When Sodium Falls
Overcorrection of hyponatremia can lead to this neurologic complication.
What is osmotic demyelination syndrome?
A longer-than-normal corrected QT interval on ECG increases the risk of this potentially life-threatening arrhythmia.
What is torsades de pointes?
The fluid accumulation in ascites is classified by this measurement obtained from paracentesis, which helps distinguish portal hypertension from other causes.
What is the serum-ascites albumin gradient (SAAG)?
A seizure that lasts more than 5 minutes or recurrent seizures without recovery of consciousness is defined as:
What is status epilepticus?
A hospitalized patient develops a new fever. As part of the initial septic workup, name at least two investigations you would order as part of the initial workup for infection
What are:
Blood cultures
Urinalysis (± urine culture)
CXR
The initial treatment for severe symptomatic hyponatremia is this solution.
What is 3% hypertonic saline?
A QT interval corrected for heart rate (QTc) above this value in men or women is generally considered prolonged.
What is >450 ms in men and >460 ms in women?
This bedside finding is used to detect ascites when dullness shifts as the patient rolls from side to side.
What is shifting dullness?
Common chronic or structural causes of new-onset seizures include these conditions.
What are stroke, brain tumor, CNS infection, or prior traumatic brain injury?
A patient on the wards develops acute kidney injury. Name three common medications that can cause kidney injury.
S – Sulfonamides
A – ACE inhibitors / ARBs
D – Diuretics (especially if volume-depleted)
M – Metformin
A – Aminoglycosides
N – NSAIDs
For many patients with euvolemic hyponatremia, this intervention is often the first step in management.
What is fluid restriction?
This electrolyte imbalance can worsen QTc prolongation
What are hypokalemia, hypomagnesemia, and hypocalcemia?
The most common cause of ascites is this chronic condition, often associated with alcohol use or hepatitis.
What is cirrhosis?
A patient faints versus has a seizure. The presence of this post-event feature a useful clinical clue that the episode was a seizure.
What is post-ictal confusion?
A patient has a pleural effusion. To determine whether it is an exudate, you use Light’s criteria. Name the three key measurements or ratios used in these criteria.
Pleural fluid protein / serum protein ratio > 0.5
Pleural fluid LDH / serum LDH ratio > 0.6
Pleural fluid LDH > 2/3 the upper limit of normal for serum LDH
This is the formula used to calculate serum osmolality.
What is 2 × [Na⁺] + glucose + urea?
This electrolyte, given intravenously at 1-2 g, is recommended to suppress tornadoes de pointes even when serum levels are normal.
What is magnesium sulphate?
A cirrhotic patient with ascites presents with fever and abdominal pain. Paracentesis is performed. A key diagnostic criterion for spontaneous bacterial peritonitis is an ascitic fluid neutrophil count equal to or above this value.
What is ≥250 cells/µL (absolute neutrophil count in ascitic fluid)?
The first-line treatment for an actively seizing patient in status epilepticus is:
What is a benzodiazepine (e.g., IV lorazepam, IM midazolam)?
A patient with acute kidney injury may need urgent dialysis. Name the classic clinical or laboratory indications for starting dialysis.
What are:
A – Severe metabolic acidosis
E – Electrolyte abnormalities (e.g., hyperkalemia)
I – Ingestion/Overdose
O – Overload
U – Uremia
A 72-year-old female presents with confusion and appears euvolemic on exam. Her labs show: sodium 122 mmol/L, serum osmolality 260 mOsm/kg, urine osmolality 550 mOsm/kg, and urine sodium 65 mmol/L. TSH and cortisol are normal. She recently started sertraline.
What is SIADH?
These commonly used hospital medications can prolong the QT interval.
What are azithromycin, ondansetron/metoclopramide, and haloperidol?
This daily sodium intake threshold is used in individuals with ascites.
What is sodium restriction less than 2 grams a day?
If seizures persist after first-line benzodiazepines, these medications are commonly used as second-line therapy in adults.
What are antiepileptic drugs such as IV phenytoin/fosphenytoin, valproate, or levetiracetam?
A patient on the ward is suspected of having acute kidney injury. Name the three key criteria used to define AKI.
What are:
Increase in serum creatinine ≥26.5 µmol/L (0.3 mg/dL) within 48 hours
Increase in serum creatinine ≥1.5× baseline within the prior 7 days
Urine output <0.5 mL/kg/h for ≥6 hours