3% NS

GilaRRT · Feb 11, 2009

okay...GilaRN, you sound like you know a lot about this stuff...not my area of expertise, but since mental health patients do have medical problems it's nice to try to stay somewhat knowledgable about medical stuff....so let me try to understand......the low Na+ levels effect more of the neuro/brain symptoms and not the heart? So tele isn't needed? correct? Is there any monitoring that should be done during the running? (obviously other then just keeping an eye on the patient)-- electronic monitoring I guess I am wondering about.....
I am curious as in psych we now and then see patients with signigicantly low Na+ levels related to water toxicity.....they will drink gallon after gallon and lower the level by diluting the blood with all the water..... I have had a patient or two with this and we limited water, locked the bathroom, and put the patient on sodium tablets....didn't end up with the need for IV but could I suppose so it would be nice to know how to handle it and know if the patient should go to medicine for treatment or if we could do it with the proper monitoring. .........

Close monitoring to include tele and seizure precautions is warranted on these patients. Especially patients with neurological effects and an acute cause for the hyponatremia. Sodium can effect cardiac conduction; however, the brain is especially sensitive to sudden changes in sodium levels. Remember, if you have sodium, water will follow. The brain is surrounded in a case of bone. So, when cerebral edema occurs, the tissue has nowhere to go. This is part of what makes managing elevated ICP difficult. If you want to know more, research the Monroe-Kellie hypothesis of volumes and cerebral compensatory mechanisms.

In addition, cardiac function is closely related to most other body systems and processes. For example, the hyponatremic patient has a seizure. During the seizure, hypoxemia develops causing cardiac irritability. You note ventricular ectopy on the monitor because of the hypoxemia and tissue hypoxia. You see, all the body systems are connected and related. This is why any "critical" patient should be on tele or some type of continuous cardiac monitoring.

Regarding "water toxicity." Hyponatremia and the neurological effects are of primary concern with these patients.

Reno1978, BSN, RN · Feb 11, 2009

If the patient is symptomatic you can't wait for it to fix itself through diuresis and water restriction.

My point was that 125 is low, but usually not life threatening. In my experience, 3% NS is given only in critical cases...and from what I've seen, that usually means Na is somewhere in the 110s or lower. I wouldn't anticipate an order for 3% NS for an asymptomatic individual with Na of 125. In fact, I seem to recall that I gave 3% NS to my last severely hyponatremic patient only until his serum Na reached 125. From that point, the 3% NS was d/c'ed and Na increase was achieved through other interventions.

hypocaffeinemia, BSN, RN · Feb 11, 2009

My point was that 125 is low, but usually not life threatening. In my experience, 3% NS is given only in critical cases...and from what I've seen, that usually means Na is somewhere in the 110s or lower. I wouldn't anticipate an order for 3% NS for an asymptomatic individual with Na of 125. In fact, I seem to recall that I gave 3% NS to my last severely hyponatremic patient only until his serum Na reached 125. From that point, the 3% NS was d/c'ed and Na increase was achieved through other interventions.

I agree with you... I'm just saying that I've seen 3% given for a sodium of 127 before because the person was actively seizing. It makes a big difference how fast they became hyponatremic, it seems, and whether or not they manifested neuro symptoms. If it's chronically 125 they've likely compensated adequately.