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Residency Exam > Sodium Cases (Tutorial session) Panopto Video Link > Flashcards

Sodium Cases (Tutorial session) Panopto Video Link Flashcards

1
Q

What is the reference range for sodium?

A

133 to 144 mmol/L

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2
Q

What is the reference range for sodium?

A

133 to 144 mmol/L

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3
Q

What is the reference range for chloride?

A

97 to 110 mmol/L

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4
Q

What is the reference range for plasma osmolality?

A

> 275 mOsm/kg

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5
Q

What is the reference range for urine osmolality?

A

100 mOsm/kg

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6
Q

What is the reference range for urine sodium?

A

< 20 mmol/L

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7
Q

What is the formula for calculated osmolarity?

A

1.86 (Na + K) + Glucose + Urea + 10

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8
Q

What is the formula for calculated osmolarity?

A

1.86 (Na + K) + Glucose + Urea + 10

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9
Q

What is the formula for calculated osmolarity?

A

1.86 (Na + K) + Glucose + Urea + 10

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10
Q

What is calculated osmolarity approximate to?

A

2 x Na

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11
Q

What is calculated osmolarity approximate to?

A

2 x Na

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12
Q

What does osmolality measure?

A

The number of osmotically active particles per kilogram of fluid

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13
Q

What does osmolality measure?

A

The number of osmotically active particles per kilogram of fluid

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14
Q

Can osmolality be measured, rather than estimated?

A

Yes

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15
Q

What does osmolality measure?

A

The number of osmotically active particles per kilogram of fluid

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16
Q

What does osmolarity measure?

A

The number of osmotically active particles per litre of fluid

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17
Q

What is the osmol gap?

A

The difference between calculated osmolarity and the measured osmolality

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18
Q

What is the osmol gap?

A

The difference between calculated osmolarity and the measured osmolality

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19
Q

What are some causes of an osmol gap?

A

Ethanol/methanol poisonings and some non-electrolyte drug intoxications which cause osmotically active particles

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20
Q

What are some causes of an osmol gap?

A

Ethanol/methanol poisonings and some non-electrolyte drug intoxications which cause osmotically active particles

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21
Q

What is the osmol gap?

A

The difference between calculated osmolarity and the measured osmolality

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22
Q

What are some causes of an osmol gap?

A

Ethanol/methanol poisonings and some non-electrolyte drug intoxications which cause osmotically active particles

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23
Q

Which organ in the body has the highest water composition?

A

The brain

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24
Q

Which organ in the body has the highest water composition?

A

The brain

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25
Q

What is the consequence of the brain being the organ with the highest water composition?

A

It is most sensitive to fluid changes

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26
Q

What is Cheyne-Stokes breathing?

A

Varying periods of breaths

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27
Q

What is Cheyne-Stokes breathing?

A

Varying periods of breaths

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28
Q

Describe the prognosis of a patient with Cheyne-Stokes breathing

A

This tends to be indicative that the patient is near death

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29
Q

What solid component of blood is assumed when measuring laboratory values in automated machines?

A

A solid component of 7%

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30
Q

What must you remember about interpreting laboratory values when the concentration of solids (i.e. proteins or lipids) increases?

A

This disrupts the calibration of the machine and thus can lead to falsely low values

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31
Q

What forms the majority of the solid component in the blood?

A

Proteins

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32
Q

Describe the relationship between an increase in urea and an increase in creatinine.

A

If the kidneys are not functioning properly, this encourages small molecule reabsorption, so urea tends to increase disproportionately to creatinine.

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33
Q

What forms the remainder of solid component in blood besides proteins?

A

Lipids

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34
Q

What must you remember about interpreting laboratory values when the concentration of solids (i.e. proteins or lipids) increases?

A

This disrupts the calibration of the machine and thus can lead to falsely low values

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35
Q

What does a high urine osmolality suggest about its concentration?

A

High urine osmolality suggests high concentration

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36
Q

Describe the relationship between an increase in urea and an increase in creatinine.

A

If the kidneys are not functioning properly, this encourages small molecule reabsorption, so urea tends to increase disproportionately to creatinine.

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37
Q

What is an example of a colloid solution?

A

5% albumin

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38
Q

Where does most intravenous isotonic saline distribute?

