I had a patient with severe electrolyte imbalance. Hyponatremia is not as simple as it is. Close observations and monitoring should be done for patients with this case. We usually think, hyponatremia is easy to correct, yes, but not all. It is very fatal if not treated well.
This may cause demyelination leading to paralysis of the patient due to rapid correction of hyponatremia. Demyelination is neurological disease caused by severe damage of the myelin sheath of nerve cells in the brainstem.
For a patient, Mr. X with these laboratory results:
One might think, is this patient still alive? yes he is, thank God, He was found unconscious on his car and now needs critical management. This laboratory results usually represents Acute Kidney Injury if not Chronic Kidney Injury/ESRD since no known history for this patient upon admission.
On nursing side, i will be focusing on hyponatremia. Yes, the patient has a lot of imbalances that needs to be corrected but i will emphasize more on nursing responsibilities for severe hyponatremia.
These includes:
1. Electrolytes monitoring every 3-4hours.
2. Gradual increase of sodium level of at least 14-16mmol/L within 48hours, is the target goal.
3. When starting continuous renal replacement therapy, strict monitoring and reporting of laboratory
results should be done, since CRRT may cause rapid correction of electrolytes which is not good
for the patient. CRRT may be done for 6-12hours on strict reassessment as ordered by the
Physician.
4. Proper IVF along with the right amount of free water should be followed as ordered by the
Physician to avoid rapid correction of sodium.
5. Level of consciousness should be strictly evaluated.
With proper management, gradually, patient has improved, electrolytes, BUN and creatinine were corrected. He has gained consciousness and was extubated.
;-)
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