N341 Sodium

Normal sodium level

135-145 mEq/L

Where does sodium live?

Outside the cell (extracellular fluid)

Function of sodium

Maintains ECF osmolality

regulates water balance

transmits impulses in nerves and muscle fibers

combines with chloride and bicarbonate to regulate acid-base balance

foods with high sodium

canned soups and veggies

cheese

ketchup

processed meats

table salt

slaty snack foods

seafoods

what should the serum osmolality (ratio of sodium to water) be

balanced

who follows who? sodium and water

water follows sodium

how does the GI tract regulate sodium

eat sodium -> absorb through the GI tract -> excrete sodium through GI tract and sweat

what is the sodium potassium pump

active transport mechanism

how aldosterone regulates sodium

low serum sodium levels -> adrenal cortex secretes aldosterone -> renal tubules conserve water and sodium

antidiuretic hormone: water excess

sodium level decreases (water excess) -> thirst diminishes -> less water intake -> ADH release is suppressed -> renal water excretion increases -> serum osmolality normalizes

antidiuretic hormone: water deficit

thirst increases -> increased water intake -> ADH release increased -> renal water excretion diminished -> serum osmolality normalized

hyponatremia level

<135 mEq/L

what does hyponatremia mean

sodium deficiency relative to the amount of water in the body

what do body fluids and cells do in hyponatremia

body fluids are diluted and cells swell

hypovolemic hyponatremia

sodium and water levels decrease in ECF

sodium loss > water loss

Renal cause of hypovolemic hyponatremia

osmotic diuresis, salt-losing nephritis, adrenal insufficiency, and diuretic use

Non renal cause of hypovolemic hyponatremia

vomiting, diarrhea, fistulas, gastric suctioning, excessive sweating, cystic fibrosis, burns, and wound drainage

hypervolemic hyponatremia

water and sodium levels increase

water gain > sodium gain

What occurs of hypervolemic hyponatremia

edema

heart failure, liver failure, nephrotic syndrome, excessive hypotonic IV fluids, hyperaldosteronism

isovolemic hyponatremia

sodium levels appear low because too much fluid is in the body

What symptoms of hyponatremia do you see first

Neurological

Signs and Symptoms of hypoatremia

SaltLoss

Stupor/coma

Agitation

Lethargic

Tachycardia

Limp muscle

OH

Seizure

Stomach Cramp

what neurological symptoms are we worried about for hyponatremia

cerebral edema

symptoms of hypovolemic hyponatremia

low BP, weak thready pulse

symptoms of hypervolemic hyponatremia

crackles, weight gain, JVD, edema

hyponatremia treatment

treat the cause

how to treat mild hyponatremia with hypervolemia

restrict fluids

oral sodium supplements

how to treat mild hyponatremia with hypovolemia

isotonic iv fluids

how to treat severe hyponatremia <120 mEq/L

hypertoni saline solution (3-5%)

Monitor for circulatory overload and worsening neuro status

nursing management of hyponatremia

prevention

monitor sodium

I & Os

daily weights

assess edema

assess VS

Causes of hyponatremia

5 Ds

Diuresis (sweating)

Diuretic

D/N/V

Drains (NG tubes)

SIADH

hypernatremia levels

>145 mEq/L

what does hypernatremia means

excessive sodium relative to the amount of water in the body

what do cells and body fluids do in hypernatremia

body fluid is saturated and cells shrink

cause of hypernatremia

1. water deficit (fever, heat, burns diarrhea, diabetes insipidus)

2. excess sodium (hypertonic solution, drowing in saltwater, oral)

who is at greatest risk for hypernatremia

patients who cannot drink voluntarily

elderly, infants, immobile, unconscious

what neurological symptom are we worried about with hypernatremia

subarachnoid hemorrhage due to CNS cells shrinking

symptoms of hypernatremia

FRIES

Flushed, fever, N/V

Restless/twitch/tremors

Increase BP/ thirst

Edema

Slow urine output ?

treatment of hypernatremia

treat underlying cause

replace fluids (oral and IV (5% dextrose))

restrict sodium intake

nursing management of hyperatremia

check vs

monitor sodium and hemoglobin

strict I&Os

daily weights

preserve skin integrity

frequently neuro checks

assess for complications of dehydration and IV treatment

protect from injury