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Therapeutics - Electrolytes - Na
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Demeclocycline
Euvolemic HYPOnatremia
fluid restriction not required
blocks AVP effects on target organs
600-1200 mg/day
3-6 days for effect
Not FDA approved for this indication
Lithium
Euvolemic HYPOnatremia
Blocks AVP effects
slow OOA
Loop Diuretics
Euvolemic HYPOnatremia
Relaxed fluid restriction
causes volume
K and Mg depletion – monitor closely
NS
Euvolemic HYPOnatremia
Rapid response
poor for long term use
Urea
Euvolemic HYPOnatremia
Can relax fluid restriction with use
Not USP formulated or FDA approved
poorly palatable
DOT NOT USE IN RENAL IMPAIRED
What are the vasopressin antagonists?
Conivaptan (vaprisol) and Tolvaptan (Samsca)
What electrolyte disorder are the vaptans used to treat?
Euvolemic and HYPERvolemic HYPOnatremia
Conivaptan
Euvolemic or HYPERvolemic HYPOnatremia
IV
t1/2
: 3.1-7.8 hrs
CYP3A4
Dose 20 mg/.5 hrs then 20-40 mg/day
Tolvaptan
Euvolemic or HYPERvolemic HYPOnatremia
Oral
t1/2 6-8 hrs
CYP3A4
CrCl of 10-79 does not require dose adjustment
Dose:
-Initial 15 mg PO daily
-titrate to 30 to 60 mg/day
Don't use:
-Urgent/acute intervention
-Unable to sense or respond to thirst
Recommended tx for HYPOvolemic hyponatremia
NS
Recommended tx for euvolemic hyponatremia
Fluid restriction 500-1000 mL
Hypertonic saline if [Na] <110 mEq/L or severe symptoms
Recommended tx for HYPERvolemic hyponatremia
Na/Fluid restriction
treat underlying disorder (CHF
renal failure
etc.)
Recommended tx for HYPERtonic hyponatremia
Treat Hyperglycemia
What are short term options for treating Hyponatremia?
Isotonic NS infusion
Hypertonic saline infusion
Vaptans
What are long term options for treating Hyponatremia?
Fluid restriction
Demeclocycline
Furosemide/NaCl
Mineralcorticoids
Urea
Vaptans
When would you use 3% NaCl to treat hyponatremia?
Severe symptoms (coma/seizures)
How fast should you administer NaCl for Hyponatremia?
0.5-1 mEq/L/hr
1/3 defecit in fist 12 hours and rest w/in several days (no greater than 12 mEq/L/24 hours or 18 mEq/L/48 hours)
How would you treat Hypernatremia?
Replace water deficit over 48-72 hours
No more than 0.5 mEq/L/hr
½ deficit with HYPOtonic solution in 12-24 hours and rest over 24-48 hours
What are the symptoms of HYPERnatremia?
Hallucinations
Confusion
Acute weight loss
dry mucus membranes
Decreased skin turgor
Intracranial bleeding
coma
Thirst (HC Addict)
What are the symptoms of <120 mEq/L and >110 mEq/L HYPOnatremia?
HA
Disorientation
Confusion
Unstable gait
Mental slowness
Irritability
Nausea (HD Cumin)
What are the symptoms of <110 mEq/L HYPOnatremia?
Seizures
Coma
Stupor
Respiratory arrest
Author
kyleannkelsey
ID
260663
Card Set
Therapeutics - Electrolytes - Na
Description
Therapeutics - Electrolytes - Na
Updated
2/7/2014, 4:22:34 AM
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