Sodium Imbalance

135 - 145 mEq/L

Normal range for sodium

ECF

Sodium is most abundant in this location

Swell

In hyponatremia, does the cell swell or shrink?

Shrink

In hypernatremia, does the cell swell or shrink?

Hyponatremia

This sodium imbalance results from the loss of total body sodium, the movement of sodium from the blood to other fluid spaces, or the dilution of serum from excessive water in the plasma.

cerebral edema and increased ICP

S/s: headache, → coma → death

Behavioral changes in hyponatremia occur due to?l

loss of consciousness

When there is a manifestation of headache in hyponatremia, it is best to observe for?

increased peristalsis, motility

In hyponatremia, what is the expected GI manifestations?

nausea, diarrhea, abdominal cramping, hyperactive bowel sounds

When there is an increased GI motility, which symptoms are manifested?

movement of ECF to ICF

Why does the cell swell in hyponatremia?

SIADH

Oversecretion of ADH can cause?

Acute hyponatremia

Commonly the result of a fluid overload in a surgical patient

exercise associated hyponatremia

a type of sodium imbalance that is commonly found in women and those of smaller structure

• imbalance of water rather than sodium

• deficiency in aldosterone

• medication: anticonvulsants, SSRIs, desmopressin acetate

pathophysiology of hyponatremia

• poor skin turgor

• dry mucosa

• headache

• low saliva production

• orthostatic hypotension

• N/V

Clinical manifestation of hyponatremia

• status epilepticus

• coma r/t to cerebral edema

neurological manifestation of hyponatremia

• urinary sodium content less than 20 mEq/L

• SG - 1.002 - 1.0004

• serum osmolality - less than 280 mOsm/kg

diagnostic findings of hyponatremia

• urinary sodium content greater than 20 mEq/L

• SG - greater than 1.012

• fluid accumulation in the cells

hyponatremia in SIADH manifestations

• PO

• nasogastric

• parenteral

most common route for administration of sodium in hyponatremia

LR, isotonic saline (0.9% NaCl)

IV therapy for hyponatremial

lithium or democlocycline (declomycin)

antagonize the osmotic effect of ADH on the nephron collecting ducts

12 mEq/L

Serum sodium should not be increased more than __________ mEq/L in 24 hours to avoid neurologic damage due to demyelination

100 mEq/L

the usual daily sodium requirement in adult

demyelination (damage myelin sheath

)

This condition occurs when the serum sodium concentration is overcorrected (exceeding 140 mEq/L) too rapidly or in the presence of hypoxia or anoxia

hypertonic solution (3% saline between 0.10 - 1mL/kg; body weight)

Recommended IV solution for severe neurologic symptoms (coma, seizure, delirium), or with TBI, to alleviate the cerebral edema.

AVP receptor antagonist

are pharmacologic agents that block the effects of ADH at the nephron, allowing diuresis and water excretion

• seizure

• delirium

• coma

symptoms that are contraindicated for AVP receptor antagonist

Tolvaptan

is an oral medication indicated for clinically significant hypovolemic and euvolemic hyponatremia that must be initiated and monitored in clinical setting

restrict fluid intake

management for hyponatremia due to water retention

elevate serum sodium enough to alleviate neurologic effects only

the aim of therapy for severe hyponatremia

duiretics

Lithium should not go with __________

SIADH (high ADH, dilutes Na)

Addisons’ Disease (low aldosterone)

Conditions that are associated with hyponatremia

ADH, thirst, RAAS

Sodium regulators

• rapid pulse rate

• normal BP

clinical manifestation for normovolemic

• rapid pulse rate

• weak, thready pulse rate

• decrease systolic pressure, orthostatic hypotension

• flat neck veins in the supine position

clinical manifestation for hypovolemic

• rapid, bounding pulse

• high or normal CVP

clinical manifestation for hypervolemic

• shallow respiration

• pulmonary edema

  • rapid, shallow respiration

  • moist crackles

pulmonary clinical manifestation for hyponatremia

• increased UO

• decreased specific gravity

renal manifestation for hyponatremia

• dry skin and mucous membrane

• pale

integumentary manifestation for hyponatremia

• lethargy

• confusion

• muscle twitching

• focal weakness

• hemiparesis

• papilledema

• seizure → death

signs of increasing ICP (Na = less than 115 mEq/L)

• restrict fluid intake

• oral Na supplements

medical management for mild hyponatremia

• isotonic liquid (NS or LR)

• high Na foods

medical management for hyponatremia related to hypovolemia

• ICU

• hypertonic (3% or 5% NaCl)

• furosemide (to treat fluid overload)

medical treatment for severe hyponatremia

• osmotic diuretics (mannitol; Osmitrol)

• lithium and democlocycline

medical management for hyponatremia related to fluid excess

osmotic diuretics (mannitol; Osmitrol)

drug that promotes excretion of water, usually for hypervolemic hyponatremia