Pediatric Hypernatremia

Sodium excess or hypernatremia is the condition where the sodium level of the body exceeded the normal limits of 145 meq/L, it can be stated that the child took in or retained excess sodium than water.  It can be due to an increase of sodium following an increase in water, or can be because of a decrease in water in excess of sodium. Fluid loss can also be caused by excessive sweating, polyuria, diarrhea or vomiting.

Causes

Hypernatremia can generally be associated to fluid deprivation. Children who are very young (still unable to assert their needs and wants) and those who are cognitively challenged are prone into developing hypernatremia. Administration of hypertonic solutions without proper and adequate water supplements directs to hypernatremia. Some instances like drowning and heatstroke can cause excess sodium as well.

Manifestations

  • Thirst
  • Dehydration (dry mucous membranes)
  • Flushed skin
  • Restlessness
  • Hallucinations
  • Edema (peripheral and pulmonary)
  • Hypotension (postural)
  • Fatigue
  • Weakness
  • Disorientation
  • Confusion
  • Muscle twitching
  • Dizziness
  • Light-headedness
  • Brain damage (can occur especially in children

Diagnosis

  • Serum sodium level is greater than 145 meq/L
  • Serum osmolality becomes more than 295 mOsm/kg
  • Urine specific gravity decreased
  • Urine osmolality decreased

Medical Management

Treatment for hypernatremia involves steady and gradual lowering of the serum sodium. This involves infusion of hypotonic electrolyte infusion (safer, gradual reduction of sodium) or an isotonic non – saline solution (a solution where you can possible infuse water without the sodium). Diuretics are also prescribed to excrete excess sodium.  However, it is recommended that reduction of sodium should be in a steady rate and no faster than 0.5 to 1 meq/L, rapid sodium drop may result to cerebral edema.

Nursing Management

  • Monitor input and output
  • Nurses should be ardent in detecting significant water losses or low water intakes amongst patient.
  • Assessment of behaviour (which is attributed to hypernatremia: most symptoms are neurologic) is recommended.
  • Offer fluids to patients at regular intervals.
  • If oral fluids are not effective and parenteral infusions are sought instead, nurses should be keen in assessing the updated serum sodium levels and note for changes or responses.
  • Check the child’s medications. Some medications contain a lot of sodium and may interfere with the medical intervention.
  • Monitor the child’s diet. Confine the food intake into hospital control. Check if the parent provides outside food that may contain high sodium levels.

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