Sodium

 Normal serum level 136-145

 Greatest concentration in ECF (plasma, interstitial spaces)
 Affects skeletal muscle contraction
 Affects cardiac contractions
 Affects nerve impulse transmission
 Normal ECF osmolarity
 Normal ECF volume
 Balance regulated by the kidneys under influence of Aldosterone, ADH, and NP

Hyponatremia less than 136

Causes: excessive sweating, diuretics, wound drainage (esp. GI), Decreased Aldosterone
secretion, hyperlipidemia, renal disease, NPO, low salt diet,

Relative hyponatremia due to dilution of serum sodium (excess hypotonic fluids, freshwater
drowning, CHF)

Maybe hyponatremia with excess fluid or without excess fluid—different symptoms/treatment

**CNS is main system to assess with hyponatremia (due to cerebral edema, increased
intracranial pressure)

**If occurs with hypovolemia, IV saline given (0.9NS, up to 2% NS or 3%)

**If occurs with hypervolemia, give osmotic diuretics (Mannitol)

**If hyponatremia caused by excess ADH secretion, give Lithium and Declomycin
(demeclocycline)

**Increase oral intake of Sodium

Hypernatremia greater than 145

**Altered cerebral function is most commom problem

**Irritability: excitable tissues overrespond to stimuli

**Give water, and low sodium diet

**If hypernatremia with fluid loss, give Hypotonic IVFs (0.25 NS or 0.45NS)

**If hypernatremia with fluid/sodium loss, give Isotonic IVFs (NS)

**If caused by poor renal excretion of Na+, give diuretics that pull sodium (Lasix, Bumex)
System Hyponatremia Hypernatremia
Cardiac **Normovolemic—Rapid --Decreased myocardial
pulse, normal BP contractility
**Hypovolemic—weak, --Diminished cardiac output
thread pulse, hypotension, low --HR and BP respond to blood
CVP, flat neck veins in supine volume
**Hypervolemic—rapid,
bounding pulse, CVP
elevated, BP normal or
elevated
Respiratory Late: shallow resp, If hypervolemic, problems
Pulmonary edema: moist associated with Pulmonary
crackles Edema
Neuromuscular --generalized weakness Early: muscle twitching
--diminished deep tendon irregular contractions
reflexes Late: muscle weakness
Diminished or absent deep
tendon reflexes
Cerebral personality changes, headache normo/hypovolemia:
Increased neural activity
agitation, confusion, seizures
hypervolemia:decreased
neural activity
lethargy, stupor, coma
GI increased motility
nausea
hyperactive BS
Diarrhea
Renal Increased urine output Decreased urine output
Decreased specific gravity Increased specific gravity
Integumentary Dry, flaky skin
presence or absence of edema
depending on fluid volume
changes