Sodium

Question 1

Treatment for mild hyponatremia

Answer 1

PO salt/gatorade

Question 2

Treatment for mild hypernatremia

Answer 2

PO free water

Question 3

Treatment for severe hypernatremia

Answer 3

IV 1/2 NS or D5water

Question 4

Treatment for severe hyponatremia

Answer 4

IV 3% sodium (use online calculator to determine rate)

Question 5

S/S severe hyponatremia

Answer 5

Na < 110 or seizures or coma

Question 6

Treatment for moderate hyponatremia/hypernatremia

Answer 6

IVF NS (for functioning kidneys)

Question 7

Major not okay complication for fast correction of sever hyponatremia

Answer 7

Central pontine myelinolysis

Question 8

Never correct sodium by more than:

Answer 8

1 mEq/hour

goal: 0.5 mEq/hour unless seizing

Question 9

How to calculate serum osmoles (memorize)

Answer 9

2Na + (Glu/18) + (BUN/2.8)

*compare calculated and measures serum osmoles

Question 10

If measured osmoles > > calculated, what does this mean?

Answer 10

Something other than Na, Glu or BUN is taking up the space –> toxic ingestions is ethylene glycol, isopropyl alcohol, methanol etc.

Question 11

How to correct measured Na value:

Answer 11

For every 100 above 100 of glucose, add 1.6 to the Na value

Question 12

When measured osoms and calculated osoms are both low, what does this mean?

Answer 12

True hypotonic hyponatremia, could be:
Hypervolemia (ie CHF) –> need diuresis
Euvolemia
Hypovolemia (S/S ie tenting does not matter, use hx ie heat exhaustion, fever, tachycardia, water restriction) –> IVF –> if pt better, pt was hypovolemic, if pt worse, pt was euvolemic –> RATS

Question 13

What does RATS stand for?

Answer 13

Used with euvolemic hyponatremia:
Renal tubular acidosis (usually type 4)
Addison's --> check cortisol
Thyroid (usually hyperthyroid) --> check TSH
SIADH (dx of exclusion)

Question 14

JG apparatus makes:

Answer 14

Renin

Question 15

Renin turns on:

Answer 15

Angiotensin II

Question 16

Angiotensin II turns on:

Answer 16

Aldosterone

Question 17

Aldosterone functions to:

Answer 17

Turn on eNaC channels to absorb water and Na –> waste K –>

Question 18

Urine in volume down state should look like:

Answer 18

Na low (surrogate for aldosterone) - If Na <20, aldosterone doing its job
Osms high (surrogate for ADH) - If osms >300, ADH functioning

Question 19

Person is euvolemic but ADH is still on, condition:

Answer 19

SIADH (dx of last resort)
UNa > 20
Osms HIGH ie >300 (indicating ADH is on) *discordant Na and urine osoms

Question 20

If serum Na low, order what three additional tests:

Answer 20

Serum osms
Urine Na
Urine osms