sodium

Hyponatremia

  • Causes:

    • Could be caused by too much or too little fluid.

    • Types:

      • Hypovolemic hyponatremia – loss of fluid and sodium.

      • Hypervolemic hyponatremia – increase in fluid and salt.

  • Functions of Sodium:

    • Blood pressure, blood volume, and pH balance.

    • Where water goes, sodium flows.

  • Hyponatremia, depressed and deflated

    • A net gain of water or loss of sodium-rich fluids that results in sodium level less than 135 mEq/L.

    • Water moves from the extracellular fluid (ECF) into the intracellular fluid (ICF) causing the cells to swell (cellular edema).

  • Risk Factors:

    • Excessive sweating.

    • Diuretics.

    • Kidney disease.

    • Inadequate sodium intake.

    • Decreased secretion of aldosterone (drains, diuretics, diarrhea, diaphoresis).

Causes of Hyponatremia

  • SIADH

  • Water intoxication (hemodilution)

  • Adrenal (Addison’s disease) - wastes sodium from the body

  • Diuretics (sodium and potassium wasting)

  • Heat exhaustion

  • Diaphoresis

Manifestations

  • Poor skin turgor

  • Dry mucosa

  • Headache

  • Decreased salivation

  • Decreased blood pressure

  • Nausea

  • Abdominal cramping

  • Neurologic changes

  • Seizures

  • Confusion

  • Restlessness

  • Coma – respiratory arrest

  • Altered mental status (AMS)

  • Lethargy

  • Diminished tendon reflexes

  • Weakness

Nursing Management for Acute Hyponatremia

  • Add salt – IV Normal Saline or Lactated Ringer’s.

  • Administer hypertonic oral and IV fluids as prescribed.

  • Administer 3% sodium chloride slowly and monitor sodium levels frequently.

  • The goal is to elevate serum sodium level enough to decrease neurological manifestations associated with hyponatremia.

  • Encourage foods and fluids high in sodium.

  • Monitor vital signs and level of consciousness (orthostatic hypotension).

  • Daily weights.

  • Fluid restriction.

  • Diuretics.

Hypernatremia BIG AND BLOATED

  • serum sodium greater than 145 meq/l

  • caused by a gain of sodium in excess of water or loss of water in excess of sodium

  • most affected are very old, very young, and cognitively impaired

  • hypernatremia is a serious electrolyte imbalance that can cause significant neurological, endocrine, and cardiac disturbances

Risk factors

  • water deprivation (npo)

  • hypertonic enteral feedings without adequate water supplement

  • heat stroke

  • burns

  • diabetes insipidus

Expected findings

  • gi: thirst, dry mucous membrane, nausea, vomiting, anorexia, edema

  • vital signs: hyperthermia, tachycardia, orthostatic hypotension

  • skin: flushed, rosy cheeks

  • neuro/musculoskeletal: increased muscle tone, restlessness, irritability, seizures, coma

Management of hypernatremia

  • gradual lowering of serum sodium level via infusion of hypotonic electrolyte solution

  • restrict sodium intake, avoid canned foods and salty foods

  • assessment for abnormal loss of water and low water intake

  • assessment for over-the-counter sources of sodium

  • monitor for cns changes due to

    restlessness and confusion

  • chloride will do everything sodium does