Nursing Management of Sodium imbalance

Sodium is necessary for the body to maintain fluid balance and is critical for normal body function. It also helps to regulate nerve function and muscle contraction.

Hyponatremia and Hyponatremia.

1. SODIUM IMBALANCE Jaison Thomas Daniel Nursing tutor Yfcon , ratnagiri

2. INTRODUCTION Sodium is one of the body's electrolytes, which are minerals that the body needs in relatively large amounts. Electrolytes carry an electric charge when dissolved in body fluids such as blood. Most of the body’s sodium is located in blood and in the fluid around cells. Sodium helps the body keep fluids in a normal balance. Sodium plays a key role in normal nerve and muscle function . The normal serum sodium level is 135 - 145 mEq / L

3. The body obtains sodium through food and drink and loses it primarily in sweat and urine. Healthy kidneys maintain a consistent level of sodium in the body by adjusting the amount excreted in the urine. When sodium consumption and loss are not in balance, the total amount of sodium in the body is affected.

4. Sources

5. Hyponatremia

6. Hyponatremia is a serum sodium level lower than 135 mEq /L (135 mmol /L ). Sodium imbalances usually are associated with fluid volume imbalances . Classification of hyponatremia in adults according to serum sodium concentration, Mild : 130-134 mmol /L Moderate : 125-129 mmol /L Profound : < 125 mmol /L

7. Hyponatremia is classified according to volume status, as follows : Hypovolemic hyponatremia Decrease in total body water with greater decrease in total body sodium Euvolemic hyponatremia N ormal body sodium with increase in total body water Hypervolemic hyponatremia I ncrease in total body sodium with greater increase in total body water

8. Hyponatremia can be further sub classified according to effective osmolality, as follows: Hypotonic hyponatremia Isotonic hyponatremia Hypertonic hyponatremia

9. Causes Increased sodium excretion Excessive diaphoresis Diuretics Vomiting Diarrhoea Wound drainage, especially gastrointestinal Kidney disease Decreased secretion of aldosterone

10. Causes Inadequate sodium intake Fasting ; nothing by mouth status Low-salt diet Dilution of serum sodium Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids Kidney disease c. Freshwater drowning Syndrome of inappropriate antidiuretic hormone secretion Hyperglycemia Heart failure

11. Clinical manifestations Cardiovascular Symptoms vary with changes in vascular volume Normovolemic : Rapid pulse rate, normal blood pressure Hypovolemic : Thready , weak, rapid pulse rate; hypotension; flat neck veins; normal or low central venous pressure Hypervolemic : Rapid, bounding pulse; blood pressure normal or elevated; normal or elevated central venous pressure

12. Clinical manifestations Respiratory Shallow , ineffective respiratory movement is a late manifestation related to skeletal muscle weakness. Neuromuscular Generalized skeletal muscle weakness that is worse in the extremities Diminished deep tendon reflexes

13. Clinical manifestations Central Nervous System Headache Personality changes Confusion Seizure. Coma Renal Increased urinary output Gastrointestinal Increased motility and hyperactive bowel sounds Nausea Abdominal cramping and diarrhea Integumentary Dry mucous membranes

14. Diagnostic Evaluations History collection P hysical examination urine osmolality serum osmolality urinary sodium concentration.

15. Management Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and gastrointestinal status. If hyponatremia is accompanied by a fluid volume deficit (hypovolemia), IV sodium chloride infusions are administered to restore sodium content and fluid volume. If hyponatremia is accompanied by fluid volume excess (hypervolemia), osmotic diuretics may be prescribed to promote the excretion of water rather than sodium.

16. Management If caused by inappropriate or excessive secretion of antidiuretic hormone, medications that antagonize antidiuretic hormone may be administered. Instruct the client to increase oral sodium intake as prescribed and inform the client about the foods to include in the diet. If the client is taking lithium, monitor the lithium level, because hyponatremia can cause diminished lithium excretion, resulting in toxicity.

17. Hypernatremia

18. Hypernatremia is a serum sodium level that exceeds 145 mEq /L (145 mmol /L ) . It is strictly defined as a hyperosmolar condition caused by a decrease in total body water ( TBW) relative to electrolyte content. Hypernatremia is a “water problem,” not a problem of sodium homeostasis.

19. Causes Decreased sodium excretion Corticosteroids Cushing’s syndrome Kidney disease Hyperaldosteronism Increased sodium intake Excessive oral sodium ingestion or excessive administration of sodium-containing IV fluids

20. Causes Decreased water intake Fasting; nothing by mouth status Increased water loss Increased rate of metabolism, fever, hyperventilation, infection, excessive diaphoresis, watery diarrhoea, diabetes insipidus

21. Clinical manifestations Heart rate and blood pressure respond to vascular volume status. Pulmonary edema if hypervolemia is present. Early: Spontaneous muscle twitches; irregular muscle contractions Late : Skeletal muscle weakness; deep tendon reflexes diminished or absent Altered cerebral function. Normovolemia or hypovolemia: Agitation , confusion, seizures Hypervolemia : Lethargy, stupor, coma

22. Clinical manifestations Extreme thirst Decreased urinary output Dry and flushed skin Dry and sticky tongue and mucous membranes Presence or absence of edema, depending on fluid volume changes

23. Diagnostic Evaluations Serum electrolytes (Na + , K + , Ca 2+ ) Glucose level Urea Creatinine Urine electrolytes (Na + , K + ) Urine and plasma osmolality 24-hour urine volume Plasma arginine vasopressin (AVP) level.

24. Diagnostic Evaluations magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain may be helpful in cases of central diabetes insipidus

25. Management The goals of management are Recognition of the symptoms, when present Identification of the underlying cause(s) Correction of volume disturbances Correction of hypertonicity

26. Management Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and integumentary status. If the cause is fluid loss, prepare to administer IV infusions. If the cause is inadequate renal excretion of sodium, prepare to administer diuretics that promote sodium loss. Restrict sodium and fluid intake as prescribed

27. Vasopressin analogs These agents may enhance sodium excretion. Desmopressin (DDAVP) Increases cellular permeability of collecting ducts, resulting in the reabsorption of water by the kidneys.

28. Avoid high sodium food, salt substitutes are cautiously use for patient with potassium imbalances