SODIUM IMBALANCES
·
Sodium
is a main cation of the ECF, plays important role in maintaining the
concentration and volume of the ECF.
·
It
Is the primary determinant of ECF osmotality.
·
Generation
and transmission of nerve impulses and regulation of acid base balance.
·
The
normal serum sodium level is 135-145 mEq/L
·
Intake
- GI tract absorbs sodium from food.
·
Sodium
excretion - Through urine, sweat and faces.
HYPONATREMIA
·
It
is defined as a plasma sodium level less than 135mEq/L.
·
Most
common electrolyte disorder in older adults.
·
Is
usually associated with changes in fluid volume status.
Causes
1.Excessive
sodium loss:
·
GI
losses: Diarrhea, Vomiting, Fistulas, NG suction.
·
Renal
losses: Diuretics, adrenal insufficiency, Sodium wasting renal disease
·
Skin
losses: Burns, wound drainage
2.Inadequate
sodium intake: Fasting
3.Excessive
water gains: Excessive hypotonic IV fluids.
4.Disease
states: SIADH, heart failure, Primary hyperaldosteronism.
CLINICAL
MANIFESTATIONS
CNS Manifestations
·
Headache,
Confusion
·
Hallucinations,
Behavioral changes
·
Seizures,
Coma and death CVS Manifestations
·
Decrease
in BP, Orthostatic hypotension, Weak and thready pulse
·
In
severe hypovolemic hypernatremia, a shock like state occurs.
Respiratory
·
Tachypnea,
dyspnea, Orthopnea, feeling short of breath, Crackles , Cheyne-stocks respiration
·
Neurogenic
hyperventilation
Gastro Intestinal
·
Nausea,
Vomiting, Hyperactive bowel sounds, Abdominal cramping, Diarrhea.
Other features
·
Dryness
of skin, mucous membrane and tongue.
MEDICAL MANAGEMENT
·
If
sodium levels of 126-135 mEq/L: Add additional salt in diet, Fluids restricted.
·
Below
125mEq/L: IV sodium replacement with Normal saline
·
115mEq/L
or less: Concentrated saline solution such as 3% NaCl is indicated until the plasma
concentration reaches 125 mEq/L .
NURSING MANAGEMENT
Diagnosis
·
Risk
for injury related to altered sensorium & decreased level of consciousness
secondary to abnormal CNS function.
Potential complications: severe neurologic changes.
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