Sodium: Fluid Electrolyte

Sodium (Na+) Normal Range

135-145

Hyponatremia <136

Hypernatremia >145

Sodium Purpose

transmit nerve impulse

muscle contractility

regulate acid-base balance

Hyponatremia (<136) Causes

Losing Sodium or Too Much Water

Actual Hyponatremia Causes

• diarrhea

• vomiting

• NG suction

• excessive diaphoresis

• diuretics

• low sodium diet

• hyperglycemia

Relative Hyponatremia Causes

• Water excessive

• SIAH

• Hypotonic IVF

• Hypoaldosternoism

Hyponatremia Manifestations

• Neurological: confusion, lethargy, headache, muscle weakness/cramp, seizures

• Cardio: postural(orthostatic) hypotension, tachycardia, decreased peripheral pulses

• Respiratory: decreased

• GI: N/V, abdominal cramps, hyperactive bowel sounds

• Renal: decreased urine output, dry mucous membrane

Hyponatremia Nursing Interventions

• Strict Intake and Output

• Seizure precautions

• increase oral sodium : broth/canned soup

• Fluid restriction

Hyponatremia Medications

IVF: 0.9% NS

Conivaptan

Tolvaptan

Hyponatremia Trick

Low sodium→ low brain function→ confusion→ seizures

Hypernatremia (>145) causes

too much sodium or not enough water

Actual Hypernatremia Causes

• excessive diet intake sodium

• IVF: hypertonic

• IV: sodium bicarbonate

• Cushing Syndrome

• Renal Failure

Relative Hypernatremia Causes

• Diabetes insipidus

• decreased water intake

• hypertonic tube feeding

Hypernatremia Manifestations

Neurological: agitation, restlessness, decrease LOC, seizures, increased deep tendon reflex

Cardio: HTN, tachycardia

Resp: decreased

GI: thirst, dry mucous membrane, N/V

Renal: Hypovolemic (low urine), DI (large amount urine)

Skin: flushed red, edema, low grade fever

Hypernatremia Nursing Interventions

• Strict Intake and Output

• Daily weights

• Neuro

• Replace water: PO, IV isotonic/hypotonic (D5W or 0.45% NSS)

Hypernatremia Trick

High Sodium= dry→thirsty→ irritable