question on Hypernatremia & how it relates to water

[MrsRNn2009]

sorry, i know this is the subject everyone asks about. this is my question & i have phoned other students and they seem as clueless as I.

I understand that Hypernatremia can be caused by:

1. too much Na intake

2. excessive water loss

3. not enough water intake

however, when a pt has hypernatremia does that mean

sodium gains leads to HYPERvolemia or HYPOvolemia??

*doesn't the excess in Na push the water out? or does the excess Na mean that the water will be excess to try & dilute it?

Help please, test is supposed to review Na and K and focus on Mg but i am confused on Na still. thanks:uhoh3:

[kgh31386, BSN, MSN, RN]

as you know, where Na goes, water goes. And if you have too much sodium, you're sucking the water out of the cells. and i'll go with a person will become Hypervolemic. because all the water gets forced into the interstitial spaces. and manifestations of hypovolemia are a decrease in BP. and as we all know if you have high sodium, you lead to hyPERtension, which is a FVE symptom.

[Daytonite, BSN, RN]

hypernatremia leads to hypervolemia. water follows sodium. so, in the case of hypernatremia you have a situation where people are retaining water. sodium is the major electrolyte in the extracellular fluid space. with potassium as the major electrolyte in the intracellular space, sodium and potassium continually shift in and out of the cells and the extracellular fluid (the sodium-potassium pump). other than that, sodium is kind of a namby-pamby electrolyte and by itself doesn't do much except attract water and hang out in the extracellular fluid. it's major functions are nerve conduction,neuromuscular function, glandular secretion and water balance. when sodium is out of whack you can see that those functions are disturbed by the signs and symptoms a person will display. the signs and symptoms of hypernatremia are:

• 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 (due to high sodium levels and high osmolarity stimulating the hypothalamus)
  
• weakness
  
• restlessness/agitation
  
• disorientation
  
• delusions
  
• hallucinations
  
• lethargic when undisturbed
  
• irritable when stimulated
  
• muscle irritability
  
• diminished or absent dtrs
  
• high pitched cry in infants
  
• seizures
  
• coma (due to swelling of brain cells)
  
• respiratory arrest due to increased osmotic pressure
  

[MrsRNn2009]

thanks to both of you. my test was today & luckily i found to good explanations of hyper/hyponatremia online & in the incredibly easy series for F&E. thanks for all of your help

[blue heeler]

thanks for the explanation, daytonite. it helps me understand.

[yoginurse2b]

Hi,

I know this might be a bit too late, but I just studied about hyper/hyponatremia, so I wanna give my two cents.

Hypernatremia can cause both hypovolemia and hypervolemia.

1) Hypernatremia + hypervolemia happens when you add both water and sodium, but add more sodium than water. This happens when you give hypertonic saline to your pt or pt has hyperadosteronism (remember increased aldosterone will cause increased sodium reabsorption, resulting hypernatremia; and sodium reabsorption causes water to passively follow it, thus causing hypervolemia)

2) Hypernatremia + hypovolemia happens when you lose both water and sodium, but lose more water than sodium. This happens when pt is getting diuretics because water loss is more than sodium loss. It also happens when pt is having diaphoresis or diarrhea, where excretion of water exceeds excretion of sodium. Or when pt is not drinking enough water. This condition also happens with diabetes insipidus where decrease ADH will decrase water reabsorption, thus increase urine output and leaves the serum more concentrated (hypernatremia)

Hope that helps.