Hyper/Hyponatremia and Treatments?

[NYCRN6]

Does anyone have a good way of remembering Hyper/Hypo natremia... what causes these (increased/decreased water in body) and how to treat it? This is always so confusing to me. Please let me know thank you!

[wlb06]

Does anyone have a good way of remembering Hyper/Hypo natremia... what causes these (increased/decreased water in body) and how to treat it? This is always so confusing to me. Please let me know thank you!

Hyper = too much (energy) or sodium in this case

natremia = Na + is sodium so Natremia or Kalemia k+ is potassium

hypervolemia is an increased amount of extracellular fluid or volume (volemia)

lots of causes..i could go there, but I think Ive done my part, someone else can cover that for ya :)

[NYCRN6]

I have been a nurse on a cardiac floor for 1 1/2 years lol I knew all that already lol

What I should have said was... what are the causes of Hypo/Hypernatremia. I thought it was the less water in your body the higher level of NA woudl be.... however I see differences and I get confused. I know NA is eliminated/excreted in different ways such as sweating/fecal matter/vomitting.... but how can i have a bulleted way of thinking?

Low NA Hypervolemic =?

Low NA Hypovolemic = ?

High NA Hypervolemic = ?

High NA Hypovolemic = ?

There is a website that describes this but it is kind of confusing.

Also i know that with a Hyponatremia you want to HOLD fluids not give them. Which makes me think okay then there is too much water in the body. (Concentrated w/ water) I know with Hypernatremia you want to encourage PO fluids and probably give some kind of solution I think it would be a Hypertonic solution (Which would shift the NA fro intracellular to extracellular). Am i getting this right?!?!

It's the damn IVF that are messin me up too! Anyways please someone help a sista out. Thanks!

[Daytonite, BSN, RN]

sodium is a major cation in the extracellular space. it promotes neuromuscular function and reflects the balance between dietary sodium intake and renal excretion.

causes of hypernatremia:

• increased sodium intake:
  
  • excessive dietary intake of sodium or water
    
  • excessive saline in iv therapy
    
  • excessive infusion of isotonic iv solutions
    

  [*]decreased sodium loss:

  • cushing's syndrome
    
  • hyperaldosteronism
    
  • decreased water output due to renal disease
    

  [*]excessive body water loss:

  • excessive sweating
    
  • extensive burns
    
  • dehydration
    
  • diabetes insipidus
    
  • osmotic diuresis
    

  [*]other causes of increased water:

  • azotemia
    
  • heart failure
    
  • pulmonary edema
    
  • lactic acidosis
    
  • long term administration of adrenocortidal hormones

symptoms of hypernatremia are symptoms of overhydration:

• elevated blood pressure (hypertension)
  
• elevated pulse (tachycardia)
  
• elevated temperature
  
• elevated respiratory rate, possible dyspnea
  
• increased body weight
  
• bounding peripheral pulses
  
• moist mucous membranes
  
• moist respiratory secretions
  
• crackles in lungs on auscultation
  
• fever
  
• edema (may be pitting)
  
• dry skin
  
• thirst
  
• weakness
  
• restlessness/agitation
  
• disorientation
  
• delusions
  
• hallucinations
  
• lethargic when undisturbed
  
• irritable when stimulated
  
• muscle irritability
  
• diminished or absent dtrs
  
• high pitched cry in infants
  
• seizures - complication of this condition
  
• coma (due to swelling of brain cells) - complication of this condition
  
• respiratory arrest due to increased osmotic pressure

medical treatment: treat the underlying cause, sodium restriction, stop the drugs promoting sodium retention, d/c ivs with saline

causes of hyponatremia:

• decreased sodium intake:
  
  • insufficient dietary intake
    
  • deficient sodium in iv fluids
    
  • n/g feeding with inadequate fluid
    

  [*]increased sodium loss:

  • addison's disease
    
  • fever
    
  • diarrhea
    
  • vomiting
    
  • excessive use of diuretics
    
  • chronic renal insufficiency
    
  • nephrotic syndrome
    

  [*]excessive body water gains:

  • excessive oral intake
    
  • excessive iv water intake
    
  • chf
    
  • siadh (syndrome of inappropriate secretion of adh)
    
  • osmotic dilution
    

  [*]third-space losses of sodium:

  • ascites
    
  • peripheral edema
    
  • pleural effusion
    
  • ileus or mechanical bowel obstruction
    
  • hidden fluid in body cavities

symptoms of hyponatremia are similar to some of the symptoms of dehydration:

• increased pulse (tachycardia)
  
• weak, thready peripheral pulses
  
• flat neck veins
  
• increased respiratory rate
  
• decreased blood pressure (hypotension)
  
• decreased body weight
  
• thick, slurred speech
  
• anorexia
  
• nausea/vomiting/abdominal cramps
  
• oliguria
  
• anuria
  
• lethargy/malaise
  
• headache
  
• confusion
  
• muscular twitching
  
• seizures - complication of this condition
  
• coma - complication of this condition
  
• respiratory arrest

medical treatment: treat the underlying cause, fluid restriction, high sodium diet, oral sodium supplements, ivs with normal saline or hypertonic saline solutions, administration of demeclocycline or lithium

[Daytonite, BSN, RN]

see this sticky post on the pathophysiology/ a & p/ microbiology/ fluid & electrolyte resources forum: https://allnurses.com/forums/2016228-post24.html

[celclt]

salt follows water- if you can get a handle on osmolarity/fluid volume-- it will help you IMMENSELY with so many processes/ diseases-- the anatomy posts above are great- get it down to the anatomy/chemistry basics and build up from there!