ELECTROLYTE IMBALANCES ) (Hyponatremia and Hypernatremia ) <br /><br /> <br />Electrolytes in body fluids are active chemicals (cations that carry positive <br />charges and anions that carry negative charges). The major cations in body <br />fluid are sodium, potassium, calcium, magnesium, and hydrogen ions. The <br />major anions are chloride, bicarbonate, phosphate, sulfate, and proteinate<br />ions.<br /><br /><br />Systemic Routes of Gains and Losses : <br />Water and electrolytes are gained in various ways. Healthy people gain fluids by drinking and <br />eating, and their daily average I&O of water are approximately equal<br />Kidneys<br />The usual daily urine volume in the adult is 1 to 2 L<br />Skin<br />Sensible perspiration 0 to 1,000 mL or more every hour <br />Insensible perspiration (approximately 500 mL/day)<br />Lungs<br />300 mL every day<br />Gastrointestinal Tract<br />100 to 200 mL daily<br /><br /><br />Sodium Deficit (Hyponatremia)<br />Hyponatremia refers to a serum <br />sodium level that is less than 135 mEq/L <br />(135mmol/L)<br /> Poor skin turgor<br /> Dry mucosa<br /> Headache<br /> Decreased saliva production<br /> Orthostatic fall in blood pressure<br /> nausea <br /> vomiting, and abdominal cramps<br /> altered mental status<br /> Status epilepticus, and coma, are <br />probably related to the cellular <br />swelling and cerebral edema <br />associated with hyponatremia<br /><br />Treatment<br />IV sodium solution to slowly raise the sodium levels in blood. This requires a stay in the hospital for frequent monitoring of sodium levels as too rapid of a correction is dangerous.<br />Medications to manage the signs and symptoms of hyponatremia, such as headaches, nausea and seizures.<br /><br /><br />Sodium Excess (Hypernatremia)<br />Hypernatremia is a serum sodium level <br />higher than 145 mEq/L (145 mmol/L)<br /> Tonic-clonic seizures<br /> Pulmonarry edema<br /> Hyperreflexia<br /> Hypertension<br /> nausea<br /> vomiting<br /> Thirst<br /> Hyperthermia<br /> Swollen dry tongue<br /> Sticky mucous membranes<br /> Hallucinations<br /> Lethargy<br /> Restlessness<br /> Irritability<br /> tachycardia<br /><br />Treatment <br /><br />Establish documented onset (acute, < 24 h; chronic, >24h)<br />In acute hypernatremia, correct the serum sodium at an initial rate of 2-3 mEq/L/h (for 2-3 h) (maximum total, 12 mEq/L/d).<br />Measure serum and urine electrolytes every 1-2 hours<br />Perform serial neurologic examinations and decrease the rate of correction with improvement in symptoms<br />Chronic hypernatremia with no or mild symptoms should be corrected at a rate not to exceed 0.5 mEq/L/h and a total of 8-10 mEq/d (eg, 160 mEq/L to 152 mEq/L in 24 h).<br />If a volume deficit and hypernatremia are present, intravascular volume should be restored with isotonic sodium chloride prior to free-water administration.<br /><br /><br /><br /><br /><br />