A Family Doctor's Tale - HYPONATREMIA

DOC I HAVE HYPONATREMIA

Hyponatremia is defined as low Sodium in the blood.

Normal blood Sodium varies from 136 to 145 mmol per liter.

Extracellular Sodium level represents only 2 per cent of the total body Sodium.

Sodium is a major determinant of intracellular volume of cells and intracellular osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.

Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.

Hyponatremia occurs with loss of salt through:
1.gastrointestinal -vomiting and diarrhea

2.urinary loss especially following use of Sodium wasting diuretics

3.sweating

4.fistula

5.diabetes mellitus.

Symptoms of hyponatremia:
1.lethargy

2.generalized fatigue

3.muscle weakness

4.reduced urination

Diagnosis:
1.Plasma Sodium levels

2.Blood sodium bicarbonate and gases

3.Urinary electrolytes

Treatment:
1.oral Sodium chloride (or salt) is given in most cases with improvement of blood Sodium level

2.Intravenous Sodium chloride dextrose solutionis given in emergency cases.

3.Bicarbonate or lactate infusion may help correct acid base disorders depending on underlying cause.

4.Treat underlying cause.

5.Frequent monitoring of progress by blood studies

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea