By: Janel Canty RNS
(Osborn, 2010)
Objectives
 To understand Hyponatremia
 To be able to recognize hyponatremia in a clinical
setting
 Be able to apply to identify what a medical
professionals would do with a patient with
hyponatremia
Pathophysiology of hyponatremia
This is defined as sodium below the normal range that
the human body requires for normal functioning.
Sodium is the most numerous cation in the extracellular
fluid, it maintains the volume through osmotic pressure,
regulates acid-base balance, and conducts nerve
impulses. When the sodium balance is off the exchange
of electrons between molecules does not take place
properly to conduct normal activities.
(Osborn, 2010)
(Osborn, 2010)
Most common Causes
 Water excess!
 Loss of sodium containing fluids
 Ace inhibitors
 diuretics
 vomiting
 diarrhea
 Renal failure
 Syndrome of inappropriate
antidiuretic hormone
(Osborn, 2010)
Sign/Symptoms
 Initially
 Headache, nausea, vomiting
 Later stages
 Hyponatremic encephalopathy, cerebral edema
 May progress to
 Hallucinations, lethargy, weakness, bradycardia, ataxia,
respiratory depression, seizures, coma, or death
 Patients may be asymptomatic
Haskal, 2007)
Prevalence
 30% of patients undergoing acute hospital care
 15% of those patients have symptoms
 One of the most common electrolyte disorders
(Haskal, 2007)
Laboratory test
 Urine osmolality
 Determines if the kidneys are damaged and can’t dilute
the urine

Greater then 100 mOsm/kg
 Serum osmolality
 Determines if it hyponatremia or another cause that
manifest the same as hyponatremia
 Urinary sodium concentration
 Determine if the hyponatremia is because of SIADH

Greater then 20-40 mEq/l
(Osborn, 2010, medscape)
What population is at risk?
 Everyone!
 Affects all races the same
 Affects both genders the same
 Happens at any age

More likely in elderly because of decreased renal function
(Osborn, 2010)
Prognosis
 In hospitalized patients
 Increased association with adverse reactions
 Increased mortality
 Severe hyponatremia (less than 105 mEq/L)
 High mortality rate

Over 50%
(Nursing central & medscape)
Interventions
 Immediately administer one boluses of 2ml/Kg of 3%
NaCl IV
 Consider other conditions that can cause
hyponatremia
 Correct underlying cause
 Assess for overcorrection of hyponatremia causing
hypernatremia
 This could cause brain damage
 A Bladder catheter should be inserted to monitor the
water balance
(Overgaard-steensen, 2011)
Patient Scenario
 A 46 year old African American male arrived at the
emergency room on 9/15 complaining of vomiting for 1
week. Upon arrival the patient had a sodium level of
130 and was admitted for treatment of hyponatremia.
Patient was tested and diagnosed with HIV after being
admitted. Patient was given Amphotericin B from 916-2012 until 10-15-2012 to treat the HIV.
Interventions for the scenario
 The patient was given 3% NaCl IV 2ml/Kg every 6
hours until Sodium levels were in normal range
 Patient was started on Amphotericin B
 To treat underlying cause of HIV
 Patient’s fluids were initially restricted to 1,000 Ml per
day
 Patient was on I&O’s
Scenario Outcome
 On 10-16-2012 the patient’s sodium serum level was 138
mEq/l
 Within normal range
Nursing Diagnosis
 Risk for life-threatening cerebral edema R/T fluid
retention or low sodium AEB serum sodium of less
than 135 mEq/L
(Osborn, 2010)
NCLEX!
 John came to the ED with a sodium level of 122 mEq/L




and was treated with 3% NaCl IV. When you come to
assess John you notice that his level of consciousness
has declined. What is this most likely from?
A. Drug use
B. Increasing the sodium levels too quickly
C. hypokalemia
D. infusing the NaCl too slowly
(Osborn, 2010)
Answer!
 John came to the ED with a sodium level of 125 mEq/L




and was treated with 3% NaCl IV. When you come to
assess John you notice that his level of consciousness
has declined. What is this most likely from?
A. Drug use
B. Increasing the sodium levels too quickly
C. hypokalemia
D. infusing the NaCl too slowly
(Osborn, 2010)
Nclex
 The nurse is caring for a patient and has just received




the laboratory data report. Which of the following
results cause the most concern?
A. Na+:115 mEq/L
B. K+:4.0 mEq/L
C.Ca+: 9 mg/dL
D.Mg+: 2.0 mg/dL
(Osborn, 2010)
Answer
 The nurse is caring for a patient and has just received




the laboratory data report. Which of the following
results cause the most concern?
A. Na+:115 mEq/L
B. K+:4.0 mEq/L
C.Ca+: 9 mg/dL
D.Mg+: 2.0 mg/dL
(Osborn,
2010)
(Osborn, 2010)
Work cited
 Haskal, R. (2007). Current issues of nurse
practitioners: hyponatremia , 563-576.
 Overgaard-steensen, C. (2011). Inital approach to the
hyponatremic patient , 139-145.
 Osborn, W. W. (2010). Medical Surgical Nursing . New
Jersey: Pearson.
 Jensen, S. (2011). Nursing Health Assessment.
Philadeplphia: Lippincott Williams and Wilkins.
Nusing Central. (2012,05).
(Osborn, 2010)