Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
7 Cards in this Set
- Front
- Back
|
SIADH
ADH, type of dx, criteria (5) |
1. Aka arginine vasopressin (AVP) and is released from the posterior pituitary
2. Diagnosis of exclusion 3. Criteria - Euvolemic - Serum hypoosmolarity - Urine not very dilute: osmolality >150 mmol/L - Urine sodium > 20 mmol/L - Normal adrenal and thyroid function |
|
|
Hypovolemic w/ hyponatremia
tx |
Volume replacement with isotonic or normal (0.9%) saline
|
|
|
Euvolemic w/ asymptomatic + symptomatic hyponatremia
tx |
1. Asymptomatic: fluid restriction
2. Symptomatic: hypertonic (3%) saline & symptoms include seizures or coma |
|
|
Rate of Na correction & possible complication
i, ii (4) |
1. Rate should not exceed 0.5 to 1 mEq/h
2.Central pontine myelinolysis (CPM) or osmotic demyelination - Quadriplegia - 'Locked-in' syndrome - Coma - Death |
|
|
OSMOLALITY
normal value, formula, measured vs. calculated, glucose vs. Na |
1. Normal range: 280 to 300 mOsm/kg
2. Formula: 2[Na+] + [Glucose]/18 + [BUN]/2.8 3. Pseudohyponatremia suspected if measured and calculated serum osmolarities are different 4. Every 100 mg/dL increase in glucose leads to 1.6 mmol/L decrease in sodium |
|
|
Causes of Hyponatremia: Pseudohyponatremia
normal osmolarity (3), ↑ osmolarity (2) |
1. Normal plasma osmolarity:
• Hyperlipidemia • Hyperproteinemia • Posttransurethral resection of prostate/bladder tumor 2. Increased plasma osmolarity • Hyperglycemia • Mannitol |
|
|
Causes of Hyponatremia: Hypoosmolar hyponatremia
i (3), ii (6), iii (3) |
1. Primary Na+ loss (secondary water gain)
• Integumentary loss: sweating, burns • Gastrointestinal loss: vomiting, diarrhea • Renal loss: diuretics, hypoaldosteronism, acute tubular necrosis 2. Primary water gain (secondary Na+ loss) • Primary polydipsia • Decreased solute intake • SIADH • Glucocorticoid deficiency • Hypothyroidism • Chronic renal insufficiency 3. Primary Na+ gain (exceeded by secondary water gain) • Heart failure • Hepatic cirrhosis • Nephrotic syndrome |
