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PHRM 825 > PHRM 825: Fluids and Electrolytes - Electrolytes - Na+ > Flashcards

PHRM 825: Fluids and Electrolytes - Electrolytes - Na+ Flashcards

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1
Q

Sodium goal concentration

A

135-145 mEq/L (remember 140)

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2
Q

Sodium is primarily an _______ cation

A

extracellular

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3
Q

Sodium is needed to maintain _______

A

cellular integrity

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4
Q

Sodium maintains ____ gradient and regulates ______ throughout the different compartments

A

Osmolar; fluid homeostasis

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5
Q

What is the most common electrolyte disturbance in hospitalized patients

A

Hyponatremia

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6
Q

Hyponatremia has significant ________

A

morbidity and mortality

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7
Q

Osmolarity calculation

A

Osm = (2*Na) + (BUN/2.8) + (Glucose/18)

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8
Q

Osmole gap (OG) exists when

A

The difference between the measured and calculated is greater than 15

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9
Q

OG is the presence of

A

Unidentified particles

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10
Q

Osmole gap calculation

A

Osm serum - Calculated Osm

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11
Q

Types of hyponatremia

A

Pseudohyponatremia, Hypertonic hyponatreamia, hypotonic hyponatremia

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12
Q

Types of hypotonic hyponatremia

A

Hypovolemic hyponatremia, isovolemic hyponatremia, hypervolemic hyponatremia

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13
Q

Pseudohyponatremia is ______

A

isotonic

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14
Q

Pseudohyponatremia definition

A

When extreme elevation of lipids and proteins increase the total plasma volume which leads to a dilution effect so the sodium appears low

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15
Q

Pseudohyponatremia calculated Osm is _____ which leads to an ____

A

Los; OG

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16
Q

Hypertonic hyponatremia is most frequently seen with _______

A

elevated blood glucose

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17
Q

Serum sodium falls by ______ for each _______ incremental increase in BG >______

A

1.6 mEq/L; 100mg/dL; 100 mg/dL

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18
Q

Equation for corrected sodium

A

Corrected Na+ = Na serum + 1.6[(BG-100)/100]

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19
Q

Hypotonic hyponatremia accounts for what percentage of all hyponatremias

A

> 90%

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20
Q

Most important step when assessing for hypotonic hyponatremia is to clinically assess the patient’s _____

A

ECF volume

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21
Q

Hypovolemic hypotonic hyponatremia is characterized by a decrease in both total body _____ and _____

A

Water and Na+

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22
Q

Renal causes of hypovolemic hypotonic hyponatremia

A
  • Diuretics/excessive diuresis
  • Adrenal insufficiency
  • Salt losing nephropathy
  • Cerebral salt wasting
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23
Q

When hypovolemic hypotonic hyponatremia is caused by the renal system, urine sodium levels will be ____

