Sodium and Water (Theilman)

high osmolality

Is this high osmolality or low osmolality?

low osmolality

Is this high osmolality or low osmolality?

-Na

-K

-Glucose

-Urea

-BUN

What is included in the calculated osmolarity equation?

K

What is sometimes left out in calculated osmolarity?

osmolarity

based on volume (osmoles per L)

osmolality

based on mass (osmoles per kg)

more diluted urine

If urine specific gravity is closer to 1, what does that mean?

Ketamine

can block ADH (vasopressin) release

V2 stimulation

opens up pores to allow water to move from collecting duct to the blood

no pores open in the collecting duct so water goes through the duct to the badder (increased urine output)

If there is not enough Vasopressin what happens?

central diabetes insipidus

low production of vasopressin (ADH)

nephrogenic diabetes insipidus

decreased collecting duct response to vasopressin

peeing alot

What is the only thing that Diabetes Insipidus and Diabetes Mellitus have in common?

arginine vasopressin (AVP) deficiency

new name for central diabetes insipidus

arginine vasopressin (AVP) resistance

new name for nephrogenic diabetes insipidus

Desmopressin

-longer DoA than vasopressin

-vasopressin analog

DDVAP tabs

only about 3% end up in the blood due to poor oral bioavailability (this is why it is in mg and not mcg like other formualtions)

DDVAP Rhinal tube

put tube in nose and mouth and blow drug into the nose

Naranjio Scale

used to see if Ketamine was the drug that caused the issue

Linezolid

can over stimulate V2 receptors causing too much water to be reabsorbed and put into the blood through the pores in the collecting duct

S- syndrome of

I- inappropriate

A- anti

D- diuretic

H- hormone

What is the neumonic with SIADH?

low Na and high water

urine output with < 20 mEq/L

high Na and low water

urine output with > 20 mEq/L

fluid restriction

chronic hyponatremia SIADH first line therapy:

hypertonic saline 3%

3x more concentrated than normal saline

anti anti diuretic hormone

-Demeclocycline

-Vaptans

Demeclocycline

-tetracycline antibiotic (original use)

-takes 3-6 days to work

-works somewhere in the collecting duct

Anti-ADH (increased urination)

What is a side effect of Demeclocycline?

Samsca

Tolvaptan

Tolvaptan (Samsca)

-blocks V2 receptors

-works in 2-4 hrs

-start with 15 mg

30 mg

After 24 hrs on 15 mg Tolvaptan you can go to _______

60 mg

After another 24 hrs on 30 mg Tolvaptan you can max out at ________

$462.20

What is the cost of a 15 mg tab of Tolvaptan?

CYP3A4

What is Tolvaptan metabolized by?

increase

Inhibitors of CYP3A4 ________ Tolvaptan concentrations.

decrease

Inducers of CYP3A4 _________ Tolvaptan concentrations.

CYP3A4 inhibitors

-Ketoconazole

-Clarithromycin

-Grapefruit juice

CYP3A4 inducers

-Rifampin

-Carbamazepine

-St John's Wort

hyponatremia

Tolvaptan (Samsca) FDA approved use:

autosomal dominant polycystic kidney disease

Tolvaptan (Jynarque) FDA approved use:

in the hospital

Samsca must be initiated where?

hepatotoxicity

What is the boxed warning of Tolvaptan?

Jynarque

available only through a restricted distribution program for ADPKD shared system REMS

Conivaptan (Vaprisol)

-IV only

-less selective for V2 receptors

-raises serum sodium

meds causing SIADH

-Chlorpropamide

-Carbamazepine

-Anti-psychotics

-SSRIs

-NSAIDs

hypertonic saline

very very scary drug

water

The prob is not the sodium, its the _________