· 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.
· 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.
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.
· 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.
· Tachypnea, dyspnea, Orthopnea, feeling short of breath, Crackles , Cheyne-stocks respiration
· Neurogenic hyperventilation
· Nausea, Vomiting, Hyperactive bowel sounds, Abdominal cramping, Diarrhea.
· Dryness of skin, mucous membrane and tongue.
· 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 .
· Risk for injury related to altered sensorium & decreased level of consciousness secondary to abnormal CNS function.
Potential complications: severe neurologic changes.