Fluids, Electrolytes, Sodium and Potassium

Functions of Sodium

• Regulate ECF volume

• Maintain blood volume

• Transmit nerve impulses

• contracting muscles

Sodium Regulation

Renal

Normal Sodium Lab Value

135-145 mEq/l

Foods high in sodium

• Processed & cured meats

• Canned Vegetables (you can wash the salt off of the vegetables)

• Fast Food

• Frozen Dinners

• Soups 

• Pt should refrain from adding salt

Hyponatremia

• level of sodium in blood is below normal range

  • Less than 135 (Critical is less than 120)

• Intracellular sodium is greater

• Fluid pulled into the cells

• Cells swell as a result

Risk factors of Hyponatremia 

• CHF

• Hypotonic IV solutions

Assessment/Cues of Hyponatremia

• Neurological changes

• Muscle Weakness/spasms

• Abdominal cramping/increased bowel sounds

Interventions of Hyponatremia

• Due to the neurological changes Safety is the #1 priority

• Manage fluid balance/correct (slow)

Types of Hyponatremia

• Euvolemic

• Hypovolemic

• Hypervolemic

Euvolemic

• No edema

• SIADH- Syndrome of inappropriate antidiuretic hormone secretion

• Diabetes Insipidus- kidneys ability to conserve water

• Addison’s- body doesn't make enough of some hormones.

Hypovolemic

• Dehydration 

• vomiting, diarrhea

• NG suction

• Diuretics

• Sweating

Hypervolemic

• Fluid volume excess

• CHF

• Renal Failure

• Liver Failure

Hypernatremia

• Too much sodium in the body

  • Level greater than 145 (critical 160)

• Fluids shift out of cels to be with extracellular sodium

• Causes cells to shrink

Risks of Hyponatremia

• Medical Causes (diabetes)

• Increased salt intake

• Decreased fluid intake 

• Fever/sweating

Assessment/cues of Hypernatremia

• Fever

• Flushed skin

• Agitated

• Decreased output

Interventions of Hypernatremia

• Safe

• Fluids slow

  • If too fast=cerebral edema

• Decreased sodium intake

How to treat Hypernatremia

• Hypotonic solution

• Water pulled back into the cell