Fundamentals 🩺: Electrolyte Imbalances (Sodium Imbalances)

Hypernatremia

Level 145 or higher

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (F)

Flushed skin

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (R)

Restless, irritable, anxious, and confused

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (I)

Increased blood pressure, fluid retention

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (E)

Edema, peripheral and pitting

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (D)

Decreased urine output, dry mouth

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (S)

Skin flushed

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (A)

Agitation

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (L)

Low-grade fever

Signs and symptoms for hypernatremia, remember “FRIED SALT” - (T)

Thirst

Causes for hypernatremia - excessive intake of sodium

• too much salty food

• hypertonic solutions in excess

Causes for hypernatremia - loss of fluids

• diarrhea

• diabetes

• excessive sweating

Causes for hypernatremia - decreased sodium exclusion

Kidney disease/dysfunction

Treatment for hypernatremia - if due to excessive intake

• restrict sodium intake

• educate patient on diet

• change/stop IV fluids

Treatment for hypernatremia - if due to volume loss

Administer IV fluids

Treatment for hypernatremia - if due to an adequate renal excretion

Administer diuretics that promote sodium loss

Functions of sodium

• balance is fluid volume

• balance is blood volume

• regulates nerve impulses

Hyponatremia

Level 135 or lower

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (S1)

Stupor, coma

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (A)

Anorexia, nausea/vomiting

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (L1)

Lethargic

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (T)

Tendon reflexes decreased

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (L2)

Limp muscles

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (O)

Orthostatic hypotension

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (S2)

Seizures/headache

Signs and symptoms for hyponatremia - Remember “SALT LOSS” (S3)

Stomach cramping

Causes for hyponatremia - excessive fluids = dilution

• CHF (congestive heart failure)

• hypotonic fluid

• liver failure

• excessive water intake

Causes for hyponatremia - Insufficient sodium intake

• NPO

• anorexia

Causes for hyponatremia - Increased sodium excretion

The 4 D’s

• Diuretics

• diarrhea

• dehydration (excessive sweating)

• drains (NGT suction)

Treatment for hyponatremia - if due to hypovolemia

administer sodium chloride infusion

Treatment for hyponatremia - Due to hypervolemia

Give diuretics

Treatment for hyponatremia - Due to excessive water intake

Restrict fluids

Treatment for hyponatremia - Nursing care

• assess mental status to monitor change in LOC

• safety precautions (call light, bed alarm)