NAIHS-COM

MBBS 8th Batch – 2nd Year

Biochemistry

Dr. Jayendra Bajracharya

Pre-lecture Assignment

Topic: Hypernatremia

Your name: Alish Bhandari

Your roll number: __8008

Directions:

1. Click the link https://youtu.be/taAMELacm60

2. Watch the above Osmosis video on Hypernatremia.

3. Fill in the blanks below by replacing the lined blanks with the appropriate single words or
phrases.

4. Post the assignment by the due date and time.

Questions

1. Hypernatremia is defined as a serum sodium concentration greater than ___145_____

mEq/L.

2. The two major ‘conceptual’ causes of hypernatremia are losing more Water_ than sodium
and gaining more sodium than water.

3. An important consequence of acute hypernatremia is shrinking of cell_ as they lose

water_ and they cannot generate osmotically_ active particles.

4. Most common causes of hypernatremia due to water loss are sweating and _moisture
breath.

5. The condition of decreased or no production of antidiuretic hormone from hypothalamus

is called central diabetes insipidus.
6. The condition in which there is normal production of antidiuretic hormone (ADH) from
hypothalamus but the ADH receptors in distal convoluted tubules and collecting tubules are
defective is called nephrogenic diabetes insipidus

7. In diabetes insipidus, the nephrons are unable to reabsorb water_ from distal convoluted
tubules and collecting tubules; this results in loss of water_ through kidneys. In this
condition, the urine is _diluted.

8. Injury to the thrist center in hypothalamus can also lead to hypernatremia.

9. In major or extensive injury to hypothalamus, there may be decreased production of ADH

and decreased _reabsorption of water. This is a dangerous combination.

10. The most common cause of hypernatremia due to sodium gain in a hospitalized patient
is giving intravenous infusion of Na+ -containing fluids in excess volumes in a quick period of
time.

11. A common cause of hypernatremia due to sodium gain is intake of too much _salt in
diet. This usually happens if there is pre-existing kidney dysfunction

12. A long-standing hypernatremia will have fewer symptoms as cell _adjust to the
hyperosmotic environment by generating osmotically_ active particles.

13. Acute hypernatremia can result in cell death,especially in the nervous_ system, which
can result in altered mental status, seizures, and coma.

14. The first step in diagnosis of hypernatremia is checking the patient’s intravascular
volume and finding out whether the patient is hypovolemic or euvolemic

15. In hypovolemic patients with hypernatremia due to dehydration in the setting of normal
kidneys, the urine osmolality is greater than 600 mOsm/kg and urine sodium concentration is
less than 20 meq/L_. These findings are seen because the kidneys are attempting to
preserve water _ and sodium.

16. In hypovolemic patients in the setting of kidney dysfunction or using osmotic or loop
diuretics, the urine sodium concentration is greater than 20meEq/L.

17. In euvolemic patients with hypernatremia, the urine osmolality is less than 300mOsm/kg
and urine sodium concentration is less than 20meq/L as the kidneys are losing water. An
example is a condition called diabetes insipidus

18. Treatment of hypernatremia depends on its underlying cause.

19. In a hypernatremia patient who is awake and alert with an intact thirst mechanism, water
should be given by oral route.

20. In a hypernatremia patient who is unconscious, Intravenous_ fluids can be given, but this
needs to be done carefuly to avoid complications like cerebral edema
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