Hyponatremia and Hypernatremia Overview

Hyponatremia

• Low sodium level (< 135 mEq/L)
• Causes:
  • Inadequate sodium intake
  • Dilution of serum sodium
• Predisposing Conditions:
  • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
  • Hyperglycemia
  • Use of tap-water enemas
  • Irrigation of gastric tubes with water instead of normal saline
• Clinical Manifestations:
  • Low serum sodium levels
  • Low urine sodium levels
  • Low urine specific gravity
  • Low urine osmolality
• Management:
  • Fluid restriction
  • Loop diuretics
  • IV hypertonic saline
• Nursing Interventions:
  • Monitor fluid intake and output
  • Monitor weight
  • Assess level of consciousness
  • Provide safety and seizure precautions
  • Encourage foods and fluids high in sodium

Hypernatremia

• Sodium level (exceeding 145 mEq/L)
• Causes:
  • Decreased sodium excretion
    • Corticosteroids
    • Cushing’s syndrome
  • Increased water loss
    • Diabetes Insipidus
    • Watery diarrhea
  • Increased sodium intake
  • Movement of potassium from the ECF to ICF
  • Magnesium deficiency

Hypokalemia

• Low potassium level (< 3.5 mEq/L)
• Causes:
  • Inadequate potassium intake
  • Increased potassium loss
• Clinical Manifestations:
  • Muscle weakness
  • Fatigue
  • Cardiac dysrhythmias
  • Constipation
• Management:
  • Oral Potassium supplements
  • IV potassium replacement
• Nursing Interventions:
  • Place the patient on a cardiac monitor
  • Monitor cardiovascular, respiratory & neuromuscular function
  • Encourage intake of foods and fluids high in potassium
  • Observe for signs of metabolic alkalosis
  • Administer potassium only after adequate urine flow has been established
  • Assess for abdominal distention, pain, or GI bleeding

Hyperkalemia

• Potassium Level (> 5.0 mEq/L)
• Causes:
  • Increased potassium intake
  • Decreased potassium excretion
• Clinical Manifestations:
  • Muscle weakness
  • Fatigue
  • Cardiac dysrhythmias
  • Nausea and vomiting
  • Diarrhea
• Management:
  • Restrict dietary potassium
  • Diuretics
  • IV calcium gluconate
  • Sodium polystyrene sulfonate (Kayexalate)
• Nursing Interventions:
  • Monitor ECG closely
  • Avoid potassium-sparing diuretics
  • Monitor I&O

Hypomagnesemia

• Low magnesium level (< 1.5 mEq/L)
• Causes:
  • Inadequate magnesium intake
  • Increased magnesium loss
• Clinical Manifestations:
  • Muscle weakness
  • Fatigue
  • Tremors
  • Seizures
  • Cardiac dysrhythmias
• Management:
  • Magnesium sulfate (IM)
  • Magnesium hydroxide (PO)
  • Magnesium-based antacids
• Nursing Interventions:
  • Monitor for signs of digoxin intoxication
  • Monitor status of airway and swallowing
  • Assess level of consciousness
  • Provide quiet environment
  • Auscultate bowel sounds
  • Encourage intake of dairy products and green leafy vegetables

Hypermagnesemia

• High magnesium level (> 2.5 mEq/L)
• Causes:
  • Reduced renal function
  • Excessive intake or absorption
• Clinical Manifestations:
  • Nausea and vomiting
  • Muscle weakness
  • Drowsiness
  • Bradycardia
  • Hypotension
• Management:
  • Stop magnesium administration
  • Diuretics
  • IV calcium gluconate
  • Dialysis
• Nursing Interventions:
  • Monitor vital signs
  • Assess for signs of heart block
  • Monitor intake and output

Hypophosphatemia

• Low phosphate level (< 2.5 mg/dL)
• Causes:
  • Inadequate phosphate intake
  • Increased phosphate loss
• Clinical Manifestations:
  • Muscle weakness
  • Fatigue
  • Bone pain
  • Respiratory failure
  • Rhabdomyolysis
• Management:
  • Oral phosphate supplements
  • IV phosphate replacement
• Nursing Interventions:
  • Monitor serum phosphorus levels
  • Encourage intake of foods high in phosphate
  • Prevent infection

Hyperphosphatemia

• High phosphate level (> 4.5 mg/dL)
• Causes:
  • Renal failure
  • Chemotherapy
  • Hypoparathyroidism
  • Respiratory acidosis or DKA
  • High phosphate intake
  • Profound muscle necrosis
  • Increased phosphorus absorption
• Clinical Manifestations:
  • Tetany
  • Anorexia
  • Nausea
  • Vomiting
  • Muscle weakness
  • Hyperreflexia
  • Tachycardia
  • Decrease urine output
  • Impaired vision
  • Palpitations
• Management:
  • Treatment of underlying disorder
  • Phosphate binders
  • Dialysis
• Nursing Interventions:
  • Monitor serum phosphorus levels
  • Restrict dietary phosphate
  • Encourage fluid intake

Acid-Base Imbalances

• Normal Values
  • pH: 7.35 to 7.45
  • PaCO2: 38-42 mm hg
• Mixed Acid-Based Disorders
  • Patients can simultaneously experience two or more independent acid–base disorders
  • Normal pH in the presence of changes in the PaCO2 and plasma HCO3 concentration immediately suggest mixed disorder
• Compensation
  • Pulmonary and renal systems compensate for each other to return the pH to normal.
  • In a single acid–base disorder, the system not causing the problem will try to compensate by returning the ratio of HCO3 to carbonic acid to the normal 20:1.
  • The lungs compensate for metabolic disturbances by changing CO2 excretion.
  • The kidneys compensate for respiratory disturbances by altering bicarbonate retention and H+ secretion.

This quiz covers the essential concepts of Hyponatremia and Hypernatremia, including their causes, clinical manifestations, and management strategies. It also highlights nursing interventions crucial for patient care in these conditions. Test your knowledge on sodium imbalances and improve your understanding of how to manage them effectively.