A

> 20 mEq/L

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24
Q

Non-renal causes of hypovolemic hypotonic hyponatremia

A
  • Blood loss/hemorrhage
  • Skin losses (burns, sweat, wounds)
  • GI losses (vomiting, diarrhea, suction)
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25
Causes of isovolemic hypotonic hyponatremia
- Adrenal insufficiency (glucocorticoid deficiency) - Hypothyroidism - Psychogenic polydipsia - SIADH
26
Meaning of SIADH
Syndrome of Inappropriate Antidiuretic hormone release
27
What is the most common cause of isovolemic hypotonic hyponatremia
SIADH
28
Characteristics of SIADH
Water intake exceeds capacity of the kidneys to excrete water
29
Causes of SIADH
Tumors, CNS disorders (stroke, head trauma, meningitis, etc), Drugs
30
Usual urine Osm and Na+ in someone with SIADH
Osm > 100 mOsm/kg | Na > 20-30 mEq/L
31
How is SIADH treated?
- Remove underlying cause if possible - First line: free H2O restriction - Vaptans (if 24-48 hrs of free h2o restriction fails)
32
Hypervolemic hypotonic hyponatremia is caused when
The total body Na+ is increased but the TBW is increased even more
33
Hypervolemic hypotonic hyponatremia is characterized by
Expanded ECF volume and edema
34
Hypervolemic hypotonic hyponatremia can be caused by
- Cirrhosis - Heart failure - Kidney failure - Nephrotic syndromes
35
Clinical presentation of hypotonic hyponatremia
Mostly asymptomatic
36
Clinical presentation of hypovolemic hypotonic hyponatremia
Dehydration; decreased skin tugor, orthostatic hypotension, tachycardia, dry mucous membranes
37
Clinical presentation of isovolemic hypotonic hyponatremia
Malaise, psychosis, seizures, coma
38
Clinical presentation of hypervolemic hypotonic hyponatremia
Fluid overload; edema and weight gain
39
Clinical presentation of acute hyponatremia
Nausea, malaise, weakness, headache, disoriented, coma, seizures, respiratory arrest
40
Goal of hypovolemic hypotonic hyponatremia treatment
Restore the volume deficit
41
Goal of isovolemic hypotonic hyponatremia treatment
Treat the underlying cause
42
Goal of hypervolemic hypotonic hyponatremia treatment
Treat the underlying cause
43
When treating Hypotonic hyponatremia the goal is to avoid rise in serum sodium >____mEq/L/hr or NMT ____ mEq/L/day
0.5 and 8-12
44
Calculated Na+ deficit calculation
TBW * (Na normal-current Na serum)
45
Rule of 8s
1/2 the sodium deficit should be replaced over 8 hours, 1/4 over the next 8 hours, and the last 1/4 over the next 8 hours
46
Rapid infusions of 3% NaCl at 1-2 mL/kg/hr over 2/3 hours should only be done in patients with
Coma or seizures
47
Total body water calculation for males
0.6 * wt (in kg) = ___L
48
Total body water calculation for females
0.5 * wt (in kg)=___L
49
In 1 L of 0.9% NaCl there are _____ mEq of Sodium
154
50
In 1 L of 3% NaCl there are ____ mEq of Sodium
513
51
Symptoms of acute symptomatic hyponatremia
Altered mental status; seizures; metabolic encephalopathy can develop
52
Metabolic encephalopathy involves what physiologic changes
Cerebral edema, increased intracranial pressure (ICP), irreversible and fatal
53
Treatment of acute symptomatic hyponatremia
Increase serum Na by 1-2 mEq/L/hr until symptoms resolve
54
Short term goal of treatment for acute symptomatic hyponatremia
Serum Na+ 120 mEq/L - does not need to be corrected to 135 if correction will be too fast
55
Result of overly rapid Na+ correction
Diffuse demyelinating lesion (central pontine myelinolysis)
56
Max increase of Na+ serum levels in 24 hours
8-12 mEq/L
57
Vaptan examples
Conivaptan (IV) and Tolvaptan (PO)
58
Conivaptan (IV) and Tolvaptan (PO) promote
Excretion of free H2O
59
Conivaptan (IV) and Tolvaptan (PO) are
Arginine vasopressin V2/V1A receptor antagonists
60
When taking vaptans (conivaptan and tolvaptan) what occurs?
- No loss in serum electrolytes - Increased urine output - Decreased urine osmolarity - Normalizes Na+ levels
61
Conivaptan is used for _____ and ______ symptomatic hyponatremia
euvolemic and hypervolemic
62
Tolvaptan is used for asymptomatic _____ and _____ hyponatremia
Euvolemic and hypervolemic
63
Vaptan contraindicaitions
- Hypovolemic hyponatremia - Patients without a sense of thirst - Anuria - Use with strong CYP3A4 inhibitors
64
Acute symptomatic hyponatremia patients should be monitored _____
closely
65
Patients with acute symptomatic hyponatremia should have serial exam of heart, lungs, and neurologic status _____ times over the first ______ hours
several; 12
66
The serum Na+ concentration in acute symptomatic hyponatremia patients should be checked every ______ hours until they are asymptomatic
2-4 hours
67
The serum Na+ concentration in acute asymptomatic hyponatremia patients should be checked every _____ hours until WNL
4-8 hours
68
Hypernatremia is always associated with ______
hypertonicity
69
______ occurs in patients with impaired thirst response or patients without access to water
Hypernatremia
70
______ can be a result of loss of water/hypotonic fluids OR ingestion of sodium/hypertonic fluids
Hypernatremia
71
With hypernatremia you must assess _______
volume status (ECF)
72
Hypernatremia from hypertonic fluids is ____
uncommon
73
How to restore hemodynamic status for hypovolemic hypernatremia patients
0.9% NaCl
74
When restoring the free water deficit you should use _____
D5W
75
_____ infusion does not affect electrolyte balance
D5W
76
Do not correct the free H2O deficit too quickly. Give _____ total deficit over 24 hours and give ____ over the next 24-48 hours
1/2; 1/2
77
While replacing the free H2O deficit the goal is _____ mEq/L/hr decrease with a max of ____ mEq/L/day
0.5; 12
78
Isovolemic hypernatremia is found in patients that have _____
Diabetes insipidus
79
Causes of isovolemic hypernatremia include
Central and nephrogenic causes
80
Isovolemic hypernatremia treatment
Desmopressin (DDAVP) and Vasopressin
81
Estimated change in sodium definition
Estimates the change (increase or decrease) in serum sodium per one liter of any given fluid
82
Estimated change in sodium calculation
Change in Naserum = (Na fluid - Na serum)/(TBW + 1L)

PHRM 825 (36 decks)

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