Differential Diagnosis
Progressive confusion related to fluid shift that causes the Brain to shrink due to sudden rise in osmolarity of blood.
What is Osmotic Myelinolysis?
Drug used to treat hyponatremia. Requiring several days to a week to cause decreased responsiveness of the collecting tubule to ADH leading to increase water excretion.
What is Demeclocycline?
Site of action of the drug vasopressin.
What is V2 aquaporin channel?
The best initial step in the management of patient with severe hypovolemia and hypernatremia?
What is Intravenous administration of .9% saline?
Should not exceed 6-8 mEq in a 24 hour period.
What is the correction rate for Hyponatremia?
A change in Sodium caused by elevation in LDL or proteins causing decreased fraction of serum to water
What is Pseudohyponatremia?
Vasopressin receptor antagonist that can be used to treat hyponatremia if initial management fails. It can cause overly rapid correction in severely hyponatremic patients.
What is Conivaptan?
Cushing syndrome usually causes what Na derangement.
What is Hypernatremia?
What is best initial step in treating a patient with decreased Cardiac Output and Hyponatremia.
What are Diuretics and Ace Inhibitors?
Hyponatremia can be caused by paraneoplastic syndrome in what type of cancer.
What is Small cell lung cancer?
A state of persistent hypernatremia (>145 mEq/L) as a result of free-water diuresis resulting in a relative water deficit.
What is Diabetes Insipidus?
Anti-depressants and Anti-Psychotics cause cause what sodium derangement?
What is hyponatremia?
A Low-Solute diet combined with high fluid intake leads to what sodium derangement
What is Hyponatremia?
What is the Best Initial treatment for a patient with Acute Hyponatremia and / or severely symptomatic Hyponatremia (ex. AMS/Hyporeflexia) to reverse neurologic symptoms and prevent Brain Herniation?
What is Hypertonic 3% saline?
Acute Hypernatremia can safely be corrected to a normal serum sodium level over what time period.
What is 24 hours?
Medical condition with decreased serum Na resulting from non osmotic stimuli for ADH secretion (ex. Increased baroreceptor firing). Leading to increased resorption of free water which in turn results in hyponatremia due to fluid dilution.
What is Congestive Heart failure?
Name 2 MOA by which Anti-Epileptic drugs can affect Na levels in humans
What are : a. Na channel blockade b. modulation of voltage gated ion channels, c. enhancement of GABA- mediated inhibitory neurotransmission, d. attenuation of glutamate-mediated excitatory neuro transmission.
What happens to Na levels in response to renal hypoperfusion, as in massive blood loss due to trauma?
What is no change in Serum Na levels?
Best initial treatment of seizures caused by severe hyponatremia.
What is 100 ml bolus of 3% saline?
Calculate the anion gap and corrected Na.
Na 127, K 3.9, Cl 92, Bicarb 14, BUN 54, CR 1.6, Glucose 600, Albumin 4.0
What is 21 and 135?
Anion gap = Uncorrected Na - Cl - Bicarb
Corrected Na = serum na + ( 1.6 x every 100 mg/dl in glucose above 100 mg/dl)
Condition that can occur after CNS injury resulting decreased free water clearance low Serum Osmolarity (<275 mOsm/kg H2O), Concentrated urine (>100mOsm/kg H20). I n a patient that is typically Euvolemic.
What is Syndrome of Inappropriate Antidiuretic Hormone secretion?
What class of drugs may be considered for treatment of severe hyponatremia after initial management. They generally are most effective if urine Osmolality is 2x greater than serum osmolality( typically Urine Osmolality is >500 MOsm / kg.
What are Loop Diuretics?
What condition/deficiency results in euvolemic hyponatremia with decreased serum osmolality(hypotonic hyponatremia) and normal K.
What is mineral corticoid deficiency (hypoaldosteronism)?
Treatment for 42 y/o f Nau, forgetful, diff concentrating. Hx Trigemina neuralgia on carbamazepine. Normal H2O and salt intake. Urine studies Na 65 mEq/L osmolality 430 mOsm/kg. Serum studies Na 126, K 4.2, BUN 7, Cr .9, TSH 3.4, serum osmolality 255 mOsm/kg
What is Fluid restriction of to 1 L daily?
Children with community acquired pneumonia are at risk of developing hyponatremia that is caused by this condition.
What is Syndrome of Inappropriate Antidiuretic Hormone Secretion?