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16 terms

SODIUM IMBALANCES

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HYPERNATREMIA (Na+ >145 mEq/L [mmol/L])
General causes
Excessive sodium intake
Inadequate water intake
Excessive water loss (increased sodium concentration)
Disease states
HYPONATREMIA (Na+ <135 mEq/L [mmol/L])
General causes
Excessive sodium loss
Inadequate sodium intake
Excessive water gain (decreased sodium concentration)
Disease states
HYPONATREMIA (Na+ <135 mEq/L [mmol/L])
caused by excessive sodium intake
Excessive sodium intake:
IV fluids: hypertonic NaCl, excessive isotonic NaCl, IV sodium bicarbonate
Hypertonic tube feedings without water supplements
Near-drowning in salt water
HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) - excessive sodium loss
GI losses: diarrhea, vomiting, fistulas, NG suction
Renal losses: diuretics, adrenal insufficiency, Na+ wasting renal disease
Skin losses: burns, wound drainage
HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused inadequate water intake
Inadequate water intake:
Unconscious or cognitively impaired individuals
HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused by disease states
Disease states:
diabetes insipidus, primary hyperaldosteronism, cushing syndrome, uncontrolled diabetes mellitus
HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused excessive water loss
Excessive water loss (increased sodium concentration):
Increased insensible water loss (high fever, heatstroke, prolonged hyperventilation), osmotic diuretic therapy, diarrhea
HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Inadequate sodium intake
Fasting diets
HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Excessive water gain (decreased sodium concentration)
Excessive hypotonic IV fluids, primary polydipsia
HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Disease states
SIADH, heart failure, primary hypoaldosteronism
Hypernatremia with Decreased ECF Volume - Manifestations
Restlessness, agitation, twitching
Intense thirst; dry, swollen tongue, sticky mucous membranes
Weight loss
Weakness, lethargy
Hyponatremia with Decreased ECF Volume - Manifestations
Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma
Dry mucous membranes
Postural hypotension, ↓ CVP, ↓ jugular venous filling, tachycardia, thready pulse
Cold and clammy skin
Hypernatremia with Normal/Increased ECF Volume
Restlessness, agitation, twitching, seizures, coma
Intense thirst, flushed skin
Weight gain, peripheral and pulmonary edema, ↑ BP, ↑ CVP
Hyponatremia with Normal/Increased ECF Volume
Headache, apathy, confusion, muscle spasms, seizures, coma

Nausea, vomiting, diarrhea, abdominal cramps

Weight gain, ↑ BP, ↑ CVP
Hypernatremia and hyponatremia with decreased ECF volume - similar manifestations
Seizures, coma
postural hypotension
decreased CVP
Hypernatremia and hyponatremia with normal/increased ECF volume - similar manifestations
- Seizure, coma
- Increased BP and CVP (central venous pressure)