Hypernatremia Causes
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Questions and Answers

What is the primary cause of hypernatremia in nonketotic hyperosmolar hyperglycemic coma of diabetes?

  • Renal insufficiency
  • Inadequate production of antidiuretic hormone
  • Excess loss of sodium ions
  • Hyperglycemia-induced osmotic diuresis (correct)

    • What is the result of renal insufficiency in relation to hypernatremia?

  • Decreased sodium reabsorption
  • Enhanced sodium retention
  • Impaired ability to concentrate urine (correct)
  • Increased sodium excretion

    • What is the consequence of excess water loss without adequate replacement?

  • Hypernatremia (correct)
  • Electrolyte imbalance
  • Fluid overload
  • Hyponatremia

    • What is the characteristic of diabetes insipidus?

    <p>Defect in production or release of antidiuretic hormone</p> Signup and view all the answers

    What is the result of taking loop diuretics?

    <p>Excess water loss</p> Signup and view all the answers

    What is the consequence of hypernatremia without disturbance in sodium balance?

    <p>Water deficit</p> Signup and view all the answers

    What is the characteristic of a patient with diabetes insipidus?

    <p>Thirst is impaired, but patient develops hypernatremia if they do not have access to water</p> Signup and view all the answers

    What is a common cause of hypernatremia?

    <p>Excessive sweating</p> Signup and view all the answers

    What is a common characteristic of the elderly population that contributes to hypernatremia?

    <p>Inability to access H2O</p> Signup and view all the answers

    What is the primary cause of inappropriate ADH secretion in SIADH?

    <p>Actual cause is often unknown</p> Signup and view all the answers

    What is the primary goal of treating hypernatremia?

    <p>H2O replacement</p> Signup and view all the answers

    Which of the following is a sign or symptom of hypernatremia?

    <p>Seizures</p> Signup and view all the answers

    Which of the following conditions is associated with increased release of ADH?

    <p>Emotional stress</p> Signup and view all the answers

    What is the effect of SIADH on urine production?

    <p>Less than maximally dilute urine</p> Signup and view all the answers

    What is the term for the shrinkage of the brain stem that occurs in hypernatremia?

    <p>Brain stem shrinkage</p> Signup and view all the answers

    What is the term for the type of hypernatremia that occurs with decreased total body water (TBW) and increased sodium levels?

    <p>Hypernatremia with hypovolemia</p> Signup and view all the answers

    Which of the following is a cause of renal losses?

    <p>Diuretics</p> Signup and view all the answers

    What is the effect of diuretics on urine production?

    <p>Increased urine production</p> Signup and view all the answers

    What is the treatment for hypernatremia in a patient who cannot drink water?

    <p>IV with D5W</p> Signup and view all the answers

    What is a common underlying cause of hypernatremia in the elderly population?

    <p>Impaired thirst</p> Signup and view all the answers

    Which of the following is a cause of non-renal losses?

    <p>Burns</p> Signup and view all the answers

    What is the effect of glucocorticoid deficiency on ADH secretion?

    <p>Increased ADH secretion</p> Signup and view all the answers

    What is the term for the type of hypernatremia that occurs with increased total body water (TBW) and increased sodium levels?

    <p>Hypernatremia with hypervolemia</p> Signup and view all the answers

    Which of the following is a characteristic of SIADH?

    <p>Plasma hypoosmolality</p> Signup and view all the answers

    What is the calcium level threshold for considering treatment?

    <p>15 mg/dL</p> Signup and view all the answers

    What is the primary concern for asymptomatic patients with a calcium level of 15 mg/dL?

    <p>Risk of nephrolithiasis</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with asymptomatic patients?

    <p>Hallucinations</p> Signup and view all the answers

    What is the primary factor in deciding whether to pursue surgery for an asymptomatic patient?

    <p>Presence of complicating problems</p> Signup and view all the answers

    What is the rate of complications in asymptomatic patients, except for nephrolithiasis?

    <p>Low</p> Signup and view all the answers

    Which of the following is a common symptom of asymptomatic patients?

