Pharmacology Revision: Management of Na+ Disorders
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Questions and Answers

What is the normal serum Na+ level?

  • 145-155 mEq/L
  • 120-130 mEq/L
  • 135-145 mEq/L (correct)
  • 150-160 mEq/L

    • What is the primary cause of hypotonic hyponatremia?

  • Renal sodium loss
  • Hypoproteinemia
  • Extra-renal sodium loss (correct)
  • Excess water intake

    • What is the treatment of severe hyponatremia with Na+ levels < 120 mEq/L?

  • 0.9% solution of sodium chloride
  • Demeclocycline
  • Hypertonic saline (3%) (correct)
  • Loop diuretics

    • What is the rate of correction of Na+ levels in the treatment of severe hyponatremia?

    <p>6-10 mEq/L in the 1st 24 h</p> Signup and view all the answers

    What is the complication of rapid correction of Na+ levels in severe hyponatremia?

    <p>Osmotic demyelination</p> Signup and view all the answers

    What is the type of fluid used in the treatment of hypovolemic hypernatremia?

    <p>0.9% solution of sodium chloride</p> Signup and view all the answers

    What is the cause of hypervolemic hypernatremia?

    <p>Conns syndrome</p> Signup and view all the answers

    What is the normal serum osmolality?

    <p>280-295 mosm/kg</p> Signup and view all the answers

    What is the target rate of serum sodium correction in acute hypernatremia?

    <p>1-2 mEq/L/h</p> Signup and view all the answers

    What is the formula to correct calcium levels in hypoalbuminemia?

    <p>Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL])</p> Signup and view all the answers

    What is the primary goal of treating severe hypercalcemia?

    <p>To maintain urine output at 100 to 150 mL/h</p> Signup and view all the answers

    What is the indication for using calcimimetics in the treatment of hypercalcemia?

    <p>2ry hyperparathyroidism</p> Signup and view all the answers

    What is the normal range of serum potassium levels?

    <p>3.5-5 mEq/L</p> Signup and view all the answers

    What is the recommended urine output during treatment of severe hypercalcemia?

    <p>100-150 mL/h</p> Signup and view all the answers

    What is the treatment of choice for severe hypercalcemia with neurologic symptoms and serum calcium levels above 18 mg/dL?

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

    What is the goal of the first step in treating severe hypercalcemia?

    <p>To maintain urine output at 100 to 150 mL/h</p> Signup and view all the answers

    What is the effect of IV Ca2+ in severe cases of hyperkalemia?

    <p>Stabilizes myocardial membrane by opposing the effect of hyperkalemia on membrane potential</p> Signup and view all the answers

    What is the mechanism of action of Mg as a natural physiologic competitive antagonist?

    <p>Competes with Ca+2 at L-Ca channels</p> Signup and view all the answers

    What is the indication of Mg in refractory hypokalemia?

    <p>Refractory hypokalemia 2ry to hypomagnesemia</p> Signup and view all the answers

    What is the adverse effect of rapid IV administration of Mg?

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

    What is the goal of managing underlying causes in CKD?

    <p>Delaying the progression</p> Signup and view all the answers

    What is the treatment for edema in CKD?

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

    What is the treatment for hyperkalemia in CKD?

    <p>Cation exchange resins</p> Signup and view all the answers

    What is the goal of management of CKD?

    <p>Delaying the progression and treating manifestations</p> Signup and view all the answers

    Study Notes

    Sodium Disorders

    • Normal serum Na+ level: 135-145 mEq/L
    • Normal serum osmolality: 280–295 mosm/kg

    Hyponatremia

    • Causes:
      • Hypotonic hyponatremia
      • Isotonic hyponatremia
      • Hypertonic hyponatremia
      • Hyperproteinemia
      • Hyperglycemia
      • Lipidemia
      • Azotemia
      • Alcohol intoxication
    • Treatment of severe hyponatremia (< 120 mEq/L):
      • Hypertonic saline (3%)
      • Rate of correction: 6-10 mEq/L in the 1st 24h, ≤18 mEq/L in 48h
      • Do not overcorrect Na+ levels to avoid osmotic demyelination
    • Treatment of chronic asymptomatic hyponatremia:
      • Hypotonic fluids and sodium restriction
      • Demeclocycline and V2 receptor antagonists
      • Loop diuretics

    Hypernatremia

    • Causes:
      • Hypovolemic hypernatremia
      • Isovolemic hypernatremia
      • Hypervolemic hypernatremia
      • Inadequate water intake
      • Excess water loss
      • Diabetes insipidus
      • Conns syndrome
    • Treatment:
      • Hypovolemic hypernatremia: isotonic saline
      • Isovolemic hypernatremia: hypotonic fluids (D5W) and free-water administration
      • Hypervolemic hypernatremia: diuretics
      • Target serum Na+ level: 145 mEq/L/h

    Calcium Homeostasis

    • Normal serum Ca2+ level: 8.5-10.2 mg/dL
    • Corrected calcium in hypoalbuminemia: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL])

    Hypercalcemia

    • Treatment:
      • Mild hypercalcemia: adequate hydration and treating the cause
      • Moderate hypercalcemia: may not require immediate treatment
      • Severe hypercalcemia: fluids, glucocorticoids, calcitonin, bisphosphonates, and hemodialysis

    Hypocalcemia

    • No mention in the provided text

    Potassium Disorders

    • Normal serum K+ level: 3.5-5 mEq/L

    Hyperkalemia

    • Treatment:
      1. IV Ca2+ (in severe cases)
      2. Increasing K+ movement into cells: glucose-insulin infusion, β2 agonist nebulizer, and IV NaHCO3
      3. Removal of K+ from the body: loop diuretics, cation-exchange resins, and dialysis

    Magnesium Homeostasis

    • Normal serum Mg2+ level: 1.5-2.5 mEq/L
    • Mechanisms of action: natural physiologic competitive antagonist of Ca2+ at L-type Ca2+ channels, NMDA receptor antagonist, and muscle relaxation
    • Indications:
      • Hypomagnesemia associated with MI and diabetic coma
      • Refractory hypokalemia
      • Torsades de pointes and digitalis-induced arrhythmias
      • Seizures in preeclampsia
      • Adjuvant in anesthesia
    • Adverse effects:
      • Diarrhea
      • Drowsiness
      • Hypotension
      • Asystole (rapid IV)
      • Teratogenic (fetal skeletal abnormalities)

    Chronic Kidney Disease (CKD)

    • Management aims:
      • Delaying the progression
      • Treating manifestations
      • Prevention of ARF
    • Delaying the progression:
      1. Management of underlying cause
      2. Blood pressure control
      3. Glycemic control
      4. Reduction of proteinuria
    • Treating manifestations:
      1. Edema with diuretics
      2. Ca2+/PO4 disturbances and renal osteodystrophy
      3. Anemia
      4. Hyperkalemia with cation exchange resins
      5. Acidosis with Na HCO3 capsules

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    Description

    This quiz covers the normal serum Na+ level and osmolality, and the management of hyponatremia, including its common causes and types.

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