A

Into the extracellular (interstitial) fluid

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39
Q

Where does most intravenous isotonic saline distribute?

A

Into the extracellular (interstitial) fluid

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40
Q

Where does most intravenous dextrose distribute?

A

Into the intracellular fluid

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41
Q

Which is generally more critical to replace: extracellular fluid or intracellular fluid?

A

Extracellular fluid

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42
Q

How does prolonged administration of intravenous isotonic saline affect serum sodium?

A

Prolonged administration of intravenous isotonic saline increases serum sodium

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43
Q

How does prolonged administration of intravenous isotonic saline affect serum chloride?

A

Prolonged administration of intravenous isotonic saline increases serum chloride

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44
Q

How does prolonged administration of intravenous isotonic saline affect serum potassium?

A

Prolonged administration of intravenous isotonic saline decreases serum potassium

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45
Q

How does prolonged administration of intravenous isotonic saline affect serum magnesium?

A

Prolonged administration of intravenous isotonic saline decreases serum magnesium

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46
Q

What is a potential complication of intravenous isotonic saline not having any calories?

A

If you give isotonic saline as maintenance fluid, this can lead to starvation ketosis

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47
Q

Describe the role of intravenous glucose

A

It corrects fluid deficits in the intracellular fluid and provides calories, without having a significant effect on serum electrolyte concentrations

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48
Q

Lactate is converted into what by the liver, provided it is functioning properly?

A

Bicarbonate

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49
Q

What is a factor which may cause intravenous isotonic saline to distribute into the periphery and third spaces rather than being maintained in the plasma?

A

If there is plasma albumin insufficiency

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50
Q

What should you give if a patient requires blood, but blood is not immediately available?

A

A crystalloid such as isotonic saline to maintain blood pressure

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51
Q

What should you give if a patient requires blood, but blood is not immediately available?

A

A crystalloid such as isotonic saline to maintain blood pressure

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52
Q

Describe the severity of oedema-associated hyponatraemias

A

These tend to be quite mild hyponatraemias

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53
Q

What is the mechanism by which ascites occurs in liver disease?

A

The liver cannot produce sufficient albumin to maintain fluid in the vascular space

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54
Q

What is a mnemonic for the diagnostic criteria for SIADH?

A

DICU-NEEN:
D: decreased plasma osmolality
ICU: inappropriately concentrated urine
N: no diuretic use
E: elevated urine sodium
E: euvolaemia
N: normal thyroid and adrenal function

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55
Q

What is the positive feedback pathway that contributes to worsening ascites?

A

When the body is ascitic, to compensate for the loss of fluid in the vascular space, sodium and fluid reabsorption is increased, but there is still insufficient albumin to maintain this fluid intravascularly, and thus this fluid is drawn into the ascitic component

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56
Q

What is the positive feedback pathway that contributes to worsening ascites?

A

When the body is ascitic, to compensate for the loss of fluid in the vascular space, sodium and fluid reabsorption is increased, but there is still insufficient albumin to maintain this fluid intravascularly, and thus this fluid is drawn into the ascitic component

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57
Q

What is a mnemonic for the diagnostic criteria for SIADH?

A

DICU-NEEN:
D: decreased plasma osmolality
ICU: inappropriately concentrated urine
N: no diuretic use
E: elevated urine sodium
E: euvolaemia
N: normal thyroid and adrenal function

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58
Q

What is a mnemonic for the diagnostic criteria for SIADH?

A

DICU-NEEN:
D: decreased plasma osmolality
ICU: inappropriately concentrated urine
N: no diuretic use
E: elevated urine sodium
E: euvolaemia
N: normal thyroid and adrenal function

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59
Q

What is a mnemonic for the diagnostic criteria for SIADH?

A

DICU-NEEN:
D: decreased plasma osmolality
ICU: inappropriately concentrated urine
N: no diuretic use
E: elevated urine sodium
E: euvolaemia
N: normal thyroid and adrenal function

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60
Q

What is a mnemonic for the diagnostic criteria for SIADH?

