Sodium is a very common electrolyte. But do we really understand this electrolyte, the role it plays in the body and how it impacts patient outcomes?
What’s the big deal?
Sodium PLAYS tHREE major roles: 1) protein synthesis, 2) maintaining our extracellular volume (bloodstream), and 3) nerve transmission.
Regarding its role in maintaining extracellular volume:
When sodium levels get too high or too low, it causes major shifts in fluid balance within the extracellular space. This can lead to cerebral edema or cerebral shrinking. And that can be a bad thing for your patient!
So, when you think about sodium, think “brain.” Too much or too little has a direct effect on brain function.
Too much: Patients can become hypernatremic if they have fluid loss without sodium loss. Patients who are dehydrated are susceptible as well as neuro patients in DI (Diabetes Insipidus).
Treatment is to give the patient fluids – typically normal saline unless they are severely dehydrated. In that case, you may give a hypotonic solution such as ½ NS.
Caution: a patient on high protein tube feeds is at risk for hypernatremia if they don’t also receive fluid boluses. Why? Think about it. We get sodium from protein. High protein diets = high sodium diets!
Too little: There are two common causes for hyponatremia. One is dilution. In a sense, the patient is “water-logged” (the patient will look wet). The second cause is when you have both fluid AND sodium loss as with a burn patient or someone with SIADH (the patient will look dry). In both cases, their sodium level may be the same. So, it’s important to assess your patient to determine the cause.
Treatment may be to just replace fluids with NS but if the sodium level is very low, you may need to give a 3% sodium solution. Caution!! A 3% sodium solution is hard on the veins and should only be used IF the patient has a true sodium loss – not if their hyponatremia is due to dilution.
ASSESSMENT: When your patient’s sodium level is either high or low, focus on these two aspects of your assessment:
· Neurological assessment – headache, confusion, irritability, altered level of consciousness, and ultimately, seizure and coma.
· Fluid status – check serum osmolality, daily weights, urine output (I’s and O’s)
Even though sodium is common, it still demands our respect. Remember – Sodium = Brain!
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