questions about sodium

[sandrakclev]

Hi - I'm a dialysis tech and have a few questions about sodium that I hope some of you will help me with. When I started in dialysis, I worked in a clinic that terminated sodium variation 30 minutes before the end of treatment. The clinic I work at now runs it all the way to the end. We also regularly give chicken broth to patients post-treatment to raise blood pressure (and we are instructed to mix it very strong). I saw on a previous post that sodium at or near the end of treatment can be dangerous to the patient - can someone give me more information about this? I'm thinking it sounds like it's an issue that needs to be raised in my clinic, but I'm having a difficult time finding information. Any information would be appreciated.

Thanks,

Sandra

[DeLana_RN, BSN, RN]

Sodium (Na) modeling is routinely used to help maintain a pt's BP during UF and to help prevent cramping; however, the nephrologist needs to order it for each pt because in some cases it's not appropriate. We usually hold it if the pt is very hypertensive.

If we do use Na modeling (for most pts), it tapers off during tx ("exponential"), although there are other options a machine may have. Therefore, a lot of sodium is added initally and very little near the end. However, some options may use a more linear approach (equal amounts are added throughout). In some cases, we may d/c Na modeling at our discretion - usually, due to increased hypertension (and sometimes, machine problems ).

As for giving salty soup or broth, this is sometimes given to bring up a pt's BP after tx; in my experience, it's not very effective, and can be time consuming (I learned long ago to give additional saline instead if the standing BP was too low after tx).

As for sodium being dangerous near or after tx, I have never heard of this.

HTH!

DeLana

[raihan]

hi. u should use sodium profile according to the condition of the patient.

[**nurse**]

We hold sodium (be it a hypertonic flush or sodium profile) the last hour of tx. The reasoning I have been told is that the extra sodium that last hour will send a patient out thirsty, they tend to drink and gain more if you do. I don't know that handing them crackers and broth for post hypertension gives them less sodium than that profile would, but I guess at post time we just want to be sure they don't fall and crack thier head or hip.