Fluid and Electrolyte Cases Part 1 Flashcards Preview

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Flashcards in Fluid and Electrolyte Cases Part 1 Deck (19)
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1
Q

Number 1 cause of euvolemic hyponatremia

A

Syndrome of Inappropriate ADH Secretion (SIADH)

2
Q

SIADH Med Causes

A
Antineoplastic agents
Antipsychoatics (Haloperidol, thioridazone, chlorpromazine)
CARBAMAZEPINE
DESMOPRESSIN
NSAIDS
OPIATES
SSRI/SNRI (fluxetine, duloxetine)
Tricyclic antidepressants (Amitriptyline, imipramine)
3
Q

Asymptomatic/Chronic Rate of Correction of Sodium

A

Increase Na by less than or equal to 0.5 mEq/h

Less than 10-12 mEq/24 hour period

4
Q

Symptomatic/Acute Rate of Correction of Sodium

A
  • Seizures, alterned mental status
    Increase Na by 1-2 mEq/h for first few hours
    No more than 12 mEq/ 24 hours
5
Q

Consequences of correcting sodium too quickly:

A

It affects the brain

Myelin sheath will disconnect from the brain cells and cannot be reconnected

6
Q

Total Body Water in Men vs Women

A

M: 0.6kg
W: 0.5
kg

7
Q

Hypotonic Hypovolemic

A

IV 0.9% saline
Severly symptomatic - 3% saline
Do hourly monitoring

8
Q

Hypotonic Euvolemic

A
Fluid resitriction (less than 1000 mL/day)
IV 3% saline if severe symptoms (+/- loop diuretic)
9
Q

Demecloycyline

A

Hypotonic Euvolemic
Inhibits action of ADH
Not used very often and it takes a while to work

10
Q

Urea

A

Hypotonic Euvolemic

Contraindication in renal or hepatic failure

11
Q

Sodium Chloride

A

Hypotonic Euvolemic
Often combined with loops
Avoid in HF pts

12
Q

Vaptans

A

ADH receptor antagonists
Free water excretion and increase sodium concentrations
DO NOT USE IN HYPOVOLEMIC PTS

13
Q

ConIVaptan (Vaprisol)

A

Local site rxn

Long lasting and can correct too quickly

14
Q

Tolvaptan (Samsca)

A

V2 only
Risk of overcorrection here too
Chronic

15
Q

Hypotonic Hypervolemic

A

Treat underlying conditions like HF (ACEi/ARB, Digoxin)
Fluid restriction less than 1000 mL/day
AVP Receptor antagonists

16
Q

Hypovolemic Hypernatremia + Hemodynamic instability (hypotension, tachycardia) Treatment

A

0.9% NaCl 200-300 mL/day continuous infusion until stability is restored
Then hypotonic fluid continuous infusion to correct water deficit (0.45% NaCl or D5W)

17
Q

Euvolemic Hypertnatremia + Central Diabetes Insipidus

A
ADH Replacement (Desmopression start at 10 mcg at night)
Measure Na q 3-4 days initially, then q 2-4 months
18
Q

Euvolemic Hypenatremia + Nephrogenic diabetes insipidus

A

Does not respond to ADH
Need to correct underlying disease
Use thiazide and salt restriction

19
Q

Hypervolemic hypertnatremia

A
Loop diuretic (Lasix 20-40 mg IV Q6)
D5W based on water deficit