Sodium (Na+)

135-145 mEq/L

Essential for acid-base, fluid balance, active & passive transport mechanism, irritability & CONDUCTION of nerve-muscle tissue

Hypernatremia:

>145 mEq/L

Signs & Symptoms

FRIED SALT (Big & Bloated)

Flushed skin

Restless, anxious, confused, irritable

Increased BP & fluid retention

Edema (Pitting)

Decreased urine output

Skin flushed & dry

Agitation

Low-Grade fever

Thirst (dry mucous membranes)

Hypernatremia Risk Factors:

Increased sodium intake

- excess oral sodium ingestion

- excess administration of IV fluids w/ sodium

- hypertonic IV fluids

Loss of fluids

- fever

- watery diarrhea

- diabetes insipidus

- excessive diaphoresis

- infection

Decreased sodium excretion

- kidney problems

HEMOCONCENTRATION = INCREASED SODIUM

Hypernatremia Interventions:

If due to loss:

- administer IV infusion

If the cause is inadequate renal excretion of sodium

- give diuretics that promote sodium loss

Restrict sodium & fluid intake as prescribed

Hyponatremia:

<135 mEq/L

Signs & Symptoms:

HYPOVOLEMIC / HYPONATREMIA: DECREASE OF FLUID & SODIUM

HYPERVOLEMIC / HYPONATREMIA: INCREASE BODY WATER THAT IS GREATER THAN SODIUM

SALT LOSS

Stupor/coma

Anorexia ( nausea/ vomiting)

Lethargy (weakness/ fatigue)

Tachycardia (thready pulse)

Limp muscles

Orthostatic hypotension

seizures/ headache

stomach cramping (hyperactive bowels)

Hyponatremia Risk Factors:

Increased sodium excretion

4 D's

-diaphoresis (high fever)

-diarrhea & vomiting

-drains (NGT suction)

-diuretics (thiazide & loop diuretics)

SIADH

Adrenal insufficiency (adrenal crisis)

Inadequate sodium intake

-fasting, NPO, low-salt diet

-kidney disease

heart failure

Hyponatremia Interventions:

ADD SALT

Administer IV sodium chloride infusions (only if due to hypovolemia)

Diuretics (if due to hypervolemia) Hyponatremia-high fluids & low salt = hemodilution

Daily weights: where sodium goes, water flows

Safety (orthostatic hypotension AKA risk for falls)

Airway protection (NPO) Do not give food to a lethargic, confused client can lead to an increased risk for aspiration

Limit water intake: hypervolemic hyponatremia (high fluid & low salt)

Teach about foods high in sodium (canned food, packaged/ processed meats