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Sodium Imbalance
When sodium levels get out of whack
| Question | Answer |
|---|---|
| Accounts for 90% of extracellular cations | Sodium |
| Most abundant extracellular solute | Sodium |
| What is the normal serum level for sodium? | 135 to 145 mEq/L |
| What is the normal amount of sodium inside a cell? | 10 mEq/L |
| What are the functions of sodium? | maintain the right extracellular fluid osmolality (concentration), fluid volume, and fluid distribution throughout the body; transmit impulses in nerve and muscle fibers; regulate acid –base balance in conjunction with chloride and bicarbonate. |
| American diets include at least 6 g/day of salt when we only need between 0.5 – 2.7 g/day. Why haven’t we turned into pillars of salt? | The more we take in the more the kidneys excrete. |
| Name 2 sources (other than urine) of sodium loss. | Sweat and GI tract |
| Sodium’s constant companion | Water |
| Ain’t Draining H20 | ADH (antidiuretic hormone) |
| What steps does the body take to restore correct serum osmolality when it rises to more than 300 mOsm/kg (too much sodium)? | Thirst/increased fluid intake; ADH/less peeing; aldosterone/more sodium and water reabsorption in the kidneys |
| What steps does the body take to correct serum osmolality when it falls to less than 280 mOsm/kg (too little sodium)? | Thirst diminishes; ADH suppressed; more pee |
| Sodium is more abundant outside cells and potassium is more abundant inside cells. Since ions usually move from an area of higher concentration to an area of lower, why doesn’t sodium flow in and potassium flow out of cells? | Sodium potassium pump works to maintain the proper concentration. |
| Give two functions of the sodium potassium pump. | creates an electrical charge necessary for neuromuscular impulse transmission and prevents cellular swelling due to influx of sodium and water |
| Three things needed for the sodium potassium pump to work | ATP, magnesium, and an enzyme |
| Refers to a deficiency of sodium in relation to the amount of water in the body | hyponatremia |
| What happens to the fluid in cells and to the fluid in blood vessels in an environment of hyponatremia? | The fluid is drawn out of the vessels into the cells. |
| What dangerous conditions could develop if fluid moves from the blood vessels to the cells? | cerebral edema and hypovolemia |
| What are the potential hazards of severe hyponatremia? | seizures, coma, and permanent neurological damage |
| Results from sodium loss or water gain | dilutional hyponatremia |
| Results from inadequate sodium intake | depletional hyponatremia |
| Both sodium and water levels decrease in extracellular fluid, especially sodium | hypovolemic hyponatremia |
| Which type of hyponatremia is mainly due to decreased sodium levels | hypovolemic hyponatremia |
| What are the renal causes of hypovolemic hyponatremia? | osmotic diuresis, salt-losing nephritis, adrenal insufficiency, and diuretic use |
| Which type of hyponatremia can be caused by osmotic diuresis, salt-losing nephritis, adrenal insufficiency, or diuretic use? | hypovolemic hyponatremia |
| Which type of hyponatremia can be caused by vomiting, diarrhea, fistulas, gastric suctioning, excessive sweating, cystic fibrosis, burns, or wound drainage? | Hypovolemic hyponatremia |
| What are the renal causes of hypovolemic hyponatremia? | osmotic diuresis, salt-losing nephritis, adrenal insufficiency, and diuretic use |
| What are some potential non-renal causes of hypovolemic hyponatremia? | vomiting, diarrhea, fistulas, gastric suctioning, excessive sweating, cystic fibrosis, burns, or wound drainage |
| What sodium/water levels are characteristic of hypovolemic hyponatremia? | decreased sodium and water levels, but mostly decreased sodium level |
| Sodium slips lower | Hypovolemic hyponatremia |
| Water waxes higher | Hypervolemic hyponatremia |
| Both water and sodium levels increase but water gain is higher | hypervolemic hyponatremia |
| What is the cause of edema associated with hypervolemic hyponatremia? | The serum sodium levels are diluted by the extra water causing the extracellular solution to be hypotonic to the intracellular volume. |
| Name five potential causes of hypervolemic hyponatremia. | heart failure, nephrotic syndrome, excessive administration of hypotonic I. V. fluids, and hyperaldosteronism |
| Which type of hyponatremia could be caused by heart failure, nephrotic syndrome, excessive administration of hypotonic IV fluids, or hyperaldosteronism? | hypervolemic hyponatremia |
