Page 233 - Critical Care Notes

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Clinical Presentation
■ Concentrated urine and decreased urine output
■ Water retention and weight gain, edema despite low urine output
■ Lethargy, weakness, fatigue, malaise
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■ Dilutional hyponatremia (serum Na 115–120 mEq/L)
■ Poor skin turgor, dry mucosa, thirst
■ Headache
■ Decreased saliva
■ Orthostatic hypotension, tachycardia
■ Loss of appetite, nausea, vomiting
■ Abdominal or muscle cramps
■ Extreme muscle weakness
■ Irritability, confusion, disorientation, delirium, hallucinations
■ Emotional and behavioral changes
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■ Seizures, coma, and death if serum Na <110 mEq/L
Diagnostic Tests
■ Comprehensive metabolic panel including BUN and creatinine. Serum uric acid
■ CBC
■ Serum ADH and serum cortisol
■ Urinalysis and specific gravity
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■ Urine Na and electrolytes
■ Plasma and urine osmolarity
■ Ultrasound of kidneys
■ Chest x-ray and CT or MRI of head
Management
■ Assess cardiac and respiratory status for heart failure.
■ Monitor vital signs frequently, O 2 saturation, and arrhythmias.
■ Assess for edema of extremities. Administer loop diuretics (e.g., furosemide
[Lasix]) or osmotic agents (e.g., mannitol [Osmitrol]).
■ Institute fluid restrictions to 500–1000 mL/day.
■ Monitor intake and output and fluid balance.
■ Weigh daily.
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■ Increase Na intake.
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■ Administer 3% hypertonic saline cautiously if low serum Na levels.
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■ Closely monitor electrolytes, especially Na levels.
■ Monitor for CNS changes.
ENDO