Hyponatremia(low serum sodium)
may result from
- a loss of sodium containing fluids
- water excess in relation to the amount of sodium (dilutional hyponatremia)
- a combination of both
- Common causes of hyponatremia from loss of sodium-rich body fluids include:
- draining wounds, diarrhea, vomiting, and primary adrenal insufficiency.
- Inappropriate use of sodium-free or hypotonic IV fluids causes hyponatremia from water excess ; may occur in patients after surgery or major trauma, or if we give fluids to patients with renal failure.
- Patients with psychiatric disorders (having an excess water intake)
- SIADH (dilutional hyponatremia caused by abnormal retention of water)
Clinical Manifestations
manifestations are due to cellular swelling and first appear in the central nervous system (CNS).
- Mild hyponatremia :minor, nonspecific neurologic symptoms: headache irritability, and difficulty concentrating.
- More severe hyponatremia can cause confusion, vomiting, seizures, and even coma. If hyponatremia is severe and develops rapidly, irreversible neurologic damage or death from brain herniation can occur.
Nursing Diagnoses :
- Electrolyte imbalance
- Risk for injury
- Acute confusion
- Potential complication: seizures and coma
Nursing Implementation
:
Managing hyponatremia from fluid loss includes :
Managing hyponatremia from fluid loss includes :
- replacing fluid (using isotonic sodium-containing solutions,
- encouraging oral intake
- withholding all diuretics
- fluid restriction may be the only treatment.
- Loop diuretics and demeclocycline may be given.
- small amounts of IV hypertonic saline solution (3% sodium chloride) can restore the serum sodium level while the body is returning to a normal water balance.
- Vasopressor receptor antagonists (drugs that block the activity of ADH) are used to treat patients who cannot tolerate fluid restrictions or have more severe symptoms. eg conivaptan (Vaprisol) and tolvaptan (Samsca). Conivaptan is given IV to hospitalized patients with severe hyponatremia from water excess. Tolvaptan is given orally to treat hyponatremia from heart failure or SIADH. Monitor serum sodium levels and the patient’s response to therapy.
- Avoid rapid correction or overcorrection. The level should not increase by more than 6 to 12 mEq/L per hour in the first 24 hours and 18 mEq/L or less per hour within 48 hours.
- Quickly increasing sodium levels can cause osmotic demyelination syndrome with permanent damage to nerve cells in the brain.
- An accurate urine output record is essential.
- a urinary catheter placed if unable to help with monitoring output.
- If the patient has an altered sensorium or is having seizures, initiate seizure precautions.
MCQ. Nick has had surgery and is having post op oedema. Which solution would you expect, as the nurse, to see being used for Nick?
A) Isotonic
b) Hypertonic
C) Hypotonic
D) Normal Saline
references :
Lewis's Medical-Surgical Nursing