Sodium Disorders

Only available on StudyMode
  • Topic: Diabetes insipidus, Endocrinology, Vasopressin
  • Pages : 5 (569 words )
  • Download(s) : 70
  • Published : April 12, 2013
Open Document
Text Preview
SODIUM DISORDERS

* Identify specific types of hyponatremia and hypernatremia using diagnostic criteria and assessment questions * Hyponatremia
* Mild: 125-130
* Nausea, Malaise
* Moderate: 115-125
* HA, Lethargy, Restlessness, Disorientation
* Severe: <115
* Seizures, Coma, Resp/Brainstem damage
* Hypernatremia
* Mild: 145-160
* Asymptomatic
* Moderate: 160-180
* Lethargy, Weak, Irritable, Confusion, Restlessness * Severe: >180
* Twitching, Seizures, Coma, Death
* Specific equations and calculations
* Serum Osmolality:
* Range: 275-290mOsm/L
* Equation: Sosm = (2xSna) + (Glucose/18) + (BUN/2.8) * Na Deficit:
* Deficit = (140-Na) + TBW
* TBW: Males: Wt(kg) x 0.6; Females: Wt(kg) x 0.5
* IV Fluid Hourly Corrected Rate:
* 1ml/kg of 3% NaCl will increase Na by 1mEq/L
* Ex: 70kg & 115mEq/L, so 70mL will increase Na to 116mEq/L * OR: Weight x Desired hourly correction rate
* Corrected Sodium:
* Corrected Na = Measured Na + 0.016 x (Serum Glucose – 100) * Free Water Deficit:
* Deficit = TBW x [(Na/140) – 1]
* Identify causes of specific types of hyponatremia and hypernatremia, including drug-induced causes * Hyponatremia
* Hypotonic: Renal and Nonrenal Losses, Polydipsia, SIADH, HypOthyroidism, CHF, Cirrhosis, Adrenal insufficiency, Nephrotic Syndrome/CRF * Isotonic: Hyperlipidemia, Hyperproteinemia

* 275-290 mOsm/L
* Hypertonic: Hyperglycemia, Mannitol, Sorbitol
* >290 mOsm/L
* Hypernatremia
* Hypovolemic: Free water loss (diarrhea, vomiting, hyperventilation, burns, fever, exercise, diuretics) * Euvolemic: Diabetes Insipidus (central or nephrogenic) * Excessive thirst, large volumes of diluted urine * Hypervolemic: Hyperaldosteronism, Excess Mineralcorticoids, Water > Na Gain) * Recommend treatment options for various types of hyponatremia and hypernatremia * HypOnatremia: Severe, Life threatening

* 3% NaCl: 1ml/kg increases Na by 1mEq/L
* Monitor [Na], Symptoms, UOP
* If symptomatic replace faster!
* HypOnatremia: HypOtonic
* HypOvolemic: Uosmol >450mOsm/L
* UNa >20 = Renal Losses
* Causes: Diuretics
* Tx:
* Fluids: 0.9% NS or LR
* Hold diuretics
* Give Steroids

* UNa <20: Nonrenal Losses
* Causes: Diarrhea, Burns, Sweating, Hyperventilation * Tx:
* Fluids: 0.9% NS or Blood Products
* Euvolemic:
* UmOsm/L <100, UNa <20
* Causes: Polydipsia (dilute urine)
* UmOsm/L >100, UNa >20
* Causes: SIADH, Hypothyroidism
* Tx:
* SIADH
* Fluid Restriction <1-2L/d
* Furosemide in combo with Salt Tablets (900mOsm/d; 6-9g/d; 1g=17mEq) * Demeclocycline
* Conivaptan, Tolvaptan
* Adrenal Insufficiency
* Steroids
* Hypothyroidism
* Thyroid Hormone
* HypERvolemic: UmOsm/L >100, UNa <20
* Causes: CHF, Cirrhosis, Nephrotic Syndrome/CRF * Tx:
* CHF
* Fluid Restriction <1-2L/d
* Salt Restriction <1-2g/d
* Diuretics
* ACEi
* Beta Blocker
* Conivaptan, Tolvaptan
* Cirrhosis
* Fluid Restriction
* Salt Restriction
*...
tracking img