Podcast
Questions and Answers
What is the primary cause of water retention at the renal distal tubules in F.SIADH?
What is the primary cause of water retention at the renal distal tubules in F.SIADH?
- Increased urine output
- Increased aldosterone levels
- Increased secretion of ADH (or vasopressin) (correct)
- Decreased serum sodium levels
Which of the following is NOT a symptom of severe hyponatremia (serum [Na+] < 120 mEq/L)?
Which of the following is NOT a symptom of severe hyponatremia (serum [Na+] < 120 mEq/L)?
- Polyuria (correct)
- Lethargy
- Brain stem herniation
- Muscle cramps
What is the typical serum sodium level range for asymptomatic hyponatremia?
What is the typical serum sodium level range for asymptomatic hyponatremia?
- 125-130 mEq/L
- 120-125 mEq/L
- 110-120 mEq/L
- 130-135 mEq/L (correct)
Which of the following is a symptom of mild hyponatremia (serum [Na+] 130-135 mEq/L)?
Which of the following is a symptom of mild hyponatremia (serum [Na+] 130-135 mEq/L)?
What is the most severe consequence of severe hyponatremia?
What is the most severe consequence of severe hyponatremia?
Which of the following is a symptom of moderate hyponatremia (serum [Na+] 120-130 mEq/L)?
Which of the following is a symptom of moderate hyponatremia (serum [Na+] 120-130 mEq/L)?
What is the recommended rate of increase in serum sodium concentration for correcting hyponatremia?
What is the recommended rate of increase in serum sodium concentration for correcting hyponatremia?
What is the consideration for correcting hyponatremia in patients with chronic hyponatremia?
What is the consideration for correcting hyponatremia in patients with chronic hyponatremia?
What is the purpose of using the equation for sodium requirement in hyponatremia?
What is the purpose of using the equation for sodium requirement in hyponatremia?
What is the recommended infusion rate calculation in hyponatremia?
What is the recommended infusion rate calculation in hyponatremia?
What is the indication for using fludrocortisone in hyponatremia?
What is the indication for using fludrocortisone in hyponatremia?
What is the recommendation for patients with severe neurologic symptoms due to hyponatremia?
What is the recommendation for patients with severe neurologic symptoms due to hyponatremia?
How often should serum sodium be monitored during rapid correction of hyponatremia?
How often should serum sodium be monitored during rapid correction of hyponatremia?
What is the consideration for patients with acute hyponatremia?
What is the consideration for patients with acute hyponatremia?
What is the primary indication for case selection?
What is the primary indication for case selection?
When may case selection be considered reasonable in patients receiving systemic therapy?
When may case selection be considered reasonable in patients receiving systemic therapy?
What is the recommended approach for dosing in case selection?
What is the recommended approach for dosing in case selection?
What should be avoided when using dextrose in case selection?
What should be avoided when using dextrose in case selection?
What should be considered when adjusting daily dosing in case selection?
What should be considered when adjusting daily dosing in case selection?
What type of medications should be avoided in case selection?
What type of medications should be avoided in case selection?
What is the maximum dose of alteplase in mg for thrombolysis in patients with acute ischemic stroke?
What is the maximum dose of alteplase in mg for thrombolysis in patients with acute ischemic stroke?
What is the recommended time frame for administration of alteplase in patients with acute ischemic stroke?
What is the recommended time frame for administration of alteplase in patients with acute ischemic stroke?
What percentage of the total dose of alteplase is administered as an intravenous bolus?
What percentage of the total dose of alteplase is administered as an intravenous bolus?
In patients with acute ischemic stroke who awake with stroke symptoms or have unclear time of onset, what imaging modality can be used to help select those who can benefit from intravenous alteplase administration?
In patients with acute ischemic stroke who awake with stroke symptoms or have unclear time of onset, what imaging modality can be used to help select those who can benefit from intravenous alteplase administration?
What is the dose of tenecteplase in mg/kg for thrombolysis in patients with acute ischemic stroke?
What is the dose of tenecteplase in mg/kg for thrombolysis in patients with acute ischemic stroke?
What is the recommended duration of the intravenous infusion of alteplase in patients with acute ischemic stroke?
What is the recommended duration of the intravenous infusion of alteplase in patients with acute ischemic stroke?
What is the approximate osmolality of the Vancomycin antimicrobial solution for intraventricular administration?
