Question

a client with hyponatremia accompanied by a fluid volume deficit is being treated with IV NORMAL SOLUTION. Which serum sodium laboratory finding indicates to the nurse that the treatment has been effective?

Answer 1

The most important cation in the extracellular fluid is sodium normal range of sodium is 135 to 145 mEq/L.Sodium can control water distribution and maintain fluid balance through out the body.Sodium can promote impulse transmission,activate enzymatic reaction,assist acid base balance and maintain muscle contractility.

Hyponatremia is occurred due to low sodium level in the body that is below 135mEq/L.It is caused by draining wounds,diarrhea,vomiting hormonal changes over use of thiazides.If is commonly seen in postoperative patients. signs and Symptoms include nausea,headache,confusion,fatigue.

Assessment:Low level of sodium cause edema that effect central nervous system leads to depression and cerebral edema.Monitor patients symptoms of central nervous system depression(headache personality changes),abdominal discomfort.Severe hyponatremia(111mEq/L) can cause tremors,seizures,coma.

Physical examination urine and serum sodium level help to diagnosis hyponatremia.

Treatment include:

Acute hyponatremia can varies by symptoms severity:

• Mild to moderate that indicate patient is at low risk of herniation:3 percent sodium chloride solution is infused at range of 0.5 to 3mL/kg/h.
• Severe hyponatremia: 100mL of 3% sodium chloride intravenously over 15minutes.

According to the European society of intensive care medicine guidelines follows:

Severe symptomatic hyponatremia:

First line:Hypertonic saline should be infused with a target range of 6mmol/L over 24hrs and increase to 8mmol/L until the serum sodium concentration reaches to 130mmol/L.If it reaches to target range that indicate given treatment is effective.

For Inappropriate anti diuretic hormone secretion:

• First line treatment:Fluid restriction
• Second line:Increase solute intake with 0.25 to 0.50 g/kg of urea per day plus loop diuretics.

For client with reduced circulating volume 0.9% sodium chloride intravenous infusion and crystalloids solution of range 0.5 to 1 mL/kg per hour.