| Sodium levels appear low but no signs of fluid volume excess and total body sodium levels remain stable | Isovolemic hyponatremia |
| Water rises alone | isovolemic hyponatremia |
| Causes include glucocorticoid deficiency, hypothyroidism, renal failure, and SIADH | Isovolemic hyponatremia |
| SIADH | syndrome of inappropriate ADH (excessive ADH) |
| ADH is released when the body doesn’t need it. | SIADH |
| What is the result of SIADH? | water retention and sodium excretion |
| Can be caused by cancers of the duodenum or pancreas and oat cell carcinoma of the lung | SIADH |
| Can be caused by CNS disorders like trauma , tumors, or stroke and pulmonary disorders like tumors, asthma, or COPD | SIADH |
| Can be caused by medications like certain oral antibiotics, chemotherapeutic drugs, psychoactive drugs, diuretics, synthetic hormones, and barbiturates | SIADH |
| How is a patient with isovolemic hyponatremia due to SIADH treated? | first the underlying cause of SIADH is addressed then the hyponatremia |
| How are low sodium levels treated initially? | fluid restriction (about 1 l/day) and diuretics |
| What are fluid restrictions matched to for a patient with SIADH and why? | the lowered urine volume so that serum osmolality increases, causing the ADH level to balance it |
| If fluid restriction does not correct the problem created by SIADH, what other treatments are available? | oral urea, high salt diet, medications like demeclocycline or lithium, and lastly hypertonic saline solution |
| How do demeclocyline and lithium work to correct hyponatremia caused by SIADH? | by blocking ADH in the kidney tubule |
| What happens to the kidney tubules if the body makes too much ADH? | Permeability increase |
| What is the result of increased permeability of kidney tubules? | increased water retention and extracellular fluid volume |
| What effect does increased water retention and extracellular fluid volume have on plasma osmolality, serum sodium levels, glomerular filtration rate, and aldosterone secretion? | Plasma osmolality decreases, sodium levels are diluted, glomerular filtration rate increases, aldosterone secretion is inhibited |
| What is the difference between sodium levels that drop gradually and sodium levels that drop quickly? | Patients will be more symptomatic if levels drop quickly. |
| What are the acute initial signs of hyponatremia? | nausea, vomiting, anorexia |
| At what serum sodium levels are acute initial signs of hyponatremia usually apparent? | between 115 mEq/L and 120 mEq/L |
| What system is primarily affected when sodium levels drop? | the neurologic system |
| What kind of neurologic symptoms of hyponatremia would we expect to see initially (7 things)? | headache, irritability, disorientation, muscle twitching, tremors, weakness, changes in LOC (shortened attention span progressing to lethargy and confusion) |
| When sodium levels drop to ______, the patient will probably suffer edema of the brain. | 110 mEq/L |
| What kind of signs and symptoms would be associated with edema of the brain? | stupor, delirium, psychosis, ataxia, possible coma and seizures |
| What signs would we see in the skin and mucous membranes of a patient with hypovolemia? | poor skin turgor; dry, cracked mucous membranes |
| What kind of vital signs would we expect to see in a patient with hypovolemia? | weak, rapid pulse; low BP; orthostatic hypotension |
| What kind of CVP, PAP, and PAWP measurements would a hypovolemic patient have? | decreased |
| What kind of hyponatremia would present with edema, hypertension, weight gain, rapid bounding pulse, and elevated CVP, PAP, and PAWP? | hypervolemic hyponatremia |
| What are the signs and symptoms of a patient with hypervolemic hyponatremia (7 things)? | edema, hypertension, weight gain, rapid bounding pulse, elevated CVP, PAP, PAWP |
| What would the serum osmolality look like for someone with hyponatremia? | less than 280 mOsm/kg |
| What would the serum sodium level look like for someone with hyponatremia? | less than 135 mEq/L |
| What would the urine specific gravity level look like for someone with hyponatremia? | < 1.010 |
| What would the hematocrit and plasma protein levels look like for someone with hyponatremia? | increased |
| What does the urine specific gravity and sodium levels look like in patients with SIADH? | increased urine specific gravity; Urine sodium levels above 20mEq/L |
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Perseverandovercome
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