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Review Chapter 27: Fluid and Electrolyte Balance in Adults

This book review chapter discusses important concepts related to fluid and electrolyte balance in adults, including body water content, osmolarity, osmolar gap, and hyponatremia. It also covers the syndrome of inappropriate ADH secretion and the treatment of hyponatremia with 3% saline solution.

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Review Chapter 27: Fluid and Electrolyte Balance in Adults

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  1. Book Review Chapter 27 Nicole McCadie DO March 11, 2010

  2. Question • The weight of total body water in a 70 kg adult male is closest to:

  3. Answer • 40 kg • 20 kg • 60 kg • 30 kg • 10 kg

  4. Question • Which of the following equations is used to estimate the serum osmolarity?

  5. Answer • [ Na+] + glucose/18 + BUN/2.8 • 2 x [ Na+] + glucose/18 + BUN/2.8 • [ Na+] + glucose/2.8 + BUN/18 • [ Na+] + glucose/8 + BUN/18 • 2 x [ Na+] + glucose/2.8 + BUN/18

  6. Question • What is the normal serum osmolarity?

  7. Answer • 215-235 mosmol/L • 175-195 mosmol/L • 250-270 mosmol/L • 275-295 mosmol/L • 115-135 mosmol/L

  8. Question • Which of the following should be considered if an osmolar gap is encountered?

  9. Answer • Laboratory analytic error • Decreased serum water content • Additional low molecular weight substances in the serum • All of the above

  10. Question • An osmolar gap should be suspected when the measured osmolality differs from the calculated osmolality by how much?

  11. Answer • < 5 • > 5 • < 10 • > 10 • > 20

  12. Question • A patient is said to have a large “osmolal gap”. What is usually meant by this term?

  13. Answer • Calculated serum osmolality is substantially greater than the measured • A substantial number of unanticipated osmotically active compounds are present • A substantial number of unanticipated serum anions are present • None of the above

  14. Question • All of the following are associated with an increased osmolal gap except:

  15. Answer • Isopropyl alcohol ingestion • Administration of mannitol • Salicylate poisoning • Methanol ingestion • Ethylene glycol ingestion

  16. Question • How much water does an average normal adult require in order to maintain fluid balance?

  17. Answer • 1-2 Liters • 2-3 Liters • 3-4 Liters • 4-5 Liters • > 5 Liters

  18. Question • In the setting of a fever insensible water loss can accelerate. How much water is lost per day per 1 degree celcius fever?

  19. Answer • 100 mL/d per 1 degree celcius fever • 200 mL/d per 1 degree celcius fever • 500 mL/d per 1 degree celcius fever • 1000 mL/d per 1 degree celcius fever • 1500 mL/d per 1 degree celcius fever

  20. Question • The major Extracellular cation is

  21. Answer • Potassium • Calcium • Chloride • Sodium

  22. Question • What is the most common cause of hypertonic hyponatremia?

  23. Answer • Hyperglycemia • Mannitol excess • Glycerol therapy • Diuretic use

  24. Question • Hyperglycemia causes hypertonic hyponatremia. Each 100 mg/dL increase in plasma glucose decreases the serum [Na+] by how much?

  25. Answer • 0.6-0.8 mEq/L • 1.6-1.8 mEq/L • 0.8-1.2 mEq/L • 6-8 mEq/L

  26. Question • In the case of isotonic hyponatremia second to hyperlipidemia or hyperproteinemia treatment of the hyponatremia is not required.

  27. Answer • True • False

  28. Question Which of the following is included in the criteria for the syndrome of inappropriate ADH secretion?

  29. Answer • Hypotonic hyponatremia • Inappropriately elevated urinary osmolality • Elevated urinary [Na+] • Clinical euvolemia • Normal adrenal, renal, cardiac, hepatic, and thyroid functions • Correctable with water restriction • All of the above

  30. Question • The syndrome of inappropriate ADH secretion is associated with which of the following?

  31. Answer • Concentrated urine • Peripheral edema • Postural hypertension • Renal failure

  32. Question • What is the equation used to calculate the total body sodium deficit?

  33. Answer • (desired plasma [Na+] – actual plasma [Na+]) x TBW • (desired plasma [Na+] – actual plasma [Na+]) x osmalarity • (desired plasma [Na+] + actual plasma [Na+]) x TBW • (desired plasma [Na+] + actual plasma [Na+]) x osmolarity

  34. Question • In which of the following situations should 3% saline solution be considered for hyponatremia?

  35. Answer • Serum [Na+] between 125-130 • Asymptomatic patient • The hyponatremia develops slowly over days • Seizure activity

  36. Question • You have a pt with severe hyponatremia and decide to correct his sodium with 3% saline solution. Which of the following is true regarding administration of this solution?

  37. Answer • The 3% solution can be administered at a rate of 125-200 ml/hr • The rise in sodium should be no greater than 0.5 to 1.0 mEq/L per hour • The rise in sodium should be no greater than 2.5 to 3.0 mEq/L per hour • In the face of seizures the rise in sodium can be increased to 2.5 to 3.0 mEq/L per hour

  38. Question • (T/F) Patients with chronic hyponatremia tend to be at greater risk for central pontine myelinolysis during the correction process

  39. Answer • True • False

  40. Question • In human studies and experimental animal models, central pontine myelinolysis has been associated with all of the following except:

  41. Answer • Rapid correction of symptomatic hyponatremia (less than 24 hours duration) • Correction of hyponatremia longer than 2 days duration at a rate greater than 0.6 mEq/L/hour • Correction of hyponatremia longer than 2 days duration at a rate greater than 25 mEq over 48 hours • Correction of hyponatremia longer than 24 hours duration at a rate greater than 2.5 mEq/hour

  42. Question • A 60 year old man with a history of CHF presents to the ED complaining of pedal edema. His mental status is clear. BP is 120/80, pulse 80. Lungs are clear, neck veins distended. Serum sodium is 105 mEq/L. Of the following therapies, which is the most appropriate?

  43. Answer • Infusion of 3% normal saline at 50ml/hour and concomitant administration of furosemide • Infusion of normal saline at 200 ml/hr with concomitant administration of furosemide • Water restriction • Administration of 40 mg of furosemide intravenously every hour until the serum sodium is normal

  44. Question • Which of the following is true regarding central pontine myelinolysis?

  45. Answer • Partial recovery occurs after induction of hyponatremia through infusion of 5% Dextrose in water • It is more common after correction of acute rather than chronic hyponatremia • It is more common in diabetic patients with pseudohyponatremia due to hyperglycemia • Most common initial symptom is burning paresthesias in the hands and feet • Patients do not typically present until a few days after treatment of hyponatremia

  46. Question • Hypernatremia…

  47. Answer • Almost never occurs in alert patients with and intact thirst mechanism • May occur after administration of single doses of charcoal • Is most commonly due to increased body stores of sodium (sodium gain) • Is best treated with normal saline • May result in central pontine myelinolysis if not treated within 72 hours

  48. Question • (T/F) Patients with central diabetes insipidus respond well to vasopressin whereas patients with nephrogenic diabetes insipidus show little or no response to vasopressin.

  49. Answer • True • False

  50. Question • An 80 year old woman is found unconscious in her unair-conditioned Houston apartment in August. Her serum sodium is 185 mEq/L. BP is 60 by palp, pulse 130. The most appropriate fluid regimen for her initial resuscitation is:

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