A

DICU-NEEN:
D: decreased plasma osmolality
ICU: inappropriately concentrated urine
N: no diuretic use
E: elevated urine sodium
E: euvolaemia
N: normal thyroid and adrenal function

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61
Q

What are 3 neurosurgical or neurological causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Guillain–Barré syndrome
  2. Subarachnoid haemorrhage
  3. Subdural haemorrhage
62
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
63
Q

What are 5 infective causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Meningitis
  2. Encephalitis
  3. Abscesses
  4. HIV
  5. Sarcoidosis
64
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
65
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
66
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
67
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
68
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
69
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
70
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
71
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
72
Q

What are 6 medication-induced causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Antidepressants (SSRIs)
  2. Anticonvulsants (CARBAMazepine, levetiracetam)
  3. Antipsychotics (haloperidol)
  4. Anti-inflammatory drugs
  5. Ecstasy
  6. CYCLOPHOSPHamide
73
Q

What are 6 medication-induced causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Antidepressants (SSRIs)
  2. Anticonvulsants (CARBAMazepine, levetiracetam)
  3. Antipsychotics (haloperidol)
  4. Anti-inflammatory drugs
  5. Ecstasy
  6. CYCLOPHOSPHamide
74
Q

What are 2 non-antidiuretic hormone antidiuretic peptide release causes of SIADH?

A
  1. Prolactinoma
  2. Waldenstrom macroglobulinaemia
75
Q

What are 6 medication-induced causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Antidepressants (SSRIs)
  2. Anticonvulsants (CARBAMazepine, levetiracetam)
  3. Antipsychotics (haloperidol)
  4. Anti-inflammatory drugs
  5. Ecstasy
  6. CYCLOPHOSPHamide
76
Q

What are 2 non-antidiuretic hormone antidiuretic peptide release causes of SIADH?

A
  1. Prolactinoma
  2. Waldenstrom macroglobulinaemia
77
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
78
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
79
Q

What are 5 respiratory causes of SIADH?

A
  1. Tuberculosis
  2. Pneumonia
  3. Pneumothorax
  4. Atelectasis
  5. Asthma
80
Q

What are 6 medication-induced causes of SIADH as a result of increased antidiuretic hormone release?

A
  1. Antidepressants (SSRIs)
  2. Anticonvulsants (CARBAMazepine, levetiracetam)
  3. Antipsychotics (haloperidol)
  4. Anti-inflammatory drugs
  5. Ecstasy
  6. CYCLOPHOSPHamide
81
Q

What is the relationship between blood glucose levels and serum sodium?

A

For every 5.6 mmol/L increase in glucose, there is a 1.6 mmol/L decrease in sodium, but the relationship is not entirely linear, so at blood glucose levels above 25 is closer to 2.4 mmol/L sodium drop per 5.6 blood glucose level

82
Q

What are 6 malignancy-induced causes of SIADH as a result of ectopic antidiuretic hormone production?

A
  1. Nasopharyngeal cancer
  2. Mesothelioma
  3. Pancreatic cancer
  4. Gastrointestinal cancers
  5. Lymphoma
  6. Sarcoma
83
Q

What are 2 non-antidiuretic hormone antidiuretic peptide release causes of SIADH?

A
  1. Prolactinoma
  2. Waldenstrom macroglobulinaemia
84
Q

What should you be suspicious for the cause of SIADH in patients with a significant smoking history?

A

Lung cancer

85
Q

How does pseudohyponatraemia occur in diabetic ketoacidosis?

A

Hyperglycaemia leads to increased extracellular hypertonicity, drawing water out of the intracellular compartment, trapping the fluid in the extracellular compartment, causing low sodium due to sodium depletion secondary to osmotic diuresis

86
Q

How does pseudohyponatraemia occur in diabetic ketoacidosis?

A

Hyperglycaemia leads to increased extracellular hypertonicity, drawing water out of the intracellular compartment, trapping the fluid in the extracellular compartment, causing low sodium due to sodium depletion secondary to osmotic diuresis

87
Q

What is the relationship between blood glucose levels and serum sodium?

A

For every 5.6 mmol/L increase in glucose, there is a 1.6 mmol/L decrease in sodium, but the relationship is not entirely linear, so at blood glucose levels above 25 is closer to 2.4 mmol/L sodium drop per 5.6 blood glucose level

88
Q

What is the relationship between blood glucose levels and serum sodium?

