Hyponatremia SIADH (MY NOTES)

Hyponatremia break it down

Hypo meaning low
Natre meaning sodium
Mia meaning in the blood

Sodium Patho and how is it managed

It's found in the ECF, AP, action, potential, regulates ECF volume and is important for neuron communication


It's managed by ADH, thirst, RASS> aldosterone manages sodium and water

Are you more thirsty with high amounts of sodium?

Yes you are

What does sodium does it exchange with?

Potassium

Hyponatremia cues

Less than 135,
impaired renal excretion( no urine or little output)
SIADH(dilute sodium )
renal disease
diuretics
adrenal insufficiency (Addisons)
fluid shifts: such as edema, hypotonic, IV, fluids, excess fluid intake, tapwater, and
G.I. losses: such as diarrhea and vomiting

When aldosterone is on, do we retain sodium and water?

Yes, we retain it

Too much ADH, and we look at our intravascular what is going to do to the levels in our intravascular space

The sodium levels are going to decrease in our intravascular space and it's going to dilute it

Why do diuretics cause hyponatremia?

Because they speed up the process, excreting fluid and electrolytes

Let's say they have been going for the past 4 to 5 days losing a lot of fluids and electrolytes more electrolytes. This can cause.

Hyponatremia

What should the nurse assess for in hyponatremia?

Muscle cramps, (sodium helps with nuero communication)
low sodium (salt is a great taste inhancer and can be found in a lot of food((:)
seizures
neuro assessment
vital signs also diarrhea and vomiting

What's the number one factor mainly worried about

Seizures because without sodium, the brain can't communicate

What kind of vital signs do we have with hyponatremia?

High heart rate, low blood pressure, weight gain and edema

What are the labs going to look like in a patient with hyponatremia?

Think low and unsalted
Low serum and urine sodium
Low urine osmolality and urine specific gravity

What are the complications for a patient with hyponatremia?

High intra cranial pressure= cerebral edema(why? And hyponatremia there is not enough space in the school, the path behind it, self swell, squeezing the brain) and pulmonary edema(crackles)

What levels can cause seizure and coma?

115 meq/ L

Why do we have to do a neuro assessment on a patient with hyponatremia?

Because of intracranial pressure that can cause cerebral Adema, which can result into seizures

What are interventions for hyponatremia?

Hypertonic solution 3% normal saline, restrict fluids and sodium can't go above 12 and 24 hours ml/rate has to be slow

What rate can't sodium go above?

12 in 24 hrs
Example: if I'm above 120 in sodium I can't go above 12 and 24 hours (132) because it can't go from hypo to hypernatremia your body will go into shock

Pharm for hyponatremia

Loop diuretic (lasix) and AVP - tolvaptan

What do we need to assess before giving a loop diuretic?

The blood pressure, heart rate, potassium, salt..... This is because loop diuretics, excrete, water, sodium and potassium

For an SIADH patient what do we give them?

It's smart to give them a loop diuretic to get rid of all that water

Loop diuretics are for

SIADH or hypervolemic hypernatremia- high ceiling diuretics (greater degree of diuresis that other diuretics) that can cause sodium and water loss in the loop of Henle

Hypertonic saline 3% normal saline

Used only in critical situations to treat hyponatremia, highly sodium, concentrated fluids at must be given slowly, because it can cause intravascular fluid overload, removes excess intercellular fluid

What do you report to your physician?(weight)

2.2lb increase is reported

furosemide can cause hypotension true or false (orthostatic hypotension)

True

Just because a patient is hyponatremic doesn't mean you just give a loop diuretic

What do your vital say, labs, weight, are they gaining edema?

If your patient has a decrease in blood pressure, it can be due to

Diarrhea of vomiting, or too much fluid

AVP-tolvaptan

Stops ADH and gets rid of H2O only assess the blood pressure in the heart rate and educate them to watch for hypotension and (INCREASES POTASSIUM)

AVP receptor antagonist

Treat hyponatremia by blocking the effects of ADH at the nephron which allows diuresis. Tolvaptan (PO), Conivaptan (IV)

AVP receptor antagonist is not given

is contraindicated and patients with delirium, coma, or seizures

For SIADH patients you can use

Furosemide and 3% hypertonic

What the primary cause of Hyponatremia?

The primary causes water retention