Therapeutics - Electrolytes - Na

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Author:
kyleannkelsey
ID:
260663
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Therapeutics - Electrolytes - Na
Updated:
2014-02-06 23:22:34
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Therapeutics Electrolytes Na
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Therapeutics - Electrolytes - Na
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Therapeutics - Electrolytes - Na
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  1. 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
  2. Lithium
    • Euvolemic HYPOnatremia
    • Blocks AVP effects
    • slow OOA
  3. Loop Diuretics
    • Euvolemic HYPOnatremia
    • Relaxed fluid restriction
    • causes volume
    • K and Mg depletion – monitor closely
  4. NS
    • Euvolemic HYPOnatremia
    • Rapid response
    • poor for long term use
  5. Urea
    • Euvolemic HYPOnatremia
    • Can relax fluid restriction with use
    • Not USP formulated or FDA approved
    • poorly palatable
    • DOT NOT USE IN RENAL IMPAIRED
  6. What are the vasopressin antagonists?
    Conivaptan (vaprisol) and Tolvaptan (Samsca)
  7. What electrolyte disorder are the vaptans used to treat?
    Euvolemic and HYPERvolemic HYPOnatremia
  8. Conivaptan
    • Euvolemic or HYPERvolemic HYPOnatremia
    • IV
    • t1/2: 3.1-7.8 hrs
    • CYP3A4
    • Dose 20 mg/.5 hrs then 20-40 mg/day
  9. 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
  10. Recommended tx for HYPOvolemic hyponatremia
    NS
  11. Recommended tx for euvolemic hyponatremia
    • Fluid restriction 500-1000 mL
    • Hypertonic saline if [Na] <110 mEq/L or severe symptoms
  12. Recommended tx for HYPERvolemic hyponatremia
    • Na/Fluid restriction
    • treat underlying disorder (CHF
    • renal failure
    • etc.)
  13. Recommended tx for HYPERtonic hyponatremia
    Treat Hyperglycemia
  14. What are short term options for treating Hyponatremia?
    • Isotonic NS infusion
    • Hypertonic saline infusion
    • Vaptans
  15. What are long term options for treating Hyponatremia?
    • Fluid restriction
    • Demeclocycline
    • Furosemide/NaCl
    • Mineralcorticoids
    • Urea
    • Vaptans
  16. When would you use 3% NaCl to treat hyponatremia?
    Severe symptoms (coma/seizures)
  17. 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)
  18. 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
  19. What are the symptoms of HYPERnatremia?
    • Hallucinations
    • Confusion
    • Acute weight loss
    • dry mucus membranes
    • Decreased skin turgor
    • Intracranial bleeding
    • coma
    • Thirst (HC Addict)
  20. What are the symptoms of <120 mEq/L and >110 mEq/L HYPOnatremia?
    • HA
    • Disorientation
    • Confusion
    • Unstable gait
    • Mental slowness
    • Irritability
    • Nausea (HD Cumin)
  21. What are the symptoms of <110 mEq/L HYPOnatremia?
    • Seizures
    • Coma
    • Stupor
    • Respiratory arrest

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