 Welcome to Nursing School Explained and this video on sodium imbalances, so we'll look at what sodium does in general in the body and then what are the causes and treatments for hypo as well as hypernatremia. As a quick reference here, typical serum sodium levels are 135 to 145. Just keep in mind that individual lab values may vary, so always look at the reference range for whatever facility that you're at to make sure that you have the correct reference range to determine if the patient's level is outside the norm. And so here as a quick reminder, sodium is a major electrolyte in the extracellular fluid and therefore it helps us regulate our fluid balance, so it's very involved in blood pressure control. It's regulated by the hormones ADH, anti-diuretic hormone, and aldosterone. And I have a separate video that goes into the RAS and how the blood pressure control in our blood is happening. It's titled mechanisms of blood pressure control and then I have a separate one on the RAS itself. And sodium always travels with chloride and water, so those kind of attract each other, so usually when chloride is high, sodium will be high, when they're low, they're both together low, and then usually when there's low sodium the patient will also have low water content because sodium attracts water and they kind of help each other regulate the fluid balance. So causes here for hypo and hypernatremia, black in heme black here we have hyponatremia, so anything that causes fluid to leave the body, specifically vomiting, some diarrhea as well, but more so vomiting when we lose a lot of stomach acid, we lose a lot of sodium. And so in turn NG tube suctioning can cause that too because it's kind of the same mechanism as if the patient was vomiting. Burn injuries, so if there are injuries to the skin itself and there's a lot of fluid loss from those burn injuries because of blisters that might have burst, with the fluid that's escaping the body through those burn injuries, sodium also leaves the body. Wounds, same principle, and then patients with chronic kidney disease tend to have hyponatremia and then also a low sodium diet, so not enough intake of sodium can cause hyponatremia and then certain medications. So that's why we always need to check these electrolytes before we administer certain medications to patients and those are the medications that have to do with either again the RAS, whatever regulates our fluid balance or the end or these hormones. So ACE inhibitors, ARBs work on the RAS and then diuretics work on the brain to either release more or less anti diuretic hormones. So whenever we have these medications we have to think about that maybe there would be a possible hyponatremia and check the level before we administer the medication. For hypernatremia now, high sodium levels greater than 145. So if we intake a lot of sodium and don't or decrease our water intake, the sodium levels will rise and the water level will go down. Hypertonic IV fluids and those are usually administered with caution and I have a separate video that goes into hypertonic IV solutions so watch that to see how this is related. Also acute renal failure as well as hyperaldosteronism, here we are back again to all the hormones that regulate. Cushing syndrome which is a regulated which also has to do with the fluid volume balance so that can cause hypernatremia and then dehydration. So if we lose a lot of water now the sodium is retained in the blood therefore it is more concentrated and so dehydration can cause hypernatremia. For medications steroids are the biggest offenders here for cause of hypernatremia. So let's look at signs and symptoms and I've put this here in red whenever you think of sodium imbalances think of altered level of consciousness because the sodium and the water either make the brain cells swell or make them dehydrated so shrink and the first signs and symptoms will be altered mental status. So here for hyponatremia first of all we have low blood pressure and the patient might have positive orthostatics because we said sodium and water work together so if we have low sodium levels a lot of fluid is lost and if that is from the intravascular space blood pressure will be low, heart rate will be high trying to compensate and the patient will be positive with orthostatics and then here we have all these neuro symptoms so irritability confusion restlessness and then altered level of consciousness. So anybody who maybe starts to be a little bit irritable and their reason for admission to the hospital would maybe be a cause for hyponatremia always think about looking at their sodium levels because it can lead to confusion and restlessness all the way to seizures fairly quickly if that sodium gets too low or too high. For hyponatremia we also have possible signs and symptoms of generalized weakness as well as muscle cramping and weakness. Over here on the hypernatremia side so high levels of sodium again all these things with altered level of consciousness irritable confusion restlessness and seizures and please watch the video on hypo and hypotonic IV solutions where I explain how the fluid shift and how that affects the brain cells and then so treatment what do we do if we detect that there are sodium imbalances so if the sodium level is low we give the patient isotonic fluids that's kind of a double whammy because many times the blood pressure will be low and the heart rate will be high and the patient is orthostatic we need to increase the fluid volume status so we need to give them isotonic IV solutions and the best one here is sodium chloride which is 0.9 percent saline or 0.9 percent sodium chloride and so we replenish their sodium their chloride because we said over here they always go together in addition we expand their fluid volume status we resolve their blood pressure and also replenish their sodium we also want to encourage a high sodium diet so maybe give them all those things that we usually tell patients to stay away from and then here is a very important tidpit so hypotonic saline we can also administer that 3% so that's very very concentrated but because it causes so such severe fluid shifts and affects the brain cells that is usually reserved if the sodium level goes below 120 so it goes quite low from the 135 that's the lower normal level in terms of hyper tonic or hypernatremia and this might be a little bit confusing here for many we also give isotonic IV fluids now you might be thinking why is that but if you think about if the sodium in the blood is very concentrated we have a high amount of sodium and usually we the patient is dehydrated so if we give them more fluids it'll kind of dissolve and make the concentration in the blood a little bit less and yes we give them a little bit of sodium and chloride here but in general we're expanding again their fluid volume status and therefore make that blood a little bit more dilute which will make that sodium level come down we also want to encourage a low sodium diet because our sodium is too high and then maybe administer diuretics in case this is due to any of these causes over here especially chronic kidney disease when we know the RAS is affected or maybe the hormones are off as such as in hyper aldosteronism or any imbalances from the 88 and the aldosterone levels in terms of our nursing consideration so because we know sodium travels with water and we know it can affect blood pressure we need to stay on top of the patient's vital signs blood pressure and heart rate check their level of consciousness because many times we've said here it affects their mental status check their labs all those that pertain to fluid volume balance sodium chloride serum osmolarity again watch the other videos if you need a little review here we want to check neuromascular changes because we know it can cause generalized weakness and maybe some muscle cramping and weakness we want to initiate seizure precautions because we know this altered mental status can lead to seizures here both on the high and low side daily weight and I know whenever we think about fluid shifts or fluid balance we have to do daily weights and eyes and also keep a close eye on the fluids that were either replenishing or removing from the body with the help of diuretics we also want to initiate fall precautions because if the patient is altered they might not be able to follow directions check the IV side because we need to give these fluids that they need and then administer any fluids as well as diuretics as needed to treat the hyponatremia and then again check their labs again follow your nursing process for your intervention reevaluate and then assess again so thank you for watching this video on hypo and hyponatremia I'll put the link in the links for the other videos that I mentioned in the description of the video below so you have easy access to it this is a topic that sometimes can get very confusing and it's kind of very involved but once you understand the basics and how it is all working together and sometimes it just it just clicks and you can get it from there thanks for watching nursing school explains see you soon