sodium.docx

Sodium is the body’s most common extracellular electrolyte. supports proper neurologic and neuromuscular function. regulates the body’s fluid balance. helps maintain blood pressure. -ingested into the body through food and drinks -excreted primarily through urine and sweat. The RDA for sodium is les...

Sodium is the body’s most common extracellular electrolyte. supports proper neurologic and neuromuscular function. regulates the body’s fluid balance. helps maintain blood pressure. -ingested into the body through food and drinks -excreted primarily through urine and sweat. The RDA for sodium is less than 2,300 mg per day, or approximately 1 teaspoon. The expected reference range of sodium is 136 to145 mEq/L. Hyponatremia occurs when levels of sodium fall below 136 mEq/L. Critical values occur at less than 120 mEq/L. Hypernatremia occurs when the sodium level exceeds 145 mEq/L, and critical values occur at levels greater than 160 mEq/L.  Multiple factors can place a client at risk for developing hyponatremia Medications Chronic or severe vomiting or diarrhea Drinking excess amounts of water Excess alcohol intake Heart, kidney, and liver problems Severe burns Excess water in the body—rather than a lack of sodium—is the most common cause of hyponatremia, as the presence of too much water dilutes the sodium level. This can occur because of drinking too much water. Thiazide diuretics are the medications that most commonly result in hyponatremia, as they cause loss of sodium through urinary loss. GI losses can occur with prolonged diarrhea or vomiting. Diseases such as heart failure and cirrhosis lead to increased retention of fluid in the body, which dilutes sodium, while certain kidney conditions can lead to excess excretion of sodium. Manifestations such as nausea and a feeling of general unwellness can occur with even mild hyponatremia. The neurologic manifestations are related to fluid shifts in the brain, which lead to cerebral edema. Moderate hyponatremia often manifests first with lethargy and confusion. Other neurologic changes may include headache, restlessness, and irritability. As hyponatremia becomes more severe, muscle twitching, further decreases in level of consciousness, seizures, and coma can occur. If hyponatremia is not reversed, a client can become unrousable, and death can occur. Routine serum electrolyte tests—either BMP or CMP—are used to measure the level of sodium and water in the blood. The provider may also prescribe a urinalysis to determine how much sodium is being excreted. FOODS HIGH IN SODIUM Roasted ham Shrimp-frozen, non-breaded Shrimp (fresh) Canned soup Frozen pizza Vegetable juice Cottage cheese Instant/Regular vanilla pudding Treatment of hyponatremia begins with identifying the underlying cause and determining the level of sodium deficiency. It is important to raise sodium levels slowly to prevent further neurologic complications. If the cause of the low sodium level is related to excessive water intake or an alteration in fluid balance, the treatment may include fluid restriction to correct the dilutional effect of too much body water. If the cause is related to sodium and fluid losses, IV fluids are administered to restore sodium and water balance. If the hyponatremia is caused by medications, these therapies may be modified or discontinued. If the hyponatremia results from a disease, such as heart failure or cirrhosis, the client’s treatment may need to be changed. If a client’s hyponatremia is caused by excess water intake, treatment should also include education. Along with the manifestations of hyponatremia, the nurse should educate on the client on the following measures: Drink water in moderation. Check urine for a pale, yellow color to indicate adequate hydration. Discuss with the provider the need to consume sports drinks with electrolytes. Use thirst as an indicator as to whether or not drinking water is necessary Hypernatremia may result from too little water, too much sodium, or a combination of the two. Excessive sodium levels will result in neurologic manifestations. Hypernatremia can occur from the following causes: Loss of body water Medications Gastroenteritis Vomiting Prolonged suction Burns Excessive sweating Chronic kidney disease Diabetes Impaired thirst response Loss of body water is the most common cause of hypernatremia. As water is removed from the body, dehydration occurs, which stimulates the thirst response. Dehydration is diagnosed most often in infants and older adults due to their inability to communicate the thirst response or diminished thirst response (in older adults). High sodium levels result in manifestations like in hyponatremia: confusion, lethargy, and irritability. Severe = muscle twitching and further changes in level of conscious with seizures and coma can occur. If not corrected, hypernatremia will eventually lead to death. Hypernatremia is diagnosed by evaluation of a BMP or CMP. A plasma osmolality test can also be performed, which will indicate elevated blood viscosity above the expected reference level of 295 mOsm/kg. Treatment for hypernatremia includes identifying the cause and initiating intravenous fluid replacement containing water and a small amount of sodium. It is important to decrease the sodium level slowly to prevent cerebral edema. Teach about foods that have a high sodium content.