What is the approximate osmolality of the Vancomycin antimicrobial solution for intraventricular administration?
Which antimicrobial solution has the highest osmolality for intraventricular administration?
Which antimicrobial solution has the highest osmolality for intraventricular administration?
What is the daily dose of Amphotericin B deoxycholate for intraventricular administration?
What is the daily dose of Amphotericin B deoxycholate for intraventricular administration?
Which of the following antimicrobial solutions is prepared in sterile water for injection (SWI) for intraventricular administration?
Which of the following antimicrobial solutions is prepared in sterile water for injection (SWI) for intraventricular administration?
What is the common adverse effect of Gentamicin, Tobramycin, and Amikacin for intraventricular administration?
What is the common adverse effect of Gentamicin, Tobramycin, and Amikacin for intraventricular administration?
Which antimicrobial solution has an unknown adverse effect for intraventricular administration?
Which antimicrobial solution has an unknown adverse effect for intraventricular administration?
What is the volume of the Gentamicin antimicrobial solution for intraventricular administration?
What is the volume of the Gentamicin antimicrobial solution for intraventricular administration?
Which of the following antimicrobial solutions has a daily dose of 10–20 mg for intraventricular administration?
Which of the following antimicrobial solutions has a daily dose of 10–20 mg for intraventricular administration?
Study Notes
Neurocritical Care
- Hyponatremia can cause neurologic symptoms such as delirium, agitation, tremor, seizure, or coma.
Clinical Symptoms of Hyponatremia
- Asymptomatic:
- Headache
- Nausea
- Vomiting
- Fatigue
- Confusion
- Anorexia
- Muscle cramps
- Depressed reflexes
- Mild hyponatremia (serum [Na+] 120-130 mEq/L):
- Malaise
- Unsteadiness
- Headache
- Nausea
- Vomiting
- Fatigue
- Confusion
- Anorexia
- Muscle cramps
- Severe hyponatremia (serum [Na+] < 120 mEq/L):
- Headache
- Restlessness
- Lethargy
- Seizures
- Brain stem herniation
- Respiratory arrest
- Death
Treatment of Hyponatremia
- Fludrocortisone 0.1-0.4 mg/day may help reduce sodium loss in cerebral salt-wasting syndrome (CSWS).
- Consider potassium supplementation for hypokalemia.
Rapid Correction of Hyponatremia
- Recommended increase in serum sodium concentration is 0.5 mEq/L/hour or less.
- Patients with chronic hyponatremia may need to be corrected more slowly.
- Patients with acute hyponatremia may tolerate quicker correction.
- Patients with severe neurologic symptoms may tolerate rapid correction of 4-6 mEq/L.
Sodium Correction Equations
- Na requirement (mmol) = total body water (0.6 × kg) × (desired Na - current Na)
- Infusion rate (mL/hr) = (Na requirement × 1000)/(infusion Na concentration × time)
Intraventricular Administration of Antimicrobials
- Vancomycin: 10-20 mg/1 mL of NS, osmolality 291 mOsm/kg
- Gentamicin: 4-8 mg/1 mL of NS, osmolality 293 mOsm/kg
- Tobramycin: 4-8 mg/1 mL of NS, osmolality 283 mOsm/kg
- Amikacin: 30 mg/1 mL of NS, osmolality 383 mOsm/kg
- Polymyxin B: 5 mg/1 mL of NS, osmolality 10 mOsm/kg
- Colistimethate: 10 mg/3 mL of NS, osmolality 367 mOsm/kg
- Amphotericin B deoxycholate: 0.5 mg/3 mL of SWI, osmolality 256 mOsm/kg (in dextrose 5%)
- Daptomycin: 5 mg/2 mL of NS, osmolality 364 mOsm/kg
Thrombolysis for Ischemic Stroke
- Alteplase 0.9 mg/kg (maximum 90 mg) within 4.5 hours of symptom onset.
- Tenecteplase 0.25 mg/kg intravenous bolus (maximum 25 mg) within 4.5 hours of symptom onset may also be considered for off-label use.
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Description
This quiz covers the clinical symptoms of hyponatremia in neurocritical care, including serum sodium levels and their corresponding symptoms. It is part of the ACCP Updates in Therapeutics Critical Care Pharmacy Preparatory Review and Recertification Course.
