Low Sodium? What are the dangers? What is the fix?

  1. 0 We have an 85 year old woman on the floor with pneumonia. She is not on any diuretics or anti-epileptic meds, no vomitting, no diarrhea. Her sodium continues to drop. A couple of days ago it was 126, then 123, yesterday 122. I told the nurse you need to call the doctor. She was like, well he was here this morning, he should have seen that sodium level. I said no "call". What are the dangers of having a low sodium level? What is usually done about it? Can you salt the patients food or is that too simplistic? She told me he ordered some urine testing and change the IV to NS. She had been on 1/2NS. The patient has a past hx of CHF.
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  3. Visit  DutchgirlRN profile page

    About DutchgirlRN

    DutchgirlRN has '33' year(s) of experience and specializes in 'OB, M/S, HH, Medical Imaging RN'. From 'Between a Rock & a Hard Place...'; 59 Years Old; Joined Aug '04; Posts: 6,698; Likes: 1,428.

    12 Comments so far...

  4. Visit  BBFRN profile page
    0
    Here's a good reference I found:

    http://www.postgradmed.com/issues/2000/05_00/fall.htm

    Hyponatremia and hypernatremia
    A systematic approach to causes and their correction
    Pamela J. Fall, MD
    VOL 107 / NO 5 / MAY 1, 2000 / POSTGRADUATE MEDICINE

    It was too much to post, but follow the link- I think it answers all of your questions.
  5. Visit  DutchgirlRN profile page
    0
    Quote from lgflamini
    Here's a good reference I found:

    http://www.postgradmed.com/issues/2000/05_00/fall.htm

    Hyponatremia and hypernatremia
    A systematic approach to causes and their correction
    Pamela J. Fall, MD
    VOL 107 / NO 5 / MAY 1, 2000 / POSTGRADUATE MEDICINE

    It was too much to post, but follow the link- I think it answers all of your questions.
    Thanks so much, great information. I will print this out and post it at work tomorrow.
  6. Visit  BBFRN profile page
    0
    No problem!
  7. Visit  kitty9898 profile page
    0
    Clinically, patients with low sodium can become confused as well as have a ton of other issues. Treatment depends on whats going on with the patient and the cause of the hyponatremia, but MD's will usually order a fluid restriction to treat the value.
    If I have a patient with an abnormall lab value like that, and am not sure if the MD is aware, I would check their note for the day. If the level is there, then I document in my note that the MD is aware. If the value is not there, I call the MD and document that they were told etc. You'd be surprised, i worked with some MD's who didn't know how or didn't want to use the computer and waited until the printed lab reports were placed in the chart, which could be a day or two later! Good Luck!
  8. Visit  schwalmys8862 profile page
    0
    Ive seen sodium as low as 116 and lower. If they have symptoms it is important ot get ahold of the doc now. Its a delicate balance with chf'ers and low sodium but you gotta treat the NA+. Just listen to lungs and watch for edema.
  9. Visit  dayshiftnurse profile page
    0
    sodium level and water go hand in hand--changes in salt levels are usually a change in the balance of water/fluid in the body. when i see low sodium i always think "CNS" and water intoxication. what happens if the serum has a low amount of sodium, there is no attaction to hold the water outside of the cell and then the water/fluid shifts INTO the cell which can cause the cell to burst. the main danger is if this happens in the brain, which of course will cause cns changes, dec. mentation, dec. LOC. hence, that is why in that case NS was ordered.

    however important considereations are CHF patients and renal patients who may have chronically low sodium and still have to be cautious with full strenth saline solutions.
  10. Visit  DONN profile page
    0
    Last pt. I had with lo NACL the DR ordered her to drink glasses of salt water thru the day. You can imagine how that went over with the pt.. I personally thought it would be better to order a "stat Ramen Noodles" because the sodium content is so high in those things. But what do I know........
  11. Visit  Tweety profile page
    0
    I knew a cardiologist who when you called him with hyponatremia he'd say "get them to eat a bag of chips and rechek the sodium level later this evening". So no, eating high sodium foods is not too simplistic, and might be helpful.

    I've seen 3% NS given often as well in patients with sodium as low as your patient.
  12. Visit  Tweety profile page
    0
    Quote from DONN
    Last pt. I had with lo NACL the DR ordered her to drink glasses of salt water thru the day. You can imagine how that went over with the pt.. I personally thought it would be better to order a "stat Ramen Noodles" because the sodium content is so high in those things. But what do I know........

    Gee, there is such a thing as NaCl tablets that patients can take. Yuck!
  13. Visit  myrianekes profile page
    0
    this is very simple, patient can go to dehydration, because salt retains fluid in the body, when salt is down, water will also go down.
  14. Visit  meownsmile profile page
    0
    You did say the doctor changed the iv fluids from 1/2 NS to NS. And i summize he reordered labs for the next morning? Was there a change in mental status? Did the patient have a fluid restriction placed and diet order was appropriate?
    Its a little difficult because we dont know WHY the patient was there but sometimes those things adjust themselves with the patients health status. So to prevent oversalting someone, as long as she isnt having any symptoms, see what the IV change does for her.
    Last edit by meownsmile on Jul 29, '06
  15. Visit  globalRN profile page
    0
    being on 1/2 ns when she is hyponatremic is part of the problem.
    that gives her more water than salt...last thing she needs.

    usually can correct low sodium that is not symptomatic and >121 with n/s iv, water restriction
    and some free salt in her food, salty broth soups , table salt , v8 juice etc


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