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Saturday, September 12, 2020

HYPONATREMIA: Causes, Assessment, Intervention



Hyponatremia is a serum sodium level lower than 135 mEq/L.  Sodium imbalance usually is associated with fluid volume imbalance. 


Increased sodium excretion 

  • Excessive diaphoresis
  • Diuretics 
  • Vomiting 
  • Diarrhoea 
  • Wound drainage, especially gastrointestinal 
  • Renal disease 
  • Decreased secretion of aldosterone
Inadequate sodium intake

  • Nothing by mouth
  • Low-salt diet
Dilution of serum sodium 

  • Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids 
  • Renal failure
  • Freshwater drowning 
  • Syndrome of inappropriate antidiuretic hormone secretion 
  • Hyperglycemia 
  • Congestive heart failure 


  • 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 

  • Shallow, ineffective respiratory movements as a late manifestation related to skeletal muscle weakness 

  • Generalized skeletal muscle weakness that is worse in the extremities 
  • Diminished deep tendon reflexes 
Cerebral function 

  • Headache 
  • Personality changes 
  • Confusion 
  • Seizures
  • Coma

  • Increased motility and hyperactive bowel sounds
  • Nausea 
  • Abdominal cramping and diarrhoea 

  • Decreased urinary specific gravity 
  • Increased urinary output

  • Monitor cardiovascular, respiratory, neuromuscular,  cerebral, renal, and gastrointestinal status.
  • If hyponatremia is accompanied by a fluid deficit, IV sodium chloride infusion are administered to restore sodium content and fluid volume. 
  • If hyponatremia is accompanied by fluid excess, osmotic diuretics are administered to promote the excretion of water rather than sodium. 
  • If the cause is inappropriate or excessive secretion of antidiuretic hormone,  medications that antagonize antidiuretic hormones, such as lithium and demeclocycline,  may be administered. 
  • Instruct client to increase oral sodium intake and inform the client about the foods to include in the diet. 

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