Disorders of Sodium and H2O balance

Question 1

What is the normal value of Sodium?

Answer 1

135-145 mmol/L

Question 2

What is the normal value of Sodium?

Answer 2

135-145 mmol/L

Question 3

What is the most common cause of Na balance?

Answer 3

Disorders of WATER balance!

Question 4

What defines hyponatremia?

Question 5

What are the symptoms of Hyponatremia?

Answer 5

CNS related- Edema in brina
N/V headache, fatigue, WEAKNESS, seizure, coma, death
Severity related to RAPIDITY and SEVERITY of hyponatremia

Question 6

What defines SEVERE Hyponatremia?

Question 7

What is osmotic adaptation?

Answer 7

Brain cells can produce or excrete osmols in order to protect against dehydration or over hydration

Question 8

What are the symptoms of Osmotic Demyelination syndrome?

Answer 8

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

Question 9

What are the symptoms of Osmotic Demyelination syndrome?

Answer 9

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

Question 10

What is the most common cause of Na balance?

Answer 10

Disorders of WATER balance!

Question 11

What defines hyponatremia?

Answer 11

less than 135 mmol/L

Question 12

WHat are rhe EU-VOLEMIC Causes of Hyopnatremia?

Answer 12

Hypoadrenalism, hypothyroidism - INC ADH
Hypothyroidism
SIAD
-inappropriate elevation of ADH DESPITE hyponatremia and euvolemic state

Question 13

What defines SEVERE Hyponatremia?

Question 14

What is osmotic adaptation?

Answer 14

Brain cells can produce or excrete osmols in order to protect against dehydration or over hydration

Question 15

What is Osmotic Demyelination syndrome?

Answer 15

Demyelination of CNS(pons)

Occurs with RAPID correction of severe hyponatremia

Question 16

What are the symptoms of Osmotic Demyelination syndrome?

Answer 16

Paraparesis, Dysarthria, dysphagia, seizure, coma and Death

Question 17

What is the Tx of True Hyponatremia?

Answer 17

Tx underlying etiology 
Take into account Os Adaptation
Severe HypoNa? Consider hypertonic Saline
Demeclocycline-increase H2O loss
Vasopressin antagonist- Urinary H2O loss

Question 18

WHat are rhe HYPO-VOLEMIC Causes of Hyopnatremia?

Answer 18

Renal losses: Diuretics Especially HYDROCHLORATHIAZIDE. osmotic diuresis(hyperglycemia)
Inc U Na+
Extra renal Losses: blood loss, diarrhea or vomiting
Dec U Na+ (Volume Depletion)
Inc U Osm

Question 19

WHat are rhe HYPER-VOLEMIC Causes of Hyponatremia?

Answer 19

Renal Failure- Inc U Na+

CHF, Cirrhosis, nephrotic synd

Question 20

WHat are rhe EU-VOLEMIC Causes of Hyopnatremia?

Answer 20

Hypoadrenalism, hypothyroidism - INC ADH
Hypothyroidism
SIAD

Question 21

What is SIAD/Hyponatremia?

Answer 21

Non-physiologic release of ADH
leading to impaired H2O excretion
No Edema

Question 22

What is the Etiology of SIAD?

Answer 22

CNS Disease- Meningitis, cancer, stroke
Drugs- CNS related, psychotropic, narcotics
Pulmonary Disease- pneumonia
Pain, Stress- post op state

Question 23

What are Diagnostic Charicteristics of SIAD?

Answer 23

HypoNa HypoOs
Innap elevated U. osm
Normovolemic on clin exam
Normal renal, adrenal and Thyroid funct

Question 24

What is Tx of Pseudohyponatremia?

Answer 24

Treat Cause: Hyperlipidemia

Myeloma

Question 25

What is the Tx of True Hyponatremia?

Answer 25

``` Tx underlying etiology Take into account Os Adaptation Severe HypoNa? Consider hypertonic Saline Demeclocycline-increase H2O loss Vasopressin antagonist- Urinary H2O loss ```

Question 26

What is the cause of Hypernatremia?

Answer 26

Water loss Na Retention Water loss > Na loss

Question 27

What are causes of Water loss?

Answer 27

``` Insensible Renal GI Hypothalmic Dis Water redist into cells ```

Question 28

What are causes of Na+ Retention?

Answer 28

Admin of Hypertonic NaCl, NaHCO3 | Salt pills

Question 29

What are defenses against Hypernatremia?

Answer 29

Stim of ADH production

Question 30

What is Diabetes Insipidus?

Answer 30

Dec ADH production or secretion | Dec Renal response to ADH

Question 31

What are causes of Central DI-CDI?

Answer 31

``` Idiopathic 75% Neurosurgery Head Trauma Hypoxic/Ischemic Encephalopathy Cancer ```

Question 32

What are the Symptoms of Central Diabetes Insipidus?

Answer 32

``` Polyuria Polydipsia Low U. Osm Undetectable Plasma ADH improvement and inc U. osm with Admin of ADH ```

Question 33

What are the causes of Nephrogenic Diabetes insipidus?

Answer 33

``` Congenital Hypercalcemia, Hypokalemia Lithium, demeclocycline Renal Parencymal Dis AI dis Osmotic Diuresis ```

Question 34

What causes Primary Polydipsia?

Answer 34

Psychiatric or Hypothalamic Dys

Question 35

What is the DDx of Polyuria/Polydipsia?

Answer 35

NDI and CDI => Hypernatremia 1^ Polydipsia => Hyponatremia Water deprivation test- Overnight Fast from H2O

Question 36

When is Tx of Hypernatremia indicated?

Answer 36

Symptomatic Volume Depleted Hypernatremia Severe (>155)

Question 37

What is the Tx of Hypernatremia?

Answer 37

Correct Cause Correct Hypernatremia with fluids CDI => Give ADH NDI => Adequate H2O