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Electrolyte Imbalance

Electrolyte Imbalance

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Published by: nospekiko21 on Aug 08, 2010
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 Sodium:Sodium is the most abundant electrolyte in the ECF; its concentration ranges from 135 to 145 mEq/L(135 to 145 mmol/L) and it is the primary determinant of ECF volume and osmolality. Sodium has amajor role in controlling water distribution throughout the body, because it does not easily cross the cellwall membrane and because of its abundance and high concentration in the body. Sodium is regulatedby ADH, thirst, and the rennin-angiotensin-aldosterone system.Sodium also functions in establishing the electrochemical state necessary for muscle contraction and thetransmission of nerve impulses. Syndrome of inappropriate secretion of antidiurectic hormone (SIADH).Decrease in the circulating plasma osmolality, blood volume, or blood pressure, arginine vasopressin(AVP) is released from the posterior pituitary. Oversecretion of AVP can cause SIADH. Patients who areat risk are the elderly, those on mechanical ventilation, and people taking selective serotonin reuptakeinhibitors.Sodium imbalance can develop under simple or complex circumstances. The two most common sodiumimbalances are sodium deficit and sodium excess.Sodium Deficit (Hyponatremia):Hyponatremia refers to a serium sodium level that is less than 135 mEq/L. plasma sodium concentrationrepresents the ratio of total body sodium to total body water, Decrease in this ration can occur because
of low total body sodium with a lesser reduction in total body water. Hyponatremic state can besuperimposed on an existing FVD or FVE.2 types of sodium imbalance:Sodium deficit (hyponatremia) S/S:-
Anorexia, nausea and vomiting, headache, lethargy, dizziness, confusion, muscle cramps andweakness, muscular twitching, seizures, papilladema, dry skin, pulse, BP, weight gain,edema.Labs indicate:-
Serum sodium and urine sodium, urine specific gravity and osmolality.Sodium Excess (hypernatremia) S/S:-
Thirst, elevated body temperature, swollen dry tongue and sticky mucous membranes,hallucinations, lethargy, restlessness, irritability, focal or grand mal seizures, pulmonary edema,hyperreflexia, twitching, nausea, vomiting, anorexia, pulse, and BP.Labs Indicate-
Serum sodium, urine sodium, urine specific gravity and osmolality, CVP.Clinical Manifestations:Depend on the cause, magnitude, and speed with which the deficit occurs. Poor skin turgor, dry mucosa,headache, decreased saliva production, orthostatic fall in blood pressure, nausea, vomiting, andabdominal cramping occur. Neurologic changes, altered mental status, status epilepticus, and coma.Related to the cellular swelling, and cerebral edema associated with hyponatremia.Patients with an acute decreased in serum sodium levels have more cerebral edema and highermortality rates than do those with more slowly developing hyponatremia. Developing in less than 48hours, associated with brain herniation and compression of midbrain structures. Chronic decreases insodium, developing over 48 hours or more, can occur in status epilepticus and cerebral pontinemyelinolysis.Features of hyponatremia associated with sodium loss and water gain include anorexia, muscle cramps,and a feeling of exhaustion. The severity of symptoms increases with the degree of hyponatremia and

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