Pediatric Hyponatremia

Hyponatremia, also called, sodium deficit is a condition wherein the body’s serum sodium level is below normal or less than 135 meq/L. This loss can precipitate due to various factors such as, vomiting, diarrhea, sweating, use of diuretics, fistulas, consuming a low – sodium diet, renal disorders and an aldosterone deficiency. It was found out that hospital-acquired hyponatremia is the most common cause of hyponatremia in children. This has been associated to hypotonic solution commonly prepared for this age group.

Manifestations

  • Decreased saliva production
  • Orthostatic fall in blood pressure
  • Poor skin turgor
  • Dry mucosa
  • Nausea
  • Abdominal cramping
  • Mental status alteration (from cellular swelling and cerebral edema)
  • Anorexia
  • Muscle cramps
  • Exhaustion
  • Increased intracranial pressure (once sodium level drops to 115 meq/L)
  • Lethargy
  • Confusion
  • Hallucinations
  • Hemiparesis
  • Papilledema
  • Seizures
  • Muscle twitching
  • Focal weakness

Diagnosis

  • Serum sodium level is less than 135 meq/L
  • Serum osmolality is decreased
  • Urinary sodium content is less than 20 meq/L (reabsorption of sodium happens)
  • Specific gravity is low, ranging between 1.002 – 1.004
  • BUN and creatinine levels

Medical Management

Treating hyponatremia starts with proper and adequate assessment. In order to fully target the condition, the health team should be able to assess the speed in which the hyponatremia occurred.

  • Since there is sodium insufficiency, replacement is recommended. There should be a thorough administration of sodium either by mouth, nasogastric tube or via the parenteral route. In children who can tolerate eating, sodium can easily be replaced through the diet or sodium tablets. In other cases, intravenous transfusion of isotonic saline solution or lactated Ringer’s solution may be done. To effectively carry out the treatment, the patient’s sodium levels should not be greater than 12 meq/L in 24 hours (otherwise, neurologic complications may occur).
  • Water restriction to a total of 800 ml in 24 hours is carried out.

Nursing Management

  1. Since treatment necessitates assessment, nurses assigned to pediatric patients must be keen and ardent in detecting possible risk factors that can predispose to hyponatremia. The sooner hyponatremia is detected, the greater chance of effective intervention.
  2. Monitor the patient’s input and output, noting for significant changes.
  3. Weigh patient accordingly.
  4. Specific gastro – intestinal manifestations should be documented such as abdominal cramps, anorexia, vomiting and nausea.
  5. Children who exhibit neurological symptoms such as lethargy confusion and seizures should be referred to doctors immediately.
  6. For patients who can independently eat, increasing sodium intake is recommended (this can be safer than an intravenous administration of sodium).
  7. Encourage patients to control water intake, for younger children. Instruct parents to monitor and control such.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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