Elevated Sodium Levels

[AeonStrike]

I was dispatched to a SNF for pt with sodium labs of 162.
He had mild edema to both legs non pitting. Slightly elevated RR and HR but not change in mental status. BP was 136/90 they had infused D5 in NS 750cc over 10 hours.
Question is what us the effect of elevated sodium on the body and was the staffs use of d5 indicated

 

[JPINFV]

I was dispatched to a SNF for pt with sodium labs of 162.
He had mild edema to both legs non pitting. Slightly elevated RR and HR but not change in mental status. BP was 136/90 they had infused D5 in NS 750cc over 10 hours.
Question is what us the effect of elevated sodium on the body and was the staffs use of d5 indicated

What is the rest of the patient's history and medications? There are numerous causes of hypernatremia, but the most common cause is excess loss of water (e.g. diuretics, osmotic diuresis, etc) or lack of water intake.

1. Elevated sodium is associated with hyperosmotic states, so you're going to have water leaving cells. The cells are going to produce proteins that work to prevent the loss of water ("osmoles"), which if hypernatremia isn't treated in 24 hours, then the patient has to be treated slowly to prevent cerebral edema.

The most common signs and symptoms are neurological (lethargy, irritability, coma, seizure, etc).

2. Yes. D5w is commonly used because hypernatremic states are more often to to a water deficit than an increase in total body sodium. My concern is that the patient is hypernatremic with what appears to be a hypervolemic state (non-pitting edema). Is the patient on dialysis?

 

[AeonStrike]

He was not on diuretics.
He was somewhat lethargic but the staff said it was baseline, even though it may not have been.
That's good to know it may be from lowered fkuid levels resulting ib higher concentration and necessarily just high sodium intake.
Also he had no history of kidney disease or hdtx. And I do jot recall his meds as it has been a few weeks.
He had chf and copd, also diabetes and htn

 

[socalmedic]

He was not on diuretics....He had chf and copd, also diabetes and htn

CHF and HTN, he/she was most likely on some form of diuretics or dialisys

 

[JPINFV]

CHF and HTN, he/she was most likely on some form of diuretics or dialisys

Just being in a health care facility alone puts the patient at risk of hypernatremia absent of any other causes (most likely because it's harder to get proper hydration, be it from lack of physical ability or having to ask for water). Also, the CHF most likely explains the edema/apparent hypervolemic state. This is a good example of having to bring multiple disease processes together to make a proper diagnosis, as the reasons for hypervolemic hypernatremic states are very limited, but that only applies if hypernatremia is considered in isolation of other conditions.

Also, to reiterate because it's critical to understanding sodium balance disorders, hypernatremic/hyponatremic are most likely due to changes in water volume than changes in total body sodium. Hyper/hyponatremia? Think water problems first. I know people who failed renal (we covered sodium, potassium, and metabolic acid/base disorders in renal) simply because they couldn't understand that point.

On a similar point, potassium disorders are often either due to potassium wasting diuretics (thiazides and loop diuretics like furosemide (lasix) are the common ones) or disorders that cause potassium to move into/out of the cells (e.g. acidosis* causes hyperkalemia through moving potassium out of the cell, beta-agonists like albuterol can cause hypokalemia by moving potassium into a cell).

*pH and potassium concentrations move in opposite directions. pH goes down, [K] goes up. pH goes up, [K] goes down.

 

[Shishkabob]

You don't remember the meds but do know they weren't on diuretics?


As socal stated, with a history of CHF and HTN, with functioning kidneys, my money is on a diuretic with a potassium supplement. Maybe the "go-to" furosemide, or maybe HCTZ.




Medicine. Recognizing patterns.

 

[AeonStrike]

It was a few weeks ago so I do not recall exactly but I am pretty sure there were not diuretics on the list, however I could be wrong

 

[JPINFV]

but I am pretty sure there were not diuretics on the list, however I could be wrong

Well... how many diuretics do you know? Also, how many pages was the patients Medication Administration Record (MAR)?

 

[mycrofft]

Once or twice had pt's with genetic hypernatremia.

Been many years ago, they used some sort of off-label medication. He left shortly after coming to us.

 

[JPINFV]

Been many years ago, they used some sort of off-label medication. He left shortly after coming to us.

Gordon's syndrome?

 

[mycrofft]

Dunno.

Someone told me the medication was "a relative of tetracycline". I was off for the two days he was there, we blew a bunch of money on his meds and he went to another jurisdiction. At least we cold send the meds with him in his paperwork.

 

[AeonStrike]

The pt had a med list that related the med to a diagnosis

 

[JPINFV]

The problem is that diuretics can be given for a lot of things.