HYPERNATREMIA & HYPONATREMIA

sodium

EXCRETION: normally retained

FUNCTION:

• neuro

• muscles

urine

(hyponatremia) decrease sodium levels

sweat (diaphoresis)

(hyponatremia) decrease sodium levels

diarrhea

(hyponatremia) decrease sodium levels

ADH or ALDOSTERONE

(hypernatremia) increases sodium levels

SIADH

(dilutional hyponatremia) decreases sodium levels by water dilution

***KIDNEYS

SODIUM

Water deficiency

hypernatremia

Sodium deficiency

hyponatremia

HYPERNATREMIA CAUSES

• KEY: Diarrhea, Sweating, Osmotic Diuretics, Polyuria, Hyperaldosteronism

• IV Hypertonic

• IV Sodium Bicarbonate

• OTHERS: Cushing, Diabetes Insipidus

HYPERNATREMIA MANIFESTATIONS

• KEY: Dry mucous membranes, Hypotension, Increased Pulses

• Restlessness & Seizures

• Weakness & Muscle cramps

• OTHERS: weight loss

Diabetes Insipidus

cause Hypernatremia

• HOW: diabetes insipidus causes excessive water loss (polyuria)

Nephrogenic Diabetes Insipidus

cause Hypernatremia

• HOW: nephrogenic diabetes insipidus causes excess water loss d/t non-responsiveness to ADH

Hyperglycemia (d/t uncontrolled diabetes)

causes Hypernatremia

CONCENTRATED HYPEROSMOLAR Enteral Nutrition

causes Hypernatremia

impaired LOC

causes Hypernatremia

• why: they’re mentally challenged to have the ability to drink water

IV Saline 3% or Sodium Bicarbonate

causes Hypernatremia

primary aldosteronism

causes Hypernatremia

• why: a tumor on the adrenal glands is causing excess secretion of aldosterone leading to sodium & water retention (though sodium soaks up the water)

hypernatremia (NEURO)

manifestation: Restlessness & Lethargy/Drowsy → Seizures

osmolality: hyperosmolality

hypernatremia d/t volume deficit

manifestation: postural hypotension & tachycardia

hypernatremia d/t volume deficit treatment

• oral hydration

• IV Normal Saline 0.9%

hypernatremia d/t excess sodium treatment

• IV Saline 0.45%

• IV 5% Dextrose in Water

  • (Isotonic pre infusion, Hypotonic after glucose metabolism)

• Diuretics (mannitol)

• Sodium Restriction

quickly treatments (ex: quickly reducing sodium levels) risk

cerebral edema

prolonged hypernatremia + QUICK treatments

GREATEST risk for cerebral edema

• why: Due to the body quickly adapting to cerebral edema, Organic osmolytes, accumulated during the adaptation, are slow to leave the cell during IV rehydration. Therefore, if the hypernatremia is corrected too rapidly, cerebral edema results as the relatively more hypertonic cell (d/t organic osmolytes) accumulates water.

seizures d/t hypernatremia

SEIZURE PRECAUTIONS

• padded side rails

• bed in lowest position

• clear the area

SODIUM-RICH BODY FLUIDS (loss in these bod fluids → hyponatremia)

• draining wounds

• diarrhea

• vomiting

• primary adrenal insufficiency (lack of ADH) → sodium-rich urine

HYPONATREMIA CAUSES

• KEY: Diarrhea, Vomiting, NG Suction, Diuretics (not osmotic), Burns, Wound Drainage, IV Hypotonic, Hypoaldosteronism

• OTHERS: Polydipsia (thirsty), Cirrhosis, SIADH

HYPONATREMIA MANIFESTATIONS

MILD: headache & difficulty concentrating (swelling)

SEVERE: Confused, Vomiting, Seizures → coma

RAPIDLY SEVERE: brain hernia (swelling)

OSMOLALITY: hypoosmolality

hyponatremia d/t volume deficit treatment

• Oral Sodium Intake

• Withhold Diuretics

• IV Normal Saline 0.9%

hyponatremia d/t excess water treatment (mild)

• FLUID RESTRICTION

• Loop Diuretics

hyponatremia d/t excess water treatment (severe)

IV Sodium Chloride 3% (small amounts)

cannot tolerate fluid restriction OR severe hyponatremia

Vasopressor Receptor Antagonists

IV infusion rates (isotonic, hypertonic, hypotonic solutions)

10-12 mEq/L per hour

IV Solution infusion considerations

INFUSE SLOWLY

• Why: quickly increasing sodium levels causes demyelination and permanent nerve cell damage

record output

when treating hyponatremia

can’t record output

catheter

IV fluids for renal failure patients

causes Hyponatremia

surgery patients

causes Hyponatremia (why: overuse of IV fluids)

infusing considerations

• avoid rapid or overcorrection

• quickly increasing sodium levels: risk for demyelination syndrome (permanent damage to nerve cells)