Hyper/Hyponatremia and Treatments?

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  • by NYCRN6
    Specializes in Oncology, Dermatology, Cardiology.

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

155 Posts

Specializes in Emergency.
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

88 Posts

Specializes in Oncology, Dermatology, Cardiology.

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

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

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

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

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

celclt

274 Posts

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!

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