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Ellen Chem Path > Sodium Fluid Balance > Flashcards

Sodium Fluid Balance Flashcards

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1
Q

Osmolality vs Osmolarity

A

Osmolality= mosm/kg
Osmolarity= mosm/L

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2
Q

What are the characteristics of Osmolality and Osmolarity?

A

Osmolality- lab calculated, accurate, unchanged by volume change
Osmolarity= more practical, easier to measure Ls of blood than Kgs

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3
Q

What is the Osmolarity gap?

A

The difference between lab calculated Osmolality and my Osmolality calculation

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4
Q

What causes an Osmolarity gap?

A

Additional solutes than Na, K, glucose and urea

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5
Q

Osmolality equation

A

2(Na + K) + glucose + urea

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6
Q

What should normal Osmolality be?

A

275-295 mosm/L

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7
Q

What value indicates an similar gap

A

> 10 mosm/L difference between lab value and my calculation

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8
Q

What regulates Na?

A

Blood volume and Osmolality

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9
Q

What happens when blood volume increases?

A

Atrial stretch, Atrial Natriuretic Peptide released, aldo renin adh decreased

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10
Q

What is the moa of aldosterone?

A
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11
Q

What is the Moa of renin?

A
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12
Q

What is the moa of adh?

A
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13
Q

What happens when blood Osmolality is high?

A

Thirst +Adh release

(Opposite for low Osmolality)

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14
Q

Step 1 of assessing hyponatraemia

A

Check plasma Osmolality

Need to know this is actually hyponatraemia!

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15
Q

What can cause euosmolar hyponatraemia

A

High lipids, proteins
Pseudohyponatraemia

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16
Q

What can cause hyperosmolar hyponatraemia

A

High glucose, ETOH
Pseudohyponatraemia

17
Q

What is step 2 of assessing true hyponatraemia?

A

Assess volume status

18
Q

How do we assess volume status

A

BP, HR, CRT
Leg oedema
Pulmonary Oedema

19
Q

What is step 1 of assessing hypovolaemic hyponatraemia?

A

Check urinary Na

20
Q

What does urinary Na <20mosm/L indicate in hypovolaemic hyponatraemia?

A

Extra renal loss

Vomiting, diarrhoea, burns,

21
Q

What does urinary Na >20mosm/L indicate in hypovolaemic hyponatraemia?

A

Renal Na Loss

Renal disease, cerebral salt wasting, diuretics- thiazides

22
Q

What is the underlying mechanism behind hypervolaemic hyponatraemia?

A

High total body water, but low intravascular volume
Fluid in the wrong place!

23
Q

What is the first step of assessing hypervolaemic hyponatraemia?

A

Check urine Na

24
Q

What does urinary Na <20mosm/L indicate in hypervolaemix hyponatraemia?

A

Congestive Cardiac Failure, Cirrhosis, nephrotic syndrome

25
Q

What does urinary Na >20mosm/L indicate in hypervolaemix hyponatraemia?

A

CKD

26
Q

How do we manage hypovolaemic hyponatraemia?

A

Treat cause
IV 0.9% NaCl

27
Q

How do we manage hypervolaemic hypernatraemia?

A

Treat cause
Fluid restrict

28
Q

What is the mechanism of hypovolaemic hyponatraemia?

A

Low total body water with appropriately high ADH, hence retaining more water relative to sodium

29
Q

What is the mechanism of euvolaemic hyponatraemia?

A

Increased water relative to sodium

30
Q

What is the first step in assessing euvolaemic hyponatraemia?

A

Check urinary sodium

31
Q

What does urinary Na <20mosm/L indicate in euvolaemic hyponatraemia?

A

Ellen Chem Path (1 decks)

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