Sodium is necessary for the body to maintain fluid balance and is critical for normal body function. It also helps to regulate nerve function and muscle contraction. Hyponatremia and Hyponatremia.

1. SODIUM
IMBALANCE
JAISON THOMAS DANIEL
NURSING TUTOR
YFCON, RATNAGIRI

2. INTRODUCTION
• Sodium is one of the body's electrolytes, which are minerals that
the body needs in relatively large amounts. Electrolytes carry an
electric charge when dissolved in body fluids such as blood.
• Most of the body’s sodium is located in blood and in the fluid
around cells. Sodium helps the body keep fluids in a normal
balance. Sodium plays a key role in normal nerve and muscle
function.
• The normal serum sodium level is
135 - 145 mEq /L

3. • The body obtains sodium through food and drink and
loses it primarily in sweat and urine.
• Healthy kidneys maintain a consistent level of sodium
in the body by adjusting the amount excreted in the
urine. When sodium consumption and loss are not in
balance, the total amount of sodium in the body is
affected.

4. Sources

5. Hyponatremia

6. • Hyponatremia is a serum sodium level lower than 135
mEq/L (135 mmol/L).
• Sodium imbalances usually are associated with fluid
volume imbalances.
• Classification of hyponatremia in adults according to
serum sodium concentration,
• Mild : 130-134 mmol/L
• Moderate : 125-129 mmol/L
• Profound : < 125 mmol/L

7. Hyponatremia is classified according to volume status, as
follows:
Hypovolemic hyponatremia
• Decrease in total body water with greater decrease in total
body sodium
Euvolemic hyponatremia
• Normal body sodium with increase in total body water
Hypervolemic hyponatremia
• Increase in total body sodium with greater increase in total
body water

8. Hyponatremia can be further sub classified according to effective
osmolality, as follows:
• Hypotonic hyponatremia
• Isotonic hyponatremia
• Hypertonic hyponatremia

9. Causes
Increased sodium excretion
• Excessive diaphoresis
• Diuretics
• Vomiting
• Diarrhoea
• Wound drainage, especially gastrointestinal
• Kidney disease
• Decreased secretion of aldosterone

10. Causes
Inadequate sodium intake
• Fasting; nothing by mouth status
• Low-salt diet
Dilution of serum sodium
• Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids
• Kidney disease c. Freshwater drowning
• Syndrome of inappropriate antidiuretic hormone secretion
• Hyperglycemia
• Heart failure

11. Clinical manifestations
Cardiovascular
• Symptoms vary with changes in vascular volume
• Normovolemic: Rapid pulse rate, normal blood pressure
• Hypovolemic: Thready, weak, rapid pulse rate; hypotension; flat
neck veins; normal or low central venous pressure
• Hypervolemic: Rapid, bounding pulse; blood pressure normal or
elevated; normal or elevated central venous pressure

12. Clinical manifestations
Respiratory
• Shallow, ineffective respiratory movement is a late manifestation
related to skeletal muscle weakness.
Neuromuscular
• Generalized skeletal muscle weakness that is worse in the
extremities
• Diminished deep tendon reflexes

13. Clinical manifestations
Central Nervous System
• Headache
• Personality changes
• Confusion
• Seizure.
• Coma
Renal
• Increased urinary output
Gastrointestinal
• Increased motility and hyperactive
bowel sounds
• Nausea
• Abdominal cramping and diarrhea
Integumentary
• Dry mucous membranes

14. Diagnostic Evaluations
• History collection
• Physical examination
• urine osmolality
• serum osmolality
• urinary sodium concentration.

15. Management
• Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and
gastrointestinal status.
• If hyponatremia is accompanied by a fluid volume deficit (hypovolemia),
IV sodium chloride infusions are administered to restore sodium content
and fluid volume.
• If hyponatremia is accompanied by fluid volume excess (hypervolemia),
osmotic diuretics may be prescribed to promote the excretion of water
rather than sodium.

16. Management
• If caused by inappropriate or excessive secretion of antidiuretic hormone,
medications that antagonize antidiuretic hormone may be administered.
• Instruct the client to increase oral sodium intake as prescribed and inform
the client about the foods to include in the diet.
• If the client is taking lithium, monitor the lithium level, because
hyponatremia can cause diminished lithium excretion, resulting in toxicity.

17. Hypernatremia

18. • Hypernatremia is a serum sodium level that exceeds 145 mEq/L
(145 mmol/L).
• It is strictly defined as a hyperosmolar condition caused by a
decrease in total body water (TBW) relative to electrolyte
content.
• Hypernatremia is a “water problem,” not a problem of sodium
homeostasis.

19. Causes
Decreased sodium excretion
• Corticosteroids
• Cushing’s syndrome
• Kidney disease
• Hyperaldosteronism
Increased sodium intake
• Excessive oral sodium ingestion or excessive administration of
sodium-containing IV fluids

20. Causes
Decreased water intake
• Fasting; nothing by mouth status
Increased water loss
• Increased rate of metabolism, fever, hyperventilation, infection,
excessive diaphoresis, watery diarrhoea, diabetes insipidus

21. Clinical manifestations
• Heart rate and blood pressure respond to vascular volume status.
• Pulmonary edema if hypervolemia is present.
• Early: Spontaneous muscle twitches; irregular muscle contractions
• Late: Skeletal muscle weakness; deep tendon reflexes diminished or
absent
• Altered cerebral function.
• Normovolemia or hypovolemia: Agitation, confusion, seizures
• Hypervolemia: Lethargy, stupor, coma

22. Clinical manifestations
• Extreme thirst
• Decreased urinary output
• Dry and flushed skin
• Dry and sticky tongue and mucous membranes
• Presence or absence of edema, depending on fluid volume changes

23. Diagnostic Evaluations
• Serum electrolytes (Na+, K+, Ca2+)
• Glucose level
• Urea
• Creatinine
• Urine electrolytes (Na+, K+)
• Urine and plasma osmolality
• 24-hour urine volume
• Plasma arginine vasopressin (AVP) level.

24. Diagnostic Evaluations
• magnetic resonance imaging (MRI) or computed tomography
(CT) scan of the brain may be helpful in cases of central
diabetes insipidus

25. Management
The goals of management are
• Recognition of the symptoms, when present
• Identification of the underlying cause(s)
• Correction of volume disturbances
• Correction of hypertonicity

26. Management
• Monitor cardiovascular, respiratory, neuromuscular,
cerebral, renal, and integumentary status.
• If the cause is fluid loss, prepare to administer IV
infusions.
• If the cause is inadequate renal excretion of sodium,
prepare to administer diuretics that promote sodium loss.
• Restrict sodium and fluid intake as prescribed

27. • Vasopressin analogs
• These agents may enhance
sodium excretion.
• Desmopressin (DDAVP)
• Increases cellular
permeability of collecting
ducts, resulting in the
reabsorption of water by the
kidneys.

28. Avoid high sodium food, salt substitutes are
cautiously use for patient with potassium imbalances