Symptomatic Severe Hyponatremia

22 Jan

I had a patient today with symptomatic hyponatremia.  I am still not sure why this patient had such an awful lyte imbalance.  I only had a few hours with the patient and he was newly admitted to our floor. It could of been anything: depending on fluid status it could of been hypervolemic, euvolemic, or hypovolemic hyponatremia; it could of been cirrhosis, heart failure, or nephrotic syndrome; it could of been SIADH, polydipsia, adrenal insufficiency or hypothhroidism: it could of been from renal loss versus extra renal losses.  At any rate it is loss of salt or a gain of water. Whew! I was confused to say the least.  Anyway the treatment was fluid restriction of 800 ml for 24 hours and infusion of 3%  Saline times 2 four hour periods at 40ml/hour with chemisty checks every 2 hours to reach a goal of Na+ equal to 120. I was pretty perturbed by this treatment to day the least.  The patient was mildy confused but easily reorientated, had vomited times 1 and had other electrolyte imbalances as well. Symptomatic Severe Hyponatremia when the serum Na+ is less than 110 really should be admitted to ICU care because replacing the sodium and potassium in that manner with hypertonic saline and blood draws every 2 hours as well as assessing the patient every hour for increased mental status changes while caring for 5 other patients is just not realistic. It is not real fair to the patient or the nurse! Well… here I am ranting and raving. I do not like to be a complainer! The outcome was good for the patient but I was lucky enough to tell a senior nurse on the floor the situation. The senior nurse told me that hypertonic solutions are risky and that the patient needs to be monitored closely in which I complied of course, but I did not really know how serious sodium replacement could be. Little nurse Jane did call up the MD and asked if this patient should be in ICU or if it was safe and appropriate to be admitted to telemetry with a nurse patient ratio of 1:6. The patient stayed on telemetry and did get better after lyte replacement therapy. It is a serious matter though. Here is a tutorial for hyponatremia that I found useful in answering my questions, after I got home and started studying of course.  We have to love those Renal MDs I mean check out the math for electrolyte and fluid replacement calculations. I mean my brain hurts just thinking about it!

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