A

For every 5.6 mmol/L increase in glucose, there is a 1.6 mmol/L decrease in sodium, but the relationship is not entirely linear, so at blood glucose levels above 25 is closer to 2.4 mmol/L sodium drop per 5.6 blood glucose level

89
Q

What is the relationship between blood glucose levels and serum sodium?

A

For every 5.6 mmol/L increase in glucose, there is a 1.6 mmol/L decrease in sodium, but the relationship is not entirely linear, so at blood glucose levels above 25 is closer to 2.4 mmol/L sodium drop per 5.6 blood glucose level

90
Q

What is a risk of correcting hyperglycaemia in diabetic ketoacidosis too quickly?

A

Life-threatening hypokalaemia

91
Q

How does bicarbonate affect potassium?

A

Bicarbonate pushes potassium into cells, dropping its serum concentration

92
Q

What are 2 aetiologies of secondary hyperaldosteronism?

A
  1. Renovascular disease
  2. Renin-secreting tumour
93
Q

What is the first priority in a patient who is hypovolaemic?

A

Maintaining fluid supply to the kidneys

94
Q

How does high aldosterone activity affect sodium and potassium?

A

High aldosterone activity increases sodium and reduces potassium

95
Q

What is the main mineralocorticoid in the body?

A

Aldosterone

96
Q

How does high aldosterone activity affect sodium and potassium?

A

High aldosterone activity decreases sodium and increases potassium

97
Q

What level of renin is typically seen in primary hyperaldosteronism?

A

Normal or low renin

98
Q

What is the role of aldosterone?

A

To increase sodium reabsorption and increase potassium excretion

99
Q

What is the role of aldosterone?

A

To increase sodium reabsorption and increase potassium excretion

100
Q

What is the main mineralocorticoid in the body?

A

Aldosterone

101
Q

What are 3 common electrolyte derangements in adrenal insufficiency and adrenal crisis?

A
  1. Hyponatraemia < 138 mmol/L
  2. Hyperkalaemia > 4.5 mmol/L
  3. Hypoglycaemia < 3.9 mmol/L
102
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
103
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
104
Q

What are 2 aetiologies of pseudohyperaldosteronism?

A
  1. Cushing’s syndrome
  2. Exogenous mineralocorticoids
105
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
106
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
107
Q

What are all forms of mineralocorticoid excess associated with?

A

Hypertension

108
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
109
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
110
Q

What are 2 aetiologies of primary hyperaldosteronism?

A
  1. Aldosterone-secreting tumour
  2. Congenital adrenal hyperplasia
111
Q

What are 2 aetiologies of secondary hyperaldosteronism?

A
  1. Renovascular disease
  2. Renin-secreting tumour
112
Q

What level of renin is typically seen in pseudohyperaldosteronism?

A

Normal or low renin

113
Q

What level of renin is typically seen in pseudohyperaldosteronism?

A

Normal or low renin

114
Q

What are 2 aetiologies of pseudohyperaldosteronism?

A
  1. Cushing’s syndrome
  2. Exogenous mineralocorticoids
115
Q

What level of renin is typically seen in primary hyperaldosteronism?

A

Normal or low renin

116
Q

What are 6 causes of extrarenal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Vomiting
  2. Diarrhoea
  3. Third spacing of fluids
  4. Burns
  5. Pancreatitis
  6. Trauma
117
Q

What are 6 causes of extrarenal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Vomiting
  2. Diarrhoea
  3. Third spacing of fluids
  4. Burns
  5. Pancreatitis
  6. Trauma
118
Q

What are 6 causes of extrarenal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Vomiting
  2. Diarrhoea
  3. Third spacing of fluids
  4. Burns
  5. Pancreatitis
  6. Trauma
119
Q

What are 6 causes of extrarenal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Vomiting
  2. Diarrhoea
  3. Third spacing of fluids
  4. Burns
  5. Pancreatitis
  6. Trauma
120
Q

What level of renin is typically seen in secondary hyperaldosteronism?

A

High renin

121
Q

What level of renin is typically seen in pseudohyperaldosteronism?

A

Normal or low renin

122
Q

What level of renin is typically seen in pseudohyperaldosteronism?

A

Normal or low renin

123
Q

What level of aldosterone is typically seen in pseudohyperaldosteronism?

