ILE I U4 Treatment

Question 1

Hypovolemic Hypotonic Hyponatremia

Answer 1

Replace w/ isotonic fluids to expand ECF; stop any diuretics

Question 2

Hypotonic euvolemic hyponatremia

Answer 2

Fluid restriction, diuretics. 3% saline if SEVERE, for chronic treatment, use demeclocycline/tolvaptan

Question 3

Hypotonic hypervolemic hyponatremia

Answer 3

Reduce fluid intake, eliminate Na intake, may use loop diuretic with 3% if severe, demeclocycline/tolvaptan

Question 4

Isotonic Hyponatremia

Answer 4

No treatment needed, this is pseudohyponatremia.

HIGH TRIGLYCERIDES

Question 5

Hypertonic hyponatremia

Answer 5

Caused by HYPERGLYCEMIA, MANNITOL, or osmotically active substance

Question 6

Hypernatremia is always

Answer 6

hypertonic

Question 7

Hypovolemic hypernatremia

Answer 7

Correct hypotension with isotonic saline first, then correct free water deficit (no more than 1/2 in 24 hr)

Question 8

Euvolemic hypernatremia

Answer 8

Correct water deficit using 1/2 NS or D5W

Question 9

Hypervolemic hypernatremia

Answer 9

Remove Na; give diuretics, dialysis if needed

Question 10

If HYPOnatremia is corrected too quickly (>6-8 mEq/L/day)

Answer 10

Osmotic demylenation syndrome

Question 11

If HYPERnatremia is corrected too quickly (>6-8 mEq/L/day)

Answer 11

Cerebral edema

Question 12

In which patients might you use demeclocycline/tolvaptan?

Answer 12

Hypotonic hypervolemic hyponatremia, hypotonic euvolemic hyponatremia