Sodium Disorders
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
* 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