Hyponatremia with hypothermia

[kkeczely]

I had a patient who was homeless and brought into the ED after been found down. He has a history of ETOH abuse and this was his third admission in the last 3 months. His sodium was 119 and temp was 32.0 C upon arrival. I live in Arizona and the temperature is normally around 96 degrees at night. He had no ETOH and no drugs in his system at the time of this admission.

I am trying to understand the correlation of hypothermia and hyponatremia for this patient. Please help!

And the odd thing was, even after we gave him a banana bag and fluids, his temp barely went up. We even had a heated blanket on him.

[kcollins08]

With a hx of ETOH abuse, the hyponatremia may be as a result of cirrhosis of the liver...beer potomania could also go hand in hand with that (hyponatremia induced by massive consumptions of beer/dilute alcoholic beverages), although you did say he didn't have any ETOH or drugs in his system at the time. What did they do for a work up? Myxedema coma can have hyponatremia and also cause a decrease in your body temperature.

There IS an electrolyte shift in hypothermia - serum potassium usually decreases in the cool period and increases in the warming period, but in regards to hypothermia and it's correlation with sodium, I've read conflicting data on that - some have reported that serum sodium increases, some that it decreases. I'm guessing that in this case the hyponatremia caused the arrest and being down for so long, along with maybe underlying conditions, led to the hyponatremia?

[nurseprnRN, BSN, RN]

It's also always ok to have more than one thing wrong with you. :)

I'm betting on the hyponatremia being related to excess fluid intake/hepatorenal disease, and the hypothermia to his being out cold (as in, unconscious) outdoors. Even if it's 96degF outside, if he's lying on a concrete or damp surface he will lose body heat to it.

The banana bag and whatever else you gave him was at room temp, and if you're in AZ that's air-conditioned room temp, so I would be really, really surprised if it warmed him up. :) It probably stressed him physiologically even more, because now he had to warm up all that stuff inside his skin, too. Warm blankets don't add much heat to anyone. Were you sure to put hot water bottles under them, around his hands, feet, groin, axillae, and head, and cover his head? Give him hot sweet (real sugar) stuff to drink, no caffeine, put some real calories in there for him to work with?

Next time you have a hypothermic, think about running his fluids through a blood warmer. Be really careful, though, to keep a close eye on the monitor and draw labs often because rewarming can cause acidosis and that can cause K+ shifts and cardiac arrhythmias. Slowly, slowly, slowly.

[kcollins08]

:edit: In the last sentence of my first post, I meant led to the hypothermia

[Esme12, ASN, BSN, RN]

I have a thought.....I have seen hyponatremia and hypothermia in the presence of Ethylene glycol poisoning (anti-freeze)..being found face down and no drugs and alcohol.

Both acute and chronic alcohol consumption can compromise kidney function, particularly in conjunction with established liver disease. Alcohol-related changes in the structure and function of the kidneys and impairment in the ability to regulate the volume and composition of fluid and electrolytes in the body.

Chronic alcoholic patients may experience low blood concentrations of important electrolytes as well as potentially severe alterations in the body acid-base balance. Alcohol can disrupt the hormonal control mechanisms that govern kidney function.........chronic drinking has further detrimental effects on the kidneys, including impaired sodium and fluid handling and even acute kidney failure.