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Acid Base And Electrolytes > Sodium Disturbances > Flashcards

Sodium Disturbances Flashcards

1
Q

What is the normal sodium concentration?

A

Na 135-145

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2
Q

Normal urine osmolality

A

<100mosm/kg

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3
Q

Normal serum osmolality

A

285 mosm/kg

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4
Q

What is the pathophysiological response to plasma hypotonicity

A

Sensed by hypothalamus - reduces synthesis of ADH - Diminished ADH in circulation - Fewer water channels in the kidney - creates water impermeable conduit - prevents water reabsorption - allows excretion of dilute urine

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5
Q

Pathophysiological response to plasma hypertonicity

A

Higher concentration of ADH - higher water permeability - excretion of concentrated urine

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6
Q

Non-osmotic causes of vasopressin release

A

Baroreceptors, Pain, stress, nausea, hypoxia, hypercapnea, medications

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7
Q

What are the three types of hyponatremia

A

Isotonic, hypotonic, hypertonic

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8
Q

Low Na+ and normal serum osmolarity

A

Isotonic hyponatremia

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9
Q

Causes of isotonic hyponatremia

A

Artifact, hypertriglyceride, paraproteinemia

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10
Q

Low Na+ and high serum osmolarity

A

Hypertonic Hyponatremia

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11
Q

Low Na+ and decreased serum osmolarity

A

Hypotonic Hyponatremia

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12
Q

What are the three types of hypotonic hyponatremia?

A

Euvolemic, Hypovolemic, Hypervolemia

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13
Q

Hypotonic Euvolemic hyponatremia definition

A

Low Na+, low osmolarity, with clinically normal volume

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14
Q

Causes of Euvolemic Hypotonic Hyponatremia

A

SIADH
Hypothyroidism
Glucocorticoid insufficiency
Medications
Reset osmstat syndrome

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15
Q

What is the pathophysiology behind hypotonic hypovolemic hyponatremia

A

Low Na+, low osmolarity, clinically low volume
Impaired urinary diluting mechanism

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16
Q

Causes of hypovolemic hypotonic hyponatremia

A

Hemhorrage, vomiting, diarrhea, diuretics, renal sodium wasting, cerebral salt wasting

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17
Q

What is the normal level of urine sodium concentration and what do we see in hypotonic hypovolemic, hyponatremia

A

Normal: 40-220
Abnormal: <10

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18
Q

Causes of hypotonic Hypervolemic hyponatremia

A

Renal failure
CHF
Cirrhosis
Nephrotic syndrome
Compromised renal diluting ability

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19
Q

Serum Osmolality 280-295 with hyponatremia

A

Pseudohyponatremia

20
Q

Serum osmolality >295 with hyponatremia

A

Hypertonic hyponatremia

21
Q

Osmolarity <280 with hyponatremia

A

Hypotonic hyponatremia

22
Q

What does a urine osmolarity <100 and >100 indicate

A

<100: primary polydipsia or potomania
>100: assess patient volume status

23
Q

What is the goal Na+ correction rate and limit for correction?

A

Rate of correction: 4-6 mEq/L/24hrs
Limit: 6-8 meq/L/24 hours

24
Q

What is the risk of rapid sodium correction?

A

Osmotic demyelination syndrome

25
Q

How to correct chronic hyponatremia (>48hrs)

A

Slow, avoid rapid shifts
Severely chronic are at high risk for demyelination
In this case give DDAVP and dextrose 5%

26
Q

Treatment for mild to moderate hypotonic hyponatremia

A

Treat underlying cause

27
Q

When can sodium be corrected quickly

A

Post-op acute changes or acute seizures

28
Q

How to treat severe hyponatremia with seizures

A

% hypertonic saline 100mls over 10mins

Repeat only twice PRN
Check BMP q1-2 hours
Only treat until symptoms subside

29
Q

How to treat hypertonic hyponatremia

A

Treat underlying condition
Most often HHS

30
Q

Hypotonic euvolemic hyponatremia treatment

A

Treat underlying condition
If acute can be corrected quickly

31
Q

Hypotonic hypovolemic hyponatremia treatment

A

Fluid resuscitation with isotonic fluid, hold diuretics

32
Q

Hypotonic Hypervolemic Hyponatremia treatment

A

Loop diuretics, V2 receptor agonist (Tolvaptan, do not give in cirrhosis)

33
Q

Management for cerebral salt wasting

A

Hypertonic solution

34
Q

SIADH treatment plan

A

Withhold medications, fluid resuscitation, increase solute intake (salt tabs), diuretics

35
Q

How to treat psychogenic polydipsia

A

Fluid restriction

36
Q

What is the most common cause of sustained hypernatremia

A

Hospital setting fluid administration

37
Q

S/s of hypernatremia

A

Weakness, lethargy, confusion, seizures, coma, dehydration, orthostatic hypotension, oliguria, change in LOC, osmotic cerebral demyelination

38
Q

What are the main causes of euvolemic hypernatremia

A

Pure water loss, Central DI, Nephrogenic DI

39
Q

What is the primary characteristic lab findings for DI

A

Hypernatremia with urine osmo <250

40
Q

S/s of hypovolemic hypernatremia

A

Orthostatic hypotension, tachycardia, decreased organ perfusion

41
Q

Common causes of hypovolemic hypernatremia

A

Loss of GI fluids, diuretics, vigorous exercise
If the Cl is <10 then it could be cutaneous or GI causes, extrarenal

42
Q

Causes and signs and symptoms of Hypervolemic hypernatremia

A

Administration of hypertonic sodium salts
S/S: hypertension, edema, CHF

43
Q

Treatment of hypernatremia fluid management

A

Goal to lower Na+ by <10 mmols/L/day, BMP q4-6hrs
D5% if unable to swallow
0.45% saline or isotonic
Avoid sterile water can cause hemolysis

44
Q

Hypovolemic Hypernatremia treatment

A

Isotonic fluid then switch to hypotonic once volume resuscitation is complete

45
Q

Euvolemic Hypernatremia treatment

A

Water ingestion or 5% Dextrose, diuretics
If CDI suspected give DDAVP
NDI suspected give thiazide diuretic with COX inhibitor

46
Q

Hypervolemia Hypernatremia treatment

A

D5%, loop diuretics, Dialysis

Acid Base And Electrolytes (7 decks)

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