Sodium

1. Causes
   1. Diabetes Insipidus

      Nota:

      • ADH: Produced in the Hypothalamus & Stored in the Posterior Pituitary Gland. Hypernatremia is Due to Water Loss. 
      1. Central:

         Nota:

         • Deficiency of the Synthesis or Release of ADH from the Posterior Pituitary Gland. 
      2. Nephrogenic
      3. Primay
   2. Impaired LOC or Unable to Obtain Fluids

      Nota:

      • This leads to Hypernatremia not being corrected. 
   3. Administration of Hyperosmolar Tube feedings
   4. Excessive Sweating
   5. IV administration of Hypertonic Solution, Sodium Drugs..
2. Intervention
   1. Drugs/IV
      1. FVE
         1. Dilute with Sodium Free IV fluids
            1. 5% Dextrose & Diuretics
      2. FVD
         1. Replace fluids orally with Isotonic or Hypotonic Fluids
            1. 5% Dextrose or 0.45 % Sodium Saline
      3. Slowly!!!

         Nota:

         • Rapid administration could cause rapid shift back into the cells causing cerebral edema. 
   2. Patient Teaching
   3. On-Going & Monitoring
      1. 24 I & O
      2. Suction

         Nota:

         • Seizure (saftey for aspiration)
      3. Daily Weights
      4. Urine Specific Gravity >1.025

         Nota:

         • Increased Sodium & Fluid Deficit
      5. Thready Pulses, & flat Neck veins

         Nota:

         • Fluid deficit w/ Hypernatremia
      6. Tachycardia & Tachypnea
      7. Changes in Sensonurim
      8. Skin Turgor & Mucous Membranes
3. Signs & Symptoms
   1. Diagnositcs
      1. Low Sodium Levels
   2. Symptomatic Hypernatremia is Rare
   3. Thirst , Dry Mouth, Dry Swollen Tongue, Sticky Mucosa
   4. Apprehension, Restless, Weakness
   5. Increased Fluid Retention & Increased BP
   6. Edema or Tenting

      Nota:

      • Edema associated with water excess & Tenting associated with fluid Deficit. 
   7. Decreased Urine Output
   8. Fever Low grade
   9. Orthostatic Hypotension
   10. Flushed Skin
4. Nursing Dx

   Nota:

   • Excessive water Loss or Excessive Sodium Intake 
   1. Risk fo Injury
   2. Risk For Fluid Volume Deficit
   3. Risk For electrolyte Imbalance
   4. Potential Complications: Seizures & Coma leading to potential Complications

1. Causes
   1. Euvolemic Hyponatremia

      Nota:

      • Sodium Levels stay Near Normal.  (Dilutional Effect) 
      1. SIADH
      2. Sodium Free Hypotonic IV fluids
   2. Hypovolemic Hyponatremia

      Nota:

      •  Decreased Sodium & Water!  *Disaproportionately more Sodium Loss 
      1. Vomiting, Diarrhea, Diaphoresis, Excessive Drainage wounds, Trauma w/ excessive Blood Loss, DIuretics
   3. Hypervolemic Hyponatremia

      Nota:

      • Increased Sodium & Water.  *Water is Porportionately more Increased!
      1. Edema
         1. Congestive Heart Failure
         2. Renal Disease
         3. Nephrotic Syndrome
2. Signs & Symptoms
   1. Decreased DTR
   2. Hypotension
   3. Diagnositics
      1. Low Sodium
   4. CNS 1st Signs

      Nota:

      • Cellular Swelling. Low concentration the fluid goes inside the cells. 
      1. Headaches
      2. Confusion
      3. Irritability
      4. Seizure
      5. Coma
3. Intervention
   1. Fluid Restriction (Dilutional Hyponatremia)

      Nota:

      • Dilutional Hyponatremia (fluid Volume Excess). Increased fluids can caused the opposite reaction Hypernatremia
      1. Severe (seizures)
         1. 3% Hypertonic Saline
      2. SIADH Treatment
         1. Vasopressins: Convaptan & Tolvaptan

            Nota:

            • Convaptan: Increase Urine Output w/o loss of Electrolytes such as Na+ & K+. This should NOT be given to a patient with hyponatremia from excessive water loss. Tolvaptan is used in Heart Failure, Liver Cirrhosis and SIADH. 
   2. Medications & IV (Loss of Na+)

      Nota:

      • Abnormal Fluid Loss
      1. Eat More Salt!
      2. Administer Sodium IV solution (Hypertonic)

         Nota:

         • Hypovolemic!
   3. Patient Teaching
   4. On-Going Monitoring
      1. Cerebral Edema

         Nota:

         • Is a potential Complication when Water moves excesively from extracellular space to Intracellular. 
      2. Hypovolemia

         Nota:

         • The fluid will Shift from the less concentrated area to more concentrated. When extraacellular fluid moves into inctracellular there is an increased risk for Hypovolemia. Nurses need to monitor for this potential complication. 
4. Nursing Dx
   1. Risk For Injury

      Nota:

      • Related to Altered Sensorium & Decreased LOC 
   2. Acute Confusion
   3. Potential Complications: Severe Neurologic Changes

      Nota:

      • If hyponatremia is left untreated, Irreversible neurologic damage can occur. 
   4. Risk for Electrolyte Imbalance

Nota:

• Sodium Levels Regulated by the Kidneys. The main function of sodium is to Maintain Body Fluids. Low Sodium Levels Inhibit ADH & NP and trigger Aldosterone Secretion. High Sodium Inhibit Aldosterone and Secrete ADH & NP.  
• Maintains Acid-Base Balance

Nota:

• GI loss Eating Disorders Continuous IVF Diuretics