hypervolemia

Question 1

Clinical manifestations of FVE result from expansion of the ECF and may
include

Answer 1

edema, distended jugular veins, and crackles (abnormal lung sounds
due to interstitial pulmonary fluid)

Question 2

In patients who are ambulatory, edema is
most evident in the

Answer 2

ankles;

Question 3

in patients who are supine, edema occurs over the

Answer 3

sacrum

Question 4

Symptomatic treatment consists of administering

Answer 4

diuretics
and restricting fluids and sodium.

Question 5

Thiazide diuretics block sodium and water
reabsorption into the bloodstream at the

Answer 5

distal tubule of the nephron, where 5%
to 10% of sodium is normally reabsorbed

Question 6

Loop diuretics, such as furosemide,
bumetanide, or torsemide, can cause a greater loss of both sodium and water
because they block sodium reabsorption in the ascending limb of the loop of
Henle, where 20% to 30% of filtered sodium is normally reabsorbed.

Answer 6

ascending limb of the loop of
Henle, where 20% to 30% of filtered sodium is normally reabsorbed.

Question 7

If renal function is so severely impaired that pharmacologic agents cannot act
efficiently, other modalities are considered to remove sodium and fluid from
the body

Answer 7

Hemodialysis or peritoneal dialysis may be used to remove
nitrogenous wastes and control potassium and acid–base balance, and to
remove sodium and fluid.

Question 8

When are diuretics prescribed for FVE?

Answer 8

When dietary sodium restriction alone is not enough to reduce edema.

Question 9

Where do thiazide diuretics act in the nephron?

Answer 9

At the distal tubule, where 5–10% of sodium is normally reabsorbed.

Question 10

What is the effect of thiazide diuretics?

Answer 10

They cause a small sodium and water loss (used for mild–moderate hypervolemia).

Question 11

Where do loop diuretics act in the nephron?

Answer 11

At the ascending limb of the loop of Henle, where 20–30% of sodium is normally reabsorbed

Question 12

What is the effect of loop diuretics?

Answer 12

They cause a large sodium and water loss (used for severe hypervolemia).

Question 13

Give examples of loop diuretics.

Answer 13

Furosemide, Bumetanide, Torsemide.

Question 14

Which electrolyte imbalance can occur with most diuretics?

Answer 14

Hypokalemia

Question 15

Which diuretics do not cause hypokalemia?

Answer 15

Potassium-sparing diuretics (aldosterone inhibitors, e.g., Spironolactone)

Question 16

What complication can occur with potassium-sparing diuretics?

Answer 16

Hyperkalemia, especially in patients with kidney impairment

Question 17

Why does hyponatremia occur during diuresis?

Answer 17

Due to increased ADH release from reduced circulating volume → water retention dilutes sodium

Question 18

What is azotemia?

Answer 18

Increased nitrogen waste (urea and creatinine) in the blood.

Question 19

Why can azotemia occur in FVE?

Answer 19

Because kidney perfusion is reduced, leading to poor excretion of waste.

Question 20

How much sodium does a normal (non-restricted) diet contain?

Answer 20

6–15 g of salt per day.

Question 21

What is the range for low-sodium diets

Answer 21

From less than 2000 mg/day to as little as 250 mg/day, depending on patient needs.

Question 22

What is it in sodium that contributes to edema?

Answer 22

Sodium chloride (salt), not sodium itself

Question 23

Give examples of natural flavor substitutes for sodium

Answer 23

Lemon juice, onions, garlic.

Question 24

When should protein intake be increased in FVE patients?

Answer 24

In malnourished patients or those with low serum protein levels

Question 25

Why is protein intake increased in some FVE patients?

Answer 25

To increase capillary oncotic pressure, which pulls fluid from tissues into blood vessels for excretion by the kidneys.

Question 26

An acute weight gain of 1 kg (2.2 lb) is equivalent to a gain of

Answer 26

approximately 1 L of fluid.

Question 26

What needs to be closely monitored when giving IV (parenteral) fluids in FVE patients?

Answer 26

The rate of infusion and the patient’s response (e.g., weight gain, lung sounds, edema).