Renal - Clinical - Na+

Front 1

Three major factors of serum osmolality:

ADH produced by, stored in:

Triggered by osmolality > ____

Two major functions of ADH?

Back 1

Na+, BUN, Glucose

hypothalamus, stored in posterior pituitary

280

water absorption in DCT, capillary casoconstriction

Front 2

Three other triggers for ADH release?

Two mechanisms for hyponatremia?

Back 2

hypotension, 7-10% decreased plasma volume, decreased effective plasma volume

psychogenic polydipsia - kidney overload
water excreting defect - inability to dilute urine

Front 3

Mechanism/symptoms of hypovolemic hyponatremia?

Mechanism/symptoms of hypervolemic hyponatremia?

4 causes of volume depletion?

Back 3

hypovolemic - volume/Na+ depletion - orthostasis, decreased skin turgor, hypotension

volume excess - edema

GI losses (diarrhea)
third spacing
adrenal insufficiency - lowered aldosterone
renal salt wasting

Front 4

Case #1: 21 y/o to ER, orthostasis, decreased skin turgor, sunken eyes, skin/mucus membranes dry.

Labs: Na 128, K 3.8, Cl 80, BUN 36, Cr 1.6

Explain: significance of labs, presentation, causes of symptoms.

Back 4

elevated BUN/Cr = ARF
symptoms = hypovolemia from GI volume loss (diarrhea)
dehydration --> poor perfusion of kidneys

Front 5

Case #2: 72 y/o to ER c/o edema to scrotum, abd, LE's, dyspnea, hx of ESRD.

Labs: Na 126, K 3.6, Cl 82, BUN 38, Cr 1.7, Alb 1.7, 24 hr urine protein 3.7

Explain labs, causes of symptoms:

Back 5

elevated BUN/Cr = ARF
symptoms = ESRD causing nephrotic syndrome, protein leakage from plasma --> decreased PCOP, fluid leaks into interstitium

hypervolemic hyponatremia

Front 6

Case #3: 36 y/o to doctor c/o alt. mental status, confusion, recent dx of TB:

Na 127, increased urine Na >20, +AFB sputum cx, ADH in plasma

Explain symptoms, causes:

What else can cause euvolemic hyponatremia?

Back 6

TB --> SIADH (dx of exclusion)

hypothyroidism
cortisol deficiency, panhypopituitarism

Front 7

Tx for volume depletion?

What effects does this have?

Tx for volume excess?

Back 7

slow IV administration of NS

gradually corrects volume, increases GFR, increases distal tubule volume, stops release of ADH

tx of underlying disorder, salt/H2O restriction, diuretics, rx to increase CO

Front 8

Some causes of SIADH?

Drug to treat SIADH?

MOA?

Back 8

oat cell carcinoma, meningitis, encephalitis, trauma, stroke, pulmonary infections, COPD, asthma

demeclocycline

reversible state of diabetes insipidus

Front 9

S/S of hyponatremia Na < 120?

Coma/death can occur with Na < ____.

Causes of hyponatremic encephalopathy in men, women?

what procedure can cause hyperosmolality?

Back 9

N/V, irritability, confusion, seizures

110

men: TURP
women: endometrial ablation

1.5% glycine irrigant

Front 10

Why can't you fix Na deficiency quickly?

Limit for tx of acute hyponatremia?

limit for tx of hyponatremia, 24 and 48 hrs:

Back 10

risk for central pontine myellinosis 2-6 days after

<20 meq/24 hrs

<12 meq/24, <18 meq/48

Front 11

Cause of hyperosmolar hyponatremia:

mechanism?

formula to find corrected Na in diabetics?

Back 11

diabetes

high intravascular concentrations of osmotic agents pulls water into lumen

measured Na + [1.5 x (glucose -150)/100]

Front 12

S/S of hypernatremia?

most common cause of hypernatremia?

Two types of diabetes insipidus?

Back 12

tremulousness, irritability, mental confusion, ataxia, seizures, coma

volume loss - not drinking enough water, loss of thirst reflex, diabetes insipidus

Neurogenic - absent/insufficient ADh
nephrogenic - ADH OK, kidney doesn't respond

Front 13

3 drugs that can cause nephrogenic DI?

electrolyte causes?

Two renal tubulointerstitial diseases that cause DI?

How do you dx? Tx?

Back 13

lithium, democlocycline, foscarnet

hypokalemia, hypercalcemia

obstructive uropathy, Sickle Cell nephropathy

water deprivation, vasopressin stim test

Tx - D5W

Front 14

Case #4: 60 y/o f to ER c/o polyuria, nocturia, excessive thirst, hx of breast ca/depression.

Labs: Na 150, K 3.8, BS 100, BUN 30, urine osmolality 150

Cause?

Back 14

central diabetes insipidus - due to breast ca mets to pituitary