sodium Flashcards
sodium - found where?
MOST ABUNDANT CATION IN ECF
* ONLY SMALL AMT FOUND IN ICF
Na role (think contractions)
IMPORTANT ROLE IN GENERATION AND TRANSMISSION
OF IMPULSES IN NERVES AND MUSCLES
HELPS REGULATE ACID-BASE BALANCE
Na regulation (TAAA da - don’t forget the heart)
- THIRST
- ADH
- ALDOSTERONE
- ANP
hyponaturemia - most common what?
- MOST COMMON ELECTROLYTE IMBALANCE SEEN IN HOSPITALIZED PATIENTS
Hyponaturemia - RISK FACTORS (SGS give me low salt)
- SODIUM LOSS
- GAIN OF WATER - hypotonic solution, rare but hypotonic solution for enteral feedings. Hazing. marathon runner.
- SIADH - risk factor is pneumonia
D5 creates a hypotonic situation - check this
brain cells most (overload the brain)
susceptible to fluid overload - cerebral edema
hyponatremia - clinical manifestations (think how you feel when you don’t have salt)
N/V, loss of energy, muscle weakness, seizures.
- DEPENDENT ON RAPIDITY & SEVERITY OF HYPONATREMIA
- MOST COMMON SX RELATED TO H2O SHIFT FROM VASCULAR SPACE INTO
CELLS AND NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE CTX
Hyponaturemia - NEUROLOGIC SYMPTOMS DON’T DEVELOP UNTIL NA+ VALUE APPROX (low salt brain at 120 min)
120-125
* SEIZURES OCCUR WHEN LEVELS REACH 115
hyponaturemia - LAB VALUES (think of normal values) and when Oz is low he makes a 280 degree)
- NA+ LESS THAN 135MEQ/L
- SERUM OSMOLALITY LESS THAN 280MOSM/KG
- SG DECREASED (EXCEPT WITH SIADH)
INTERVENTIONS - hyponaturemia - assess what? (same stuff)
- ASSESS AND DOCUMENT LOC,
ORIENTATION, NEURO STATUS WITH
VS - I & O DAILY WTS
- MONITOR SERUM LEVELS
CLOSELY - FREE FLUID RESTRICTION
hyponaturemia - DON’T CORRECT TOO
QUICKLY to prevent…(salt in the brain)
NEUROLOGIC DAMAGE
SECONDARY TO LYSIS OF
MYELIN
normal saline percent (saline is small)
.9%
hyponatermia - intervention - just one…and when it gets to what number?
ADMINISTER HYPERTONIC 3%
SALINE SOLUTION ONLY IF
DANGEROUSLY LOW (AT
LEAST 118 OR LOWER VALUE)
increased water
higher bp, if you have hyponateremia
- GREATER THAN NORMAL CONCENTRATION OF NA+ IN ECF caused by..
EXCESS WATER LOSS OR OVERALL SODIUM EXCESS
* MAY OCCUR WITH WATER LOSS, WATER DEPRIVATION, OR NA+ GAIN
who is usually admitted for hypernaturemia?
elderly - don’t want to drink
hypernatermia - causes (hyper is anything without enough H20)
- INCREASED SENSIBLE AND INSENSIBLE H2O LOSS
- DIARRHEA (hypo AND hyper)
- WATER DEPRIVATION/SODIUM GAIN
- DIABETES INSIPIDUS (you aren’t absorbing water, so Na levels get too high)
- EXCESS ALDOSTERONE SECRETION (gain of Na)
free water prevents hyperosmolar state
hypernaturemia - CLINICAL MANIFESTATIONS related to…
WATER SHIFT FROM CELLS (CELLULAR DEHYDRATION) INTO
VASCULAR SPACE
* ALSO RELATED TO NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE
CONTRACTION
DIAGNOSTIC TESTS - hypernaturemia - numbers (just think of normal range for Na - over is hyper) and osmolality above what? (os is 3 less than 300)
- SODIUM GREATER THAN 145
- SERUM OSMOLALITY ABOVE 297
- SG INCREASED, EXCEPT WITH DIABETES INSIPIDUS
HYPERNATREMIA interventions (basically just water)
- I&O
- DAILY WTS
- ASSESS AND DOCUMENT LOC, NEURO STATUS AND ORIENTATION WITH VS
- IV OR ORAL H2O REPLACEMENT
INTERVENTIONS - hypernaturemia - how many days needed to correct hypernaturemia? and why? (salt needs 2 days)
(DESMOPRESSIN ACETATE)
* REORIENT PT AS NEEDED
* DECREASE DIETARY NA+ INTAKE
* CORRECT HYPERNATREMIA SLOWLY (to prevent cerebral edema), OVER 2 DAYS
chloride is ICF or ECF?
- MOST ABUNDANT EXTRACELLULAR ANION AND MAKES UP FOR TWO THIRDS
PLASMA ANIONS
chloride absorption, production, and excretion where?
- REGULATION
- GI - MOST ABSORBED IN INTESTINES. CHLORIDE PRODUCED MAINLY IN
STOMACH AS HYDROCHLORIC ACID (run the risk of alkalosis with loss of hydrochloric acid) - KIDNEYS - EXCRETED AND REABSORBED IN KIDNEYS
headache characteristic of
hyponaturemia
treatment hyponaturemia - stop drinking
fluid restriction, stop low sodium diet. maybe change diuretic.
potassium - located where?
- MAJOR CATION IN ICF
low potassium causes what heart problem?
dysrthmia
K+ regulation (Alden is a KID who regulates K+)
- DIETARY INTAKE
- KIDNEYS - PRIMARY REGULATORS
OF K+ BALANCE - ALDOSTERONE
- INSULIN
HYPOKALEMIA - common or not? (little Kalema is common)
- ONE OF THE MOST COMMON ELECTROLYTE IMBALANCES
- CHANGES IN SERUM K+ REFLECTIVE OF ECF VALUES NOT TOTAL BODY
VALUES
hypokalemia - causes - eating? (can never eat enough potassium)
ETIOLOGY
* DUE TO LOSS FROM BODY OR MOVEMENT OF K+ INTO CELLS
* RARELY RESULT OF INADEQUATE INTAKE
which diuretic for hyperkalemia? (you know the one)
lasix and furosemide
CLINICAL MANIFESTATIONS of hypokalemia CLINICAL MANIFESTATIONS
RARELY DEVELOP UNLESS K+ DROPS below…(think of normal values)
3.0
hypokalemia - DIAGNOSTIC TESTS - what is decreased on blood test? (when kalema is low, she needs maggie and milk)
- ECG: MAY SEE ST SEGMENT DEPRESSION, FLATTENED T
WAVE, PRESENCE OF U WAVE & VENTRICULAR
DYSRHYTHMIAS - DECREASED MG+ OR DECREASED CA++
if Mg is low, what else is usually low? (when maggie gets low, she needs milk and salt to pick her up)
Ca is and Na are usually low as well
INTERVENTIONS - hypokalemia - how much K+ supplement is usually ordered? (need vitamin K from 40 - 80)
- ADMINISTER K+ SUPPLEMENT AS
ORDERED - USUAL DOSE = 40-80MEQ
hypokalemia INTERVENTIONS - encourage foods…
- ENCOURAGE FOODS HIGH IN K+