HYPONATREMIA:
What is Sodium ?
- Major ECF cation
- Daily requirement = 100 mEq = 6 gm salt for a normal human being
- Normal value in adult plasma : 135-145 mEq/L
What is hyponatremia ?
Plasma NA+ < 135 mEq/L
Types of hyponatremia:
1] Pseudo hyponatreia : associated with normal or increased tonicity
2] Isotonic hyponatremia :extra cellular fluids expands along with isotonic fluids with no NA in it
Eg : hyperproteinemia, hyperlipidemia
3] Hypertonic hyponatremia : shift of water into ECF along witrh Na
Eg hyperglycemia , mannitol use
4] Hypo tonic hyponatremia: most common hyponatremia as per clinical point of view
Occurs due to :
i] impaired renal water excretion
ii] excess intake of water
It is of 3 types :
i] hypovolemic : total water & total sodium loss eg vomiting, diarrhea, NG suction, burns, sweating
ii] euvolemic : hyponatremia with normal ECF content eg ADDISON’S disease, diabetes incipidus
iii] hypervolemic : increase fluid & sodium eg CCF, liver failure, kidney failure
Sign & Symptoms : SALT LOSS
S- Seizures & Stupor
A-Abdominal cramping, attitude changes (confusion)
L-Lethargic
T-Tendon reflexes diminished, trouble concentrating (confused)
L-Loss of urine & appetite
O-Orthostatic hypotension, overactive bowel sounds
S-Shallow respirations (happens late due to skeletal muscle weakness)
S-Spasms of muscles
NURSING IMPLICATIONS:
Watch cardiac, respiratory, neuro, renal, and GI status:
Hypovolemic Hyponatremia: give IV sodium chloride infusion to restore sodium and fluids (3% Saline hypertonic solution….harsh on the veins…given in ICU usually through central line very slowly…must watch for fluid overload)
Hypervolemic Hyponatremia: Restrict fluid intake and in some cases administer diuretics to excretion the extra water rather than sodium to help concentrate the sodium. If the patient has renal impairment they may need dialysis.
If patient takes Lithium remember to monitor drug levels because lithium excretion will be diminished and this can cause lithium toxicity.
Instruct to increase oral sodium intake and some physicians may prescribe sodium tablets. Food rich in sodium include: bacon, butter canned food, cheese, hot dogs, lunch meat, processed food, table salt
Caused by SIADH or antidiuretic hormone problems: fluid restriction or treated with an antidiuretic hormone antagonists called Declomycin which is part of the tetracycline family (don’t give with food especially dairy or antacids…bind to cations and this affect absorption).
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