A

Normal or low aldosterone

124
Q

If a patient has hypovolaemic hyponatraemia, and urinary sodium is under 20 mmol/L, what does this suggest?

A

Extrarenal losses

125
Q

What level of renin is typically seen in pseudohyperaldosteronism?

A

Normal or low renin

126
Q

What level of aldosterone is typically seen in primary hyperaldosteronism?

A

High aldosterone

127
Q

If a patient has hypovolaemic hyponatraemia, and urinary sodium is under 20 mmol/L, what does this suggest?

A

Extrarenal losses

128
Q

What level of aldosterone is typically seen in secondary hyperaldosteronism?

A

High aldosterone

129
Q

What level of aldosterone is typically seen in pseudohyperaldosteronism?

A

Normal or low aldosterone

130
Q

What are all forms of mineralocorticoid excess associated with?

A

Hypertension

131
Q

Describe the relationship between magnesium and potassium

A

It is very difficult to correct hypokalaemia if a patient also has hypomagnesaemia as magnesium is involved in the energy reactions needed to create potassium

132
Q

Describe the effect of diuretics on magnesium

A

Magnesium can be significantly depleted by diuretics

133
Q

Describe the relationship between magnesium and potassium

A

It is very difficult to correct hypokalaemia if a patient also has hypomagnesaemia as magnesium is involved in the energy reactions needed to create potassium

134
Q

What is a common cause of hyponatraemia in psychiatry patients?

A

Polydipsia

135
Q

What is the usual treatment for hypovolaemic hypernatraemia?

A

Isotonic saline

136
Q

If a patient has hypervolaemic hyponatraemia, and urinary sodium is over 20 mmol/L, what does this suggest?

A

Acute or chronic renal failure

137
Q

What is a drug which is commonly implicated in causing hypervolaemic hypernatraemia?

A

Fludrocortisone

138
Q

What is a drug which is commonly implicated in causing hypervolaemic hypernatraemia?

A

Fludrocortisone

139
Q

If a patient has hypervolaemic hyponatraemia, and urinary sodium is over 20 mmol/L, what does this suggest?

A

Acute or chronic renal failure

140
Q

What is the mechanism by which lung disease can cause SIADH?

A

Increased antidiuretic hormone release

141
Q

If a patient has hypovolaemic hyponatraemia, what should you assess next?

A

Urinary sodium

142
Q

If a patient has hypervolaemic hyponatraemia, what should you assess next?

A

Urinary sodium

143
Q

If a patient has hypervolaemic hyponatraemia, what should you assess next?

A

Urinary sodium

144
Q

What are 3 potential causes of hypervolaemic hyponatraemia with urinary sodium is over 20 mmol/L?

A
  1. Nephrotic syndrome
  2. Cirrhosis
  3. Cardiac failure
145
Q

If a patient has hypervolaemic hyponatraemia, and urinary sodium is over 20 mmol/L, what does this suggest?

A

Acute or chronic renal failure

146
Q

If a patient has hypovolaemic hyponatraemia, and urinary sodium is over 20 mmol/L, what does this suggest?

A

Renal losses

147
Q

If a patient has hypovolaemic hyponatraemia, and urinary sodium is under 20 mmol/L, what does this suggest?

A

Extrarenal losses

148
Q

What are 6 causes of renal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Diuretic excess
  2. Mineralocorticoid deficiency
  3. Salt-losing deficiency
  4. Bicarbonaturia with renal tubular acidosis and metabolic alkalosis
  5. Ketonuria
  6. Osmotic diuresis
149
Q

What are 6 causes of extrarenal losses of sodium causing hypovolaemic hyponatraemia (i.e. with urinary sodium over 20 mmol/L)?

A
  1. Vomiting
  2. Diarrhoea
  3. Third spacing of fluids
  4. Burns
  5. Pancreatitis
  6. Trauma
150
Q

What are 5 causes of euvolaemic hyponatraemia?

A
  1. Glucocorticoid deficiency
  2. Hypothyroidism
  3. Stress
  4. Drugs
  5. SIADH
151
Q

What is the usual urinary sodium in euvolaemic hyponatraemia?

A

> 20 mmol/L

Residency Exam (22 decks)

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