Sodium Imbalances

Hyponatremia Clinical Manifestations

SALT LOSS

Hyponatremia - First S (SALT LOSS)

Stupor/coma

Hyponatremia - A (SALT LOSS)

Anorexia

Hyponatremia - First L (SALT LOSS)

Lethargy

Hyponatremia - T (SALT LOSS)

Tendon reflex abnormalities/depressed reflexes

Hyponatremia - Second L (SALT LOSS)

Limp muscle/weakness/cramps

Hyponatremia - O (SALT LOSS)

Orthostatic hypotension

Hyponatremia - Second S (SALT LOSS)

Seizure/headaches/confusion/cerebral swelling

Hyponatremia - Third S (SALT LOSS)

Stomach/abdominal cramping/NVD

Hyponatremia - Management/Treatment

Restrict water intake and/or replace sodium. Sodium replacement can be dietary or IV hypertonic saline for severe neurologic symptoms. Close fluid balance monitoring (I&O, daily weights, labs) and medication adjustment. Gradual correction is preferred to minimize osmotic brain injury

Hypernatremia Signs/Symptoms

FRIED SALT

Hypernatremia - 6 D's

Diarrhea, Dehydration, Diabetes Insipidus, Diuretics, Diseases (Cushing's syndrome), Doctors (iatrogenic, excessive IV sodium solutions)

Hypernatremia (HIGH SALT) - First H

Hyperventilation, hypercortisolism

Hypernatremia (HIGH SALT) - I

Increased sodium intake

Hypernatremia (HIGH SALT) - G

GI tube feeding without water

Hypernatremia (HIGH SALT) - Second H

Heat stroke, hypertonic solution

Hypernatremia (HIGH SALT) - S

Sodium excretion issue

Hypernatremia (HIGH SALT) - A

Aldosterone production increased

Hypernatremia (HIGH SALT) - L

Loss of fluids

Hypernatremia (HIGH SALT) - T

Thirst

Hypernatremia Clinical Manifestions (FRIED SALT) - F

Fever

Hypernatremia Clinical Manifestions (FRIED SALT) - R

Restlessness, agitation

Hypernatremia Clinical Manifestions (FRIED SALT) - I

Increased fluid retention

Hypernatremia Clinical Manifestions (FRIED SALT) - E

Edema (peripheral, pitting)

Hypernatremia Clinical Manifestions (FRIED SALT) - D

Dry mouth

Hypernatremia Clinical Manifestions (FRIED SALT) - S

Skin flushed

Hypernatremia Clinical Manifestions (FRIED SALT) - A

Altered LOC, confusion

Hypernatremia Clinical Manifestions (FRIED SALT) - L

Low urinary output

Hypernatremia Clinical Manifestions (FRIED SALT) - T

Thirst (extreme)

Hypernatremia Management/Treatment

Gradual lowering of serum Na+ to avoid cerebral edema; isotonic or hypotonic fluids initially; monitor for fluid shifts and cerebral edema; restrict Na+ intake