Term
|
Definition
Serum Na <136mEq/L
Sever <120 |
|
|
Term
| What are the physical assessment findings for Hyponatremia? |
|
Definition
| Dry mucus membranes, Tachycardia, depressed reflexes, pulmonary edema |
|
|
Term
What are some causes of Pseudohyponatremia?
What is the serum osmolality? |
|
Definition
Hyper-protienemia, glycemia,lipidemia
typically normal ~280mOsm/kg |
|
|
Term
Hypovolemic Hypotonic Hyponatremia
Serum & Urine Osm?
Etiology? |
|
Definition
Serum Osm <280
Urine Osm>450
GI fluid loss, diarrhea, overdiureses, sweating |
|
|
Term
| When correcting severe hypovolemic hyponatremia what is the initial goal and guidelines? |
|
Definition
goal to 120mEq
Do NOT correct >12mEq/L within 24 hrs or 18mEq/L over first 48hrs |
|
|
Term
|
Definition
= 0.5L/kg x (Desired-Current [Na])
Replace 1/3 in 6-12 hrs & remaining 2/3 over 24-48 hrs |
|
|
Term
|
Definition
| =pt. weight kg x (0.6 males 0.45 females) |
|
|
Term
| Calculate Change in Serum Na with 1 L of infusate |
|
Definition
= [IVna-Sna]/ (BW+IVvol)
IVna: [Na] of infusate |
|
|
Term
What are the Vaptans and what are they used for?
What class of drugs are they?
How do they work?
How much do they change serum Na?
When should they be used? |
|
Definition
Conivaptan & Tolvaptan- Euvolemic & Hypovolemic Hyponatremia
AVP receptor antagonist
Increase urine output and Increase Serum Na (lose just water)
6-8mEq/L
Once serum Na is 125mEq/L |
|
|
Term
| How to treat Euvolemic Hyponatremia? |
|
Definition
NSS +loop diuretic
3% Saline+ loop diuretic
OR
Vaptans if Sna >125mEq/L
(fluid for Na, diuretic to balance water) |
|
|
Term
| BY how much does water restriction raise serum Na? |
|
Definition
|
|
Term
How long does it take for Demeclocycline and Lithium to work?
What are they used for?
Are they FDA Approved for this use? |
|
Definition
3-6 days
SIADH/Euvolemic Hyponatremia
Not FDA approved for Hyponatremia |
|
|
Term
How to treat chronic SIADH?
Any other considerations with ea. tx? |
|
Definition
Water Restriction(primary tx, inc by 1-2mEq)
Conivaptan/Tolvaptan(inc 6-8mEq/day)
NaCl Tablets/loop diuretics
Demeclocycline &Lithium
(not FDA approved, takes 3-6days to work)
|
|
|
Term
| What are the monitoring parameters for a person with Acute SIADH (Euvolemic Hyponatremia)? |
|
Definition
| serum sodium, vascular irritation, mental status and urine output |
|
|
Term
| Conivaptan and Tolvaptan are contraindicated in______? |
|
Definition
| Hypovolemic Hyponatremia because they cause a decrease in BP |
|
|
Term
| What diseases cause Hypervolemic Hyponatremia? |
|
Definition
CHF
Cirrhosis
Nephrotic Syndrome |
|
|
Term
| What is the treatment for Hypervolemic Hyponatremia? |
|
Definition
fluid restriction+loop diuretic
dietary restriction of Na
conivaptan/tolvaptan |
|
|
Term
What is the serum Na for Hypernatremia?
Etiology?
Assessment? |
|
Definition
>145mEq/L
Osmotic Diuresis
Diabetes Isipidus
Na Overload |
|
|
Term
How do you approach tx of Hypovolemic Hypernatremia?
How often should they be monitored? |
|
Definition
If no presence of hypotension calculate FWD (determines how much water to give that will lower the serum Na)
If hypotensive give NSS or Lactated Ringers to raise BP, then calc FWD and give D5W or 0.45% Saline
Monitor Q2-4hrs |
|
|
Term
What is the problem?
Pt. with neurological changes, urine volume>3L/day, and urine osmolality <250mOsm/kg |
|
Definition
|
|
Term
What are Central and Nephrogenic DI?
What electrolyte imbalance are they associated with? |
|
Definition
Central DI- dec activity of AVP
Nephrogenic DI- resistant to AVP activity
Isovolemic Hypernatremia |
|
|
Term
How does Desmopressin work?
What electrolyte imbalance is it used to tx? |
|
Definition
It increases urine osmolality and decreases urine output
Isovolemic Hypernatremia |
|
|
Term
How does Hydrochlorothiazide work to tx Isovolemic Hypernatremia?
What class of drugs is it? |
|
Definition
Effects Na homeostasis
Thiazide Diuretic |
|
|
Term
| What is the etiology of Hypervolemic Hypernatremia? |
|
Definition
Sodium Overload
Increased Cap Hydrostatic Pressure
Nephrotic Syndrome
Decreased Colloid Osm Pressure |
|
|
Term
| How would you tx a CHF patient with Hypervolemic Hypernatremia? |
|
Definition
| Loop diuretic is most potent |
|
|
Term
| What is the infusion rate for Hypovol. Hyponatremia in the presence and absence of symptoms? |
|
Definition
Presence- 1.5mEq/L per hr
Absence- 0.5mEq/L per hr |
|
|
