Treatment And Management

Question 1

At what rate can chronic hyponatremia be treated?

Answer 1

Correct at 0.5 mmol/hour

Question 2

How fast can acute hyponatremia with neurological features be corrected?

Answer 2

1. You can do a correction of 7-10 mmol over 6 hours

Question 3

How is edema treated?

Answer 3

1. Treat underlying cause
2. Salt and water restriction
3. Diuretics- loop and/or combo
4. ACEi or ARB if applicable
5. Nitrates if applicable
6. Compression stockings (probably not acutely)

Question 4

How do you pick a fluid for hyponatremia?

Answer 4

1. Has to be hypertonic to urine
2. Determine mmol of sodium needed
3. Pick solution with higher osmolarity- osmoles=2x mmol Na
4. Determine the rate to administer (depends on acute or chronic)

Question 5

What is the non pharmacological treatment for essential hypertension?

Answer 5

1. DASH diet
2. Low sodium diet
3. Exercise
4. Decrease in waist circumference
5. EtOH less than 2 drinks/ day
6. Smoking cessation

Question 6

What are the pharmacologic treatments for hypertension?

Answer 6

1st line: diuretics (thiazides), b blockers, ACEi, calcium channel blockers

Question 7

How do we treat hypernatremia?

Answer 7

1. Administer hypotonic solution
Calculations:
1. TBW deficit 
2. Infusion time (based on maximally 0.5mmol/HR correction)
3. Insensible losses
4. Infusion rate = 1+3 /2 

5. Monitor electrolytes and adjust as necessary

Question 8

How is nephrogenic DI treated?

Answer 8

Thiazide diuretics: assist in reaching new steady state of hyponatremia, so more water ends of up being reabsorbed proximally
NSAIDS- block prostaglandin action (which would otherwise keep afferent arteriole open)

Question 9

What are the indications for hemodialysis?

Answer 9

Acidosis (refractory)
Electrolyte abnormalities (refractory)
Intoxications
Overload
Uremia