sodium Flashcards
What maintains osmotic pressure
Sodium
When ingesting Na→ what happens
↑ serum osmolality→ thirst and release of ADH→ the kidneys retain water
Sodium maintains
blood volume and blood pressure
Water follows sodium and sodium also travels with what
Chloride
Hyponatremia <133
Excess water accumulates and dilutes the normal Na concentration
specific gravity for someone with hyponatremia
<1.008
Two different volume issues can cause hyponatremia
hypervolemia and hypovolemia Hypovolemic hyponatremia is the most common
what causes hyponatremia
*Diarrhea, Vomiting, Burns, Sweating (Insensible fluid loss)
*GI suctioning
*Drugs – more commonly seen with thiazide diuretics
Signs and Symptoms (Think Neuro!)
*Neuro in type: Lethargy, Headache, Confusion, Apprehension, Seizures, Coma
*N/V, muscular weakness, & diminished reflexes
* Severe hyponatremia (<115) can lead to permanent neurological damage r/t cerebral edema
Low volume (_____________) hyponatremia is the most common. It occurs when the plasma osmolality and volume is ______. Volume depletion causes release of ______, which causes ___________ of water and Na (but to a lesser degree – resulting in hyponatremia).
hypovolemia
low
ADH
retention
what kind of assessment would you preform on a patient with hyponatremia
Focused Neuro Assessment
Treat this with what IV solutions
NS or D5NS to slow the increase of Na
While treating hyponatremia slow increases in serum Na is important to avoid
Neurological damage
Another way to treat hyponatremia
increase Na in diet
Extra water, retention of fluids (H2O) creates a
dilution effect
Excess Volume (______________) hyponatremia
hypervolemic
causes of hypervolemic hyponatremia
*Hypervolemia [Heart Failure (retention of fluids)]
*Continuous hypotonic solutions (D5W & D5.45NS or .45NS) – in critical care
*Malnutrition
*Addison’s disease (K retention and Na excretion because of inadequate release of aldosterone and cortisol)
Treatment would include
*Fluid/water restriction
*Daily weights (#1 indicator of fluid imbalance)
*I & O
*Administer steroids (in case of Addison’s disease)
*Neuro Assessments
Hypernatremia (>145) occurs when
too much water is lost or too much Na is consumed
The most common cause of hypernatremia is
inadequate water intake (elderly), excess excretion of urine due to meds
Other causes include
*Severe vomiting and diarrhea
*Steroids or Cushing Syndrome (promotes Na retention and K excretion because of additional release of aldosterone and cortisol)
*Stress cause release of cortical, which promotes Na retention and K excretion
Signs and Symptoms of hyernatremia
*Thirst
*S/Sx of dehydration (fever, flushed skin, dry mucous membranes, tachycardia, decreased urine output, orthostatic hypotension)
*N/V & anorexia
*Severe Na levels – restlessness, irritability, cerebral edema (seizures and coma)
Hypernatremia Treatment
Administering sodium free fluids (oral or IV). Infuse NS and free water (D5W) slowly.
*Daily Weight & I & O
*Sodium restriction
Fast infusions may cause a sudden increase in serum Na, which may move fluids from the intravascular space into the cells and this can cause
(brain swelling being most dangerous) the pt. at risk for neurological damage
