Hyponatremia (decreased serum sodium)
Older patients develop more symptoms than younger ones. Symptoms are more severe in cases of faster development of hyponatremia. In moderate hyponatremia, or above 115 meq/l, symptoms include:
- lethargy or weakness
- altered personalities
In severe cases, which are less than 115 meq/L, patients may show signs of:
- neurological hyper excitability
In postmenopausal women, severe cerebral edema can occur.
1) History- with identification of cause and physical examination.
2) serum and urine electrolytes
3) serum and urine osmolality
4) assessment of fluid status
Identification of cause and type of hyponatremia is needed to determine method of treatment. In hypovolemic hyponatremia- 0.9% NaCl or normal saline should be given intravenously. In hypervolemic patients- fluid restriction and diuretics may be needed. In normovolemic hyponatremia- the cause should be treated. In some situations- 3% saline may be needed for treatment which should be given in a monitored, ICU setting.
Complications of Treatment
Rapid correction of hyponatremia can cause neurological problems- such as brain demyelination. Hyponatremia should be corrected at the rate of 0.5 meq/L/hr. Correction should not be greater than 10 meq/L in 24 hrs.
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