(Osborn, 2010)

By: Janel Canty RNS

Hyponatremia

ObjectivesTo understand HyponatremiaTo be able to recognize hyponatremia in a

clinical settingBe able to apply to identify what a medical

professionals would do with a patient with hyponatremia

(Osborn, 2010)

Pathophysiology of hyponatremia This is defined as sodium below the normal range that the human body requires for normal functioning. Sodium is the most numerous cation in the extracellular fluid, it maintains the volume through osmotic pressure, regulates acid-base balance, and conducts nerve impulses. When the sodium balance is off the exchange of electrons between molecules does not take place properly to conduct normal activities.

What is the range of sodium

concentration that the body would like?

Correct!135-145 mEq/L

(Osborn, 2010)

Most common CausesWater excess!Loss of sodium containing fluidsAce inhibitorsdiureticsvomitingdiarrheaRenal failure Syndrome of inappropriate

antidiuretic hormone

(Osborn, 2010)

Sign/SymptomsInitially

Headache, nausea, vomitingLater stages

Hyponatremic encephalopathy, cerebral edemaMay progress to

Hallucinations, lethargy, weakness, bradycardia, ataxia, respiratory depression, seizures, coma, or death

Patients may be asymptomatic

Haskal, 2007)

Prevalence30% of patients undergoing acute hospital

care15% of those patients have symptoms

One of the most common electrolyte disorders

(Haskal, 2007)

Laboratory test Urine osmolality

Determines if the kidneys are damaged and can’t dilute the urine Greater then 100 mOsm/kg

Serum osmolalityDetermines if it hyponatremia or another cause

that manifest the same as hyponatremiaUrinary sodium concentration

Determine if the hyponatremia is because of SIADH Greater then 20-40 mEq/l

(Osborn, 2010, medscape)

(Osborn, 2010)

What population is at risk?Everyone!

Affects all races the sameAffects both genders the sameHappens at any age

More likely in elderly because of decreased renal function

Prognosis In hospitalized patients

Increased association with adverse reactions Increased mortality

Severe hyponatremia (less than 105 mEq/L) High mortality rate

Over 50%

(Nursing central & medscape)

Interventions Immediately administer one boluses of

2ml/Kg of 3% NaCl IVConsider other conditions that can cause

hyponatremiaCorrect underlying cause

Assess for overcorrection of hyponatremia causing hypernatremia This could cause brain damage

A Bladder catheter should be inserted to monitor the water balance

(Overgaard-steensen, 2011)

Patient Scenario A 46 year old African American male arrived

at the emergency room on 9/15 complaining of vomiting for 1 week. Upon arrival the patient had a sodium level of 130 and was admitted for treatment of hyponatremia. Patient was tested and diagnosed with HIV after being admitted. Patient was given Amphotericin B from 9-16-2012 until 10-15-2012 to treat the HIV.

Interventions for the scenarioThe patient was given 3% NaCl IV 2ml/Kg

every 6 hours until Sodium levels were in normal range

Patient was started on Amphotericin B To treat underlying cause of HIV

Patient’s fluids were initially restricted to 1,000 Ml per day

Patient was on I&O’s

Scenario Outcome On 10-16-2012 the patient’s sodium serum

level was 138 mEq/lWithin normal range

(Osborn, 2010)

Nursing DiagnosisRisk for life-threatening cerebral edema R/T

fluid retention or low sodium AEB serum sodium of less than 135 mEq/L

(Osborn, 2010)

NCLEX!John came to the ED with a sodium level of

122 mEq/L and was treated with 3% NaCl IV. When you come to assess John you notice that his level of consciousness has declined. What is this most likely from?

A. Drug useB. Increasing the sodium levels too quicklyC. hypokalemiaD. infusing the NaCl too slowly

(Osborn, 2010)

Answer!John came to the ED with a sodium level of

125 mEq/L and was treated with 3% NaCl IV. When you come to assess John you notice that his level of consciousness has declined. What is this most likely from?

A. Drug useB. Increasing the sodium levels too

quicklyC. hypokalemiaD. infusing the NaCl too slowly

(Osborn, 2010)

Nclex The nurse is caring for a patient and has just

received the laboratory data report. Which of the following results cause the most concern?

A. Na+:115 mEq/LB. K+:4.0 mEq/LC.Ca+: 9 mg/dLD.Mg+: 2.0 mg/dL

Answer The nurse is caring for a patient and has just

received the laboratory data report. Which of the following results cause the most concern?

A. Na+:115 mEq/LB. K+:4.0 mEq/LC.Ca+: 9 mg/dLD.Mg+: 2.0 mg/dL

(Osborn, 2010)

(Osborn, 2010)

Questions??

(Osborn, 2010)

Work citedHaskal, R. (2007). Current issues of nurse

practitioners: hyponatremia , 563-576.Overgaard-steensen, C. (2011). Inital

approach to the hyponatremic patient , 139-145.

Osborn, W. W. (2010). Medical Surgical Nursing . New Jersey: Pearson.

Jensen, S. (2011). Nursing Health Assessment. Philadeplphia: Lippincott Williams and Wilkins. Nusing Central. (2012,05).