1.0 Sodium Deficit: Hyponatremia

Hyponatremia

<135 mEq/L or mmol/L

Refers to a serum sodium level that is _________. This can present as an acute or chronic form 

Acute Hyponatremia

Dilutional Hyponatremia

Osmolites

Cerebral edema

commonly the result of fluid overload in a surgical patient.  This is ___________ because the excess water dilutes the sodium in the bloodstream 

• Serum sodium is less than 135, but developed in less than 48 hours. Braincells have not yet formed the _________ causing water to shift rapidly to the neuron = high risk for ___________ = neurologic symptoms 

Rapid Cytogenic Polydipsia

compulsive urge to drink more than 6 liters of water without the physical need to do so

ok

ACUTE HYPONATREMIA

•  post-op hypotonic fluids, acute water intoxication, NDDA, use of molly or ecstasy, SIADH triggers, Rapid Cytogenetic Polydipsia

Chronic Hyponatremia

seen more frequently in patients outside the hospital settings, has longer duration, and has less serious neurologic Sequelae. 

Chronic Hyponatremia

• Serum sodium less than 135, continuously developing for more than 48 hours. The brain is able to Adapt by loosing the intracellular osmolites 

Osmolites

• small naturally occurring organic molecules, which maintains osmotic balance , to protect against water stress, and stabilize protein without disrupting cellular functions.  

Osmotic Demyelination Syndrome

CHRONIC HYPONATREMIA

• Although it limits Cerebral edema, it makes the brain vulnerable to ______________ especially when sodium is raised too fast . 

SIADH

Heart failure

Liver cirrhosis

CKD

Diuretic, SSRIs, Thiazide

• Chronic Hyponatremia is common to patient with: 

Exercise Associated Hyponatremia

More common in women and those of smaller stature. It can occur during extreme temperature, because of excessive fluid intake before exercise, or prolonged exercise that results in excessive loss of sodium through perspiration 

ok

EXERCISE ASSOCIATED HYPONATREMIA

• Serum sodium decreased for up to 24 hours during prolonged physical activity. 

• Primarily due to excessive intake of hypotonic fluid (low electrolyte). It exceeds the sweat and urine losses causing EAH 

• Non-osmotic AVP secretion during exercise 

• NSAIDs: can be euvolemic or hypervolemic less common with hypovolemic EAH. 

• Central Pontine Myelinolysis

• Extrapontine Myelinolysis

OSMOTIC DEMYELINATION SYNDROME

Central Pontine Myelinolysis

ODS: Affects the pons

Extrapontine Myelinolysis

ODS: If other areas of the brain is involved 

Osmotic Demyelination Syndrome

is a serious neurological condition. The myelin sheaths are destroyed due to rapid correction of low blood sodium. 

Alcohol

Severe Malnutrition

Advanced Liver Disease

Prolonged Diuretic Use

ODS: Other Factors

• _________

• _________

• _________

• _________