PRAYER

Our Father, We thank you for being with us today and for all the
blessings. Lord bless our teachers and schoolmates. May we grow
also in your grace and knowledge and we humbly ask for your
forgiveness in our sin. Lord teach us to love you above all things.
Amen.
ELECTROLYTES IMBALANCES

MA. JASMINE D. DE LARA

BSN-2
HYPONATREMIA & HYPERNATREMIA
HYPONATREMIA
DEFINITION:

• Defined as a serum or plasma sodium less than 135 mEq/L. It is a

condition where sodium levels in the blood are lower than normal.
• Hyponatremia is one of the most commonly encountered electrolyte
disorders among both adults and children.
• Sodium is an essential electrolyte that helps maintain the balance of
water in and around your cells.
• Hyponatremia has sometimes been referred to as
“water intoxication” especially when it is due to the consumption
of excess water.
HYPONATREMIA
TYPES:

• Euvolemic Hyponatremia is where the water in the body increases but

the sodium stays the same.
• Hypovolemic Hyponatremia is where the patient has lost a lot of fluid
and sodium. 
• Hypervolemic Hyponatremia is where the body has increased in fluid
and sodium. However, sodium decreases due to dilution and because
total body water and sodium are regulated independently in the body. 
HYPONATREMIA
CAUSES/RISK FACTORS:
• The most common frequent cause of neonatal Hyponatremia is
hypovolemic dehydration.
• Certain medications
• Heart, kidney and liver problems
• Syndrome of Inappropriate Anti- Diuretic Hormone (SIADH)
• Chronic, severe vomiting or diarrhea
• Drinking too much water
• Hormonal changes
• The recreational drug ecstasy
HYPONATREMIA
INCIDENCE:

• The prevalence of hyponatremia is lower in the ambulatory setting. The

US armed forces reported 1579 incident diagnoses
of exertional hyponatremia among active \service members from 2003
through 2018, for a crude overall incidence rate of 7.2 cases per
100,000 person-years.
HYPONATREMIA
PATHOPHYSIOLOGY:

• Plasma osmolality has a role in the pathophysiology of hyponatremia. Osmolality refers

to the total concentration of solutes in water. Effective osmolality is the osmotic gradient
created by solutes that do not cross the cell membrane. Effective osmolality determines
the osmotic pressure and the flow of water.Plasma osmolality is maintained by strict
regulation of the arginine vasopressin (also called antidiuretic hormone [ADH]) system
and thirst. If plasma osmolality increases, ADH is secreted and water is retained by the
kidneys, thus decreasing serum osmolality. If plasma osmolality decreases, ADH also
decreases, resulting in diuresis of free water and a return to homeostasis.
HYPONATREMIA
DIAGNOSTIC EVALUATION/TEST OF THE DISEASE

• There are three essential laboratory tests in the evaluation of patients.

with hyponatremia that, together with the history and physical
examinationn, help to establish the primary underlying etiologic
mechanism: urine osmolality, serum osmolality and urinary sodium
concentration.
HYPONATREMIA
SIGNS& SYMPTOMS

• Nausea and vomiting

• Headache
• Confusion
• Loss of energy, drowsiness and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps
• Seizures
• Coma
HYPONATREMIA
MEDICAL MANAGEMENT:

• In general, hyponatremia is treated with fluid restriction (in the setting

of euvolemia), isotonic saline (in hypovolemia), and diuresis (in
hypervolemia). A combination of these therapies may be needed
based on the presentation. Hypertonic saline is used to treat severe
symptomatic hyponatremia. Medications such as vaptans may have a
role in the treatment of euvolemic and hypervolemic hyponatremia.
The treatment of hypernatremia involves correcting the underlying
cause and correcting the free water deficit.
HYPONATREMIA
NURSING MANAGEMENT:

• Keep in mind that misuse of hypertonic saline can be extremely dangerous.

• Closely monitor intake and output. Assess for changes in level of
consciousness and monitor for seizure activity.
• Educate the patient and family about the role of sodium in the body and
what a low blood level means. If fluid intake is restricted, tell the patient
how much water he or she can drink and formulate a plan for spreading out
intake during the day.
HYPERNATREMIA
HYPERNATREMIA
DEFINITION:

• Is the medical term used to describe having too much sodium in the blood. Sodium is an
important nutrient for proper functioning of the body. Most of the body’s sodium is
found in the blood. It’s also a necessary part of the body’s lymph fluids and cells.
• Occurs when the serum sodium concentration is higher than 145 milliequivalents per
liter (mEq/l).
HYPERNATREMIA
CAUSES

• Hypernatremia is usually caused by limited access to water or an

impaired thirst mechanism and less commonly by diabetes insipidus.
HYPERNATREMIA
RISK FACTORS:

Risk factors for Hypernatremia include the following:

• Advanced age
• Mental or physical impairment
• Uncontrolled diabetes (solute diuresis)
• Underlying polyuria disorders
• Diuretic therapy
HYPERNATREMIA
INCIDENCE:

• Occurs in approximately 1% of hospitalized patients. The condition usually develops after

hospital admission. An incidence closer to 2% has been reported in debilitated elderly
persons and in breastfed infants.
HYPERNATREMIA
PATHOPHYSIOLOGY:

• When hypernatremia (of any etiology) occurs, cells become dehydrated. Either the

osmotic load of the increased sodium acts to extract water from the cells or a portion of
the burden of the body's free water deficit is borne by the cell.
HYPERNATREMIA
DIAGNOSTIC EVALUATION/TEST OF THE DISEASE:

• Hypernatremia is often diagnosed through blood tests. Urine tests can also be used to
identify high levels of sodium along with urine concentration. Both blood and urine tests
are fast, minimally invasive tests that require no preparation. Hypernatremia tends to
develop as a result of underlying conditons. Other tests depend on your medical history
and additional symptoms.
HYPERNATREMIA
SIGNS & SYMPTOMS:

• Fever and Flushed skin

• Restless
• Really agitated
• Increased fluid retention
• Edema
• confused
• Decreased urine output
• Dry mouth/skin
HYPERNATREMIA
MEDICAL MANAGEMENT:

• In patients with hypernatremia of longer or unknown duration, reducing the sodium

concentration more slowly is prudent. Patients should be given intravenous 5% dextrose
for acute hypernatremia or half-normal saline (0.45% sodium chloride) for chronic
hypernatremia if unable to tolerate oral water.
 HYPERNATREMIA
NURSING MANAGEMENT:

• Restrict sodium intake. Know foods high in salt.

• Keep patient safe because they will be confused and agitated.
• Doctor may order to give isotonic or hypotonic solutions such as 0.45%
NS (which is hypotonic and most commonly used). Give hypotonic
fluids slowly because brain tissue is at risk due to the shifting of fluids
back into the cell (remember the cell is dehydrated with
hypernatremia) and the patient is at risk for cerebral edema. In other
words, the cell can lyse if fluids are administered too quickly
• Educate patient and family about sign and symptoms of high sodium
level and proper foods to eat.