Hypo and hyper natraemia Quiz

1. Hyponatremia is defined as sodium levels lower than mEq/L.

2. ___ is an electrolyte complication of syndrome of inappropriate antidiuretic
hormone secretion, which leads to neuronal swelling and cerebral edema, causing
altered mental status and seizures.
3. The most common cause of hypernatremia in the elderly is ___
4. Hydrochlorothiazide will (decrease/increase) serum sodium levels.
5. Damage to the posterior pituitary can result in , which presents with
hyponatremia, decreased BUN, low serum osmolality, high urine osmolality, and
other symptoms of free water retention.
6. Primary hyperaldosteronism from Conn syndrome is a cause of mild
(hypo/hyper) natremia.
7. Rapid correction of which electrolyte imbalance is a cause of central pontine
myelinosis.
8. Selective serotonin reuptake inhibitors side eects includes , which feaures
decreased serum sodium levels. List 3 other Side eects of SSRIs
9. Approximately 1% of post-operative patients develop this electrolyte imbalance
requiring treatment with fluid restriction.
10. In euvolemic patients, (hypernatremia/hyponatremia) can occur via central or
nephrogenic diabetes insipidus.
11. , occurs via over-rapid IV correction of hyponatremia. This can lead to what
complication ______?
12. One of lithium's side eects aects the kidneys, leading to what electrolyte
imbalance ?
13. Hyponatremia is a paraneoplastic syndrome commonly
accompanying cancer.
14. If hypernatremia is corrected too quickly, plasma osmolarity may result in
cerebral edema, which can lead to seizures and death.

15. Select the most appropriate diagnosis from the given list for the following U&Es
A 72-year-old male presents with weakness and weight loss.

A 25-year-old female presents with weight loss and general fatigue.

A 55-year-old male with type 2 diabetes presents for annual review.

 16. Is it true or false that hypokalaemia may be caused by the following?

Aldosterone antagonists
Angiotensin converting enzyme inhibitors
Digoxin
Insulin
Thiazide diuretics

ANSWERS

1. 135mEq/L
2. Hyponatraemia
3. Decreased intake
4. Decrease
5. SIADH
6. Hypernatraemia
7. Hyponatraemia
8. SIADH (Mnemonic: 6Ss - Sleep disturbance, sexual dysfunction, Seretonin
syndrome, Sickness (nauseau), Slow onset (of eectiveness)
9. Hyponatraemia
10. Hypernatraemia
11. Central pontine myelinosis, locked in syndrome
12. Hypernatraemia
13. Small lung cancer: Mnemonic: Small cell = Small Sodium
14. Decreased

15.

This is a dilutional hyponatraemia with all parameters low but a profound hyponatraemia.
This suggests SIADH which may be due to conditions such as pneumonia, subarachnoid
haemorrhage (or head injury) and malignancies such as bronchial carcinoma - this may
liberate ectopic ADH.

The weight loss and fatigue associated with hyponatraemia are important here and with
the hyperkalaemia and high urea suggest a diagnosis of Addison's disease - primary
hypoadrenalism. The condition is typically autoimmune in origin and is associated with
hypotension so the patient may also describe dizziness. It is diagnosed with a short
synacthen test with low responses of cortisol to the ACTH stimulus. Steroid therapy can
be life saving.

This man with type 2 diabetes mellitus has impaired renal function and this would suggest
chronic renal failure most probably related to diabetic nephropathy. Other common
causes of chronic renal impairment include hypertension , intrinsic renal disease and
drugs such as non-steroidal therapy.

16.
Aldosterone antagonists (for example, spironolactone) are used as potassium sparing
diuretics and may cause hyperkalaemia.

ACE inhibitors may cause hyperkalaemia.

Digoxin does not cause hypokalaemia but care should be taken to avoid hypokalaemia if
it is used with a diuretic, as hypokalaemia predisposes to digoxin toxicity.

Thiazides inhibit sodium reabsorption at the distal convoluted tubule. Hypokalaemia is a

common side-eect.