    <p>Crying easily</p> Signup and view all the answers

    What is the primary approach for managing asymptomatic patients with a calcium level of 15 mg/dL?

    <p>Conservative approach</p> Signup and view all the answers

    What is the most common underlying cause of asymptomatic patients' symptoms?

    <p>Neuromuscular disturbances</p> Signup and view all the answers

    What is the osmotic threshold for ADH release in individuals with hyponatremia?

    <p>Subnormally low</p> Signup and view all the answers

    What is the characteristic of ADH secretion in some individuals with SIADH?

    <p>Erratic and independent of osmotic control</p> Signup and view all the answers

    What is the effect of low plasma osmolality on ADH levels in a small group of people with SIADH?

    <p>ADH is not suppressed</p> Signup and view all the answers

    What is the plasma osmolality level at which symptoms of hyponatremia occur?

    <p>12 mg/dL</p> Signup and view all the answers

    What is the characteristic of ADH release in classical SIADH?

    <p>Sustained ADH release</p> Signup and view all the answers

    What is the relationship between ADH levels and plasma osmolality in some individuals with SIADH?

    <p>ADH levels vary appropriately with plasma osmolality</p> Signup and view all the answers

    What is the term used to describe the abnormal resetting of the osmotic threshold for ADH release in some individuals with SIADH?

    <p>Reset osmostat</p> Signup and view all the answers

    What is the effect of hypoosmotic plasma on ADH levels in individuals with normal osmotic control?

    <p>ADH levels decrease</p> Signup and view all the answers

    Study Notes

    Hypernatremia

    • Caused by excess loss of H2O from the body that is not adequately replaced
    • Most common cause of hypernatremia from osmotic diuresis is hyperglycemia, seen in nonketotic hyperosmolar hyperglycemic coma of diabetes
    • Renal insufficiency can prevent maximally concentrated urine, predisposing to excess Na+
    • When H2O deficit exists, hypernatremia occurs without disturbance in Na+ balance
    • Excess sweating can cause H2O loss and hypernatremia
    • Diabetes insipidus is a defect in production or release of ADH by posterior pituitary, leading to inability to secrete a concentrated urine

    Hypernatremia in the Elderly

    • Common in the elderly due to:
      • Inability to access H2O
      • Impaired thirst
      • Impaired renal concentrating ability
      • Increased insensible H2O loss

    Diagnosis and Treatment of Hypernatremia

    • Diagnosis:
      • Signs and symptoms: thirst, CNS symptoms (brain stem shrinkage, confusion, neuromuscular irritability, seizures, coma)
    • Treatment:
      • H2O replacement is primary goal
      • If patient cannot drink, IV with D5W

    Principle Causes of Hypernatremia

    • Hypernatremia with hypovolemia:
      • Diarrhea
      • Pancreatitis
      • 3rd spacing
      • Small bowel obstruction
      • Rhabdomyolysis
      • Burns
    • Hypernatremia with euvolemia:
      • ADH secretion
      • Postop narcotics
      • Pain
      • Emotional stress
    • Hypernatremia with hypervolemia:
      • Heart failure
      • Hepatic cirrhosis

    Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

    • Less than maximally dilute urine in presence of plasma hypoosmolality and hyponatremia
    • Etiology: often unknown, but sustained ADH release
    • Pathogenesis:
      • Classically, SIADH is sustained ADH release
      • In some, ADH secretion is erratic and apparently independent of osmotic control
      • In others, ADH levels vary appropriately with plasma osmolality, but osmotic threshold for ADH is abnormally low

    Diagnosing SIADH

    • Symptoms of hyponatremia occur when plasma osmolality falls to 120 mmol/dL, ionized Ca+ is almost 51%

    Treatment of SIADH

    • If symptoms are mild and Ca+ is 15 mg/dL, conservative approach is appropriate
    • If asymptomatic, decision for or against surgery is based on complicating problems

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    Description

    This quiz covers the causes of hypernatremia, including excessive sweating, burns, and taking loop diuretics. Understand the pathogenesis of hypernatremia and its relationship to water loss.

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