Understanding Hypernatremia: High Sodium Levels

• Sodium is a major electrolyte found in ECF (extracellular fluid).
• Sodium is essential for acid-base balance, fluid balance, active and passive transport mechanism, irritability and conduction of nerve-muscle tissue.
• The normal sodium range is 135-145 mEq/L.

Hypernatremia

• Hypernatremia occurs when sodium levels are greater than 145 mEq/L.
• Signs and symptoms of hypernatremia include flushed skin, restlessness, anxiety, confusion, irritability, increased BP and fluid retention, edema (pitting), and decreased urine output.
• Other signs and symptoms include skin flushed and dry, agitation, low-grade fever, and thirst (dry mucous membranes).
• Risk factors for hypernatremia include increased sodium intake, excess oral sodium ingestion, excess administration of IV fluids with sodium, and hypertonic IV fluids.
• Other risk factors include loss of fluids, fever, watery diarrhea, diabetes insipidus, excessive diaphoresis, and infection.
• Decreased sodium excretion and kidney problems are other risk factors.
• Hemoconcentration results in increased sodium.

Hyponatremia

• Hyponatremia occurs when sodium levels are less than 135 mEq/L.
• Hypovolemic hyponatremia occurs with a decrease in fluid and sodium.
• Signs and symptoms of hypovolemic hyponatremia include stupor/coma, anorexia (nausea/vomiting), lethargy (weakness/fatigue), and tachycardia (thready pulse).
• Hypervolemic hyponatremia occurs with an increase in body water that is greater than sodium.
• Signs and symptoms of hypervolemic hyponatremia include limp muscles (muscle weakness), orthostatic hypotension, seizures/headache, and stomach cramping (hyperactive bowels).
• Risk factors for hyponatremia include increased sodium excretion.
• The "4 D's" of increased sodium excretion are diaphoresis (ex: high fever), diarrhea and vomiting, drains (NGT suction), and diuretics (thiazide and loop diuretics).
• Other risk factors include SIADH, adrenal insufficiency (adrenal crisis), and inadequate sodium intake such as fasting, NPO, and low-salt diet.
• Kidney disease and heart failure are also risk factors.

Management

• Management acronym is ADD SALT
• Administer IV sodium chloride infusions only if due to hypovolemia.
• Give diuretics if due to hypervolemia.
• Hyponatremia can lead to high fluids and low salt, resulting in hemodilution.
• Complete daily weights, remember where sodium goes, water flows.
• Ensure safety to avoid orthostatic hypotension and risk for falls.
• Provide airway protection and do not give food to a lethargic or confused client due to increased risk for aspiration
• Limit water intake in hypervolemic hyponatremia (high fluid & low salt).
• Teach about foods high in sodium, like canned food, packaged/processed meats, etc.
• If hyponatremia is due to fluid loss, administer IV infusions.
• If the cause is inadequate renal excretion of sodium, give diuretics that promote sodium loss.
• Restrict sodium and fluid intake as prescribed.

Learn about hypernatremia, a condition characterized by elevated sodium levels (above 145 mEq/L). Explore its causes, including increased sodium intake and fluid loss. Recognize key signs and symptoms like flushed skin, confusion and decreased urine output.