - lithium toxicity
nephrogenic DI
79
the below are treatments for what condition? thiazides amiloride chlorpropamide indomethacin
nephrogenic DI
80
What are three approaches to treating hypernatremia?
hospitalization if severe stop water loss replace water deficit
81
what is a precaution to replacing water deficit?
dont do it too rapidly, can cause CPM
82
In order to replace free water in hypernatremia, what must be calculated?
water deficit
83
how do you calculate water deficit?
deficit = normal TBW - current TBW
84
current TBW is calculated by...
normal serum na x normal TBW/ measured serum na

Clinical Laboratory Medicine (9 decks)

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