Hyponatremia

Introduction:

Hyponatremia is an abnormally low amount of sodium in the blood. Low levels of
sodium may be due to loss of sodium from the body, movement of sodium from the
blood to other spaces, or dilution of sodium concentration within the plasma. Some
causes include increased excretion or abnormal excretion of sodium, water imbal-
ance, hormonal imbalance (such as excess ADH), ecstasy (methylenedioxymethy-
lamphetamine) use, hypothyroidism, renal failure, diuretics, diarrhea, vomiting, and
wound drainage.

PROGNOSIS

Identification and correction of the underlying cause is important in treatment of
hyponatremia. Water restriction of all patients with hyponatremia will help to pre-
vent further dilution of the plasma concentration of sodium. Seizure and death may
occur if the electrolyte imbalance is not identified and corrected.


SIGNS AND SYMPTOMS
• Hypotension, especially orthostatic (with position changes—from lying to
sitting) due to decrease in cardiac output in setting of hypovolemia
• Nausea
• Diarrhea due to increased gastrointestinal motility
• Increased bowel sounds due to increased gastrointestinal motility
• Malaise or excessive activity
• Muscle weakness
• Decreased deep tendon reflexes
• Personality changes due to cerebral edema and increased intracranial pressure
• Altered level of consciousness
• Seizure

TREATMENT

• Water restriction.
• Administer saline solution IV if patient has fluid deficit (hypovolemic).
• Furosemide if fluid-overloaded.
• Treat underlying cause to correct problem.

NURSING DIAGNOSES
• Deficient fluid volume
• Excess fluid volume
• Risk for disturbed thought processes
• Decreased cardiac output

NURSING INTERVENTION
• Record fluid intake and output to monitor fluid status.
• Monitor vital signs.
• Weigh patient daily.
• Monitor for signs of dehydration: decreased skin turgor (elasticity), dry
mucous membranes, decreased sweating, neurologic changes.
• Appropriate oral hygiene for dry mucous membranes.
• Proper skin care is especially important if the patient is experiencing diarrhea
or dehydration.
• Explain to the patient fluid restriction and dietary modifications.
• Increase sodium in diet appropriately, considering comorbidities.