Sodium -exam 5 Flashcards
what are the 5 functions of sodium?
- maintain Bp
- blood volume
- pH balance (acid base)
- controlling nerve impulses
- stimulating muscle contractions
Na is a big impact on the bodys _ _
fluid balance
Na is a major electrolyte in _ _
ECF
Na controls
water balance
Na is regulated by?
- ADH
- Aldosterone
- sodium and potassium pump
What three things do we need to think of when we think sodium?
- Think brain, Neuro checks, and safety
lab value range for Na
135-145mEq/L
Impaired water excretion caused by inability to suppress secretion of ADH; water retention causes dilutional hyponatremia
SIADH
water excess in relation to the amount of sodium
dilutional hyponatremia
retaining fluid and sodium causing hemodilution of Na+
water intoxication
excessive fluid intake without physiologic stimuli
psychogenic polydipsia
shifts solutes into the cell
hypotonic fluids
anything below what is hyponatremia
less then 135
hypotonic fluids shifts fluid where?
into the cell
hypertonic fluids shift where?
out of the cell
common causes of hyponatremia from loss of sodium rich body fluids include? (4)
- draining wounds
- diarrhea
- vomiting
- primary adrenal insufficiency
SIADH results in dilutional hyponatremia caused by
abnormal retention of water
mild hyponatremia - symptoms
- headache
- irritability
- difficulty concentrating
severe hyponatremia - symptoms
- confusion
- vomiting
- seizures
- and even coma
what fluid would we give to a patient after fluid loss?
isotonic sodium containing solutions
what two medications can be given to a patient with hyponatremia?
- loop diuretics
- demeclocycline
what IV solution can we give to a pt with hypernatremia?
3% sodium chloride
what is essential when monitoring a pt with hypernatremia?
I&O
what are some mild symptoms related to hyponatremia?
headache, N/V, fatigue
what are some moderate symptoms related to hyponatremia
lethargy, weakness, altered LOC
what are some severe symptoms of hyponatremia ?
sz, brainstem herniation, respiratory arrest, and death
No volume loss
Euvolemic
Low Na with ECF volume normal
Euvolemic
Na loss with ECF volume depletion
Hypovolemic
Na loss with increased ECF volume
hypervolemic
inadequate sodium intake can be caused by
- fasting
- NPO status
- Low Na in diet
Increased Na excretion can be caused by
-diarrhea, diuretics, drainage, diaphoresis
-vomiting
- kidney disease
- Addisons
Sodium loss and water retention
Hypoaldosteronism (addisonâs)
we replace sodium slowly or quickly? why?
slowly! if given to rapid can lead to neruo damage!
what is the MAXimum per hour
0.5mEq/L
when giving sodium slowly how much can the lab value sodium go up in the body in a 24 hr period?
6-12 pts
how often do we check sodium levels?
2-4 hours
with a patient experiencing hypovolemic what saline do we given to correct fluid volume status and Na+?
0.9% NS
what solution do we use for extremely low Na+
3% NS
When giving 3% NS where must we give it through and why?
central line because it is highly caustic on veins
this med excretes water but not Na+, what am I?
mannitol
give osmotic diuretics and fluid restriction
hypervolemic
Causes SIADH
Euvolemic
in severe hyponatremia - what is this lab value?
less than 120mEq/L
with SEVERE hyponatremia what do we administer and what rate?
administer 3% saline IV SLOWLY
what do we insert into a patient for strict I&O
indwelling catheter
if Na is overcorrected too quickly what syndrome can occur?
demyelination syndrome
causing damage to nerve cells in the brain
demyelination syndrome
causes your body to retain too much water and commonly leads to hyponatremia
SIADH
this upset electrolytes, especially sodium. what am i ?
SIADH
high levels of ADH retain water - this is caused by
SIADH
a pt has a decreased sodium and increased water retention - what might this be caused by?
SIADH
3 causes to SIADH?
- small cell lung cancer
- severe brain trauma
- sepsis infections of brain
vasopressor drugs block what
ADH
ADH is produced in the area of the brain called?
and secreted into the blood by the
hypothalamus; pituitary gland
ADH is released by the
pituitary gland
with SIADH there is too much - in the blood
water
too much ADH
hyponatremia
synthetic ADH
desmopressin, Vasopressin
ADH decreases - -
urine output
ADH does what to the BP
Increased
if a patient is experiencing an headache what should this alert you to
SIADH
Low Na can lead to
seizures and death!
How much fluid can a person have ?
800-1000ml/day
blocks effect of ADH resulting in more dilute urine
demeclocycline
medications and caffeine can be a
diuretic
increasing oral sodium intake what can you do?
salt tablets, bacon, processed foods
what is important in the treatment of a pt with SIADH
daily weight and I&O
cause kidneys to retain sodium
corticosteroids
may occur with inadequate water intake, excess water loss
hypernatremia
excess sodium intake with inadequate water intake can lead to
hypernatremia
primarily the results of water shifting out of cells into ECF with resultant dehydration and shrinkage of cells
hypernatremia
in primary water deficit , what fluid is given to replace
with isotonic solutions such as 0.9 % sodium chloride
if a patient has sodium excess what would you give fluid wise
expect diluting the high sodium concentration with sodium free IV fluids, such as 5% dextrose in water
occurs due to prolonged exposure to glucocorticoids or a tumor producing excessive cortisol by adrenals
cushings syndrome
high sodium and water retention
hyperaldosteronism
severe hypernatremia is defined as sodium levels ??
> 160
examples of sodium gain include IV admin of what?
hypertonic saline or bicarb
the serum level for hypernatremia should not decrease more then what
8-15 pts
quickly reducing levels can cause rapid shift in water back into the cells, causing what
what condition is this? hyper or hypo?
cerebral edema - hypernatremia
in a patient with hypernatremia and increased sodium intake what might the pt be ingesting or getting?
too many processed foods
hypertonic solutions (3%NS or 5%NS)
alka seltzer, aspirin
in a pt with hypernatremia and they have a decrease in water intake what might be causing this
fasting
NPO status
hemoconcentration
increased water loss
in a patient with hypernatremia and they have increased water loss what might be causing this
dehydration - too much water loss and Na gain
infection
diabetes insipidus
with a patient with hypernatremia you need to bring the sodium levels down slowly why?
rapid correction can lead to sz due to rapid fluid shifts in the brain
what solutions do we give to a pt experiencing hypernatremia
hypotonic solutions, 1/2 NS, D5W
what are the important interventions associated with hypernatremia
- patient safety b/c they are confused and agitated
- weigh daily
- I&O
- neuro checks/precautions
what moderate symptoms of hypernatremia should we watch for
- confusion
- swollen and dry red tongue
- muscle twitching
- thirst
what severe symptoms of hypernatremia should we watch for?
- N/V
- increased muscle tone
- seizures
- coma
ADH (vasopressin) deficiency
Diabetes Insipidus
your patient presents with increased sodium and diluted urine what condition might your patient have
Diabetes Insipidus
causes of diabetes insipidus
- damage to brain
- tumors
- trauma
2 symptoms of diabetes insipidus
polydipsia
polyuria
SIadh
Soaked Inside
DI
dry inside
your patient has a high urine output and high sodium and they are at risk for hypovolemic shock what condition am i
Diabetes insipidus
your patient has a low urinary output, low sodium level, and is at risk for seizures what condition am i?
SIADH
