What would the practical relevance of this be as a dietitian? How may high/low sodium change your decision-making? Considering decisions around saline etc are usually out of the RD remit.
Great question! Depending on the facility/team, RDs can definitely have a part in managing serum sodium levels. First off, RDs will want to be able to understand the etiology/reasoning of the hypo/hypernatriemia and any plans for management currently in place by communicating with the care team. This allows everyone to be on the same page to avoid duplication of treatments, as well as to get a thought as to the next steps for the patient (ex. diuretic increases or discontinuation in the near future). Keep in mind there are some cases that these levels may also be purposeful, such as induced hypernatremia to prevent/manage cerebral edema in neuro patients. Based on the patient plans and needs, RDs can often play a part in free water flushes and volume restriction for sodium management. Additionally, RDs in some facilities will write the entire custom TPN order including electrolytes and additives. In these facilities, the RD will have to select an appropriate sodium provision based on sodium labs and other clinical treatments that may be in place. Treatments for abnormal sodium levels may also impact other electrolyte needs such as potassium wasting diuretics. Should there be additional electrolyte management needs, the RD can help continue that conversation in the care team and may make recommendations for electrolyte repletion as needed. All around, being a part of the care team will require RDs to understand why someone may have abnormal sodium status, what approaches need to be taken to improve sodium status, and how the whole system may be impacted by management plans. Hope this helps!
For the recommendations on "not doing it too quickly", the recommendations are lower than that of 1/2NS (77mEq/L) which I often see being used to correct sodium levels. Should 1/2NS not be used?
Good question! We chatted with a neurointensivist to get a clearer answer for you, and this is what they said: Presuming you’re speaking about hyponatremia, ideally, you would start with the etiology of the hyponatremia and a baseline serum sodium level. Typically 3% NaCl is used with the rate being adjusted to avoid over correcting (no more than ~8-10 mEq/L increase in serum Na levels in 24 hrs). Normal saline will typically not raise serum Na levels quick enough. And 1/2 NS would make the low serum Na worsen, providing additional volume without enough sodium.
Oh, I misread that as the amount of sodium that could be given, not the rise in serum levels! Okay, that makes much more sense now. I have seen NS and 1/2 NS used in hyponatremia, but I am wondering if that has been to slow down the increase with 3%NaCl when they may have just provided too much. I don't order IVF so I'll have to pay more attention in the future. Thank you for the response!
What would the practical relevance of this be as a dietitian? How may high/low sodium change your decision-making? Considering decisions around saline etc are usually out of the RD remit.
Great question! Depending on the facility/team, RDs can definitely have a part in managing serum sodium levels. First off, RDs will want to be able to understand the etiology/reasoning of the hypo/hypernatriemia and any plans for management currently in place by communicating with the care team. This allows everyone to be on the same page to avoid duplication of treatments, as well as to get a thought as to the next steps for the patient (ex. diuretic increases or discontinuation in the near future). Keep in mind there are some cases that these levels may also be purposeful, such as induced hypernatremia to prevent/manage cerebral edema in neuro patients.
Based on the patient plans and needs, RDs can often play a part in free water flushes and volume restriction for sodium management. Additionally, RDs in some facilities will write the entire custom TPN order including electrolytes and additives. In these facilities, the RD will have to select an appropriate sodium provision based on sodium labs and other clinical treatments that may be in place. Treatments for abnormal sodium levels may also impact other electrolyte needs such as potassium wasting diuretics. Should there be additional electrolyte management needs, the RD can help continue that conversation in the care team and may make recommendations for electrolyte repletion as needed.
All around, being a part of the care team will require RDs to understand why someone may have abnormal sodium status, what approaches need to be taken to improve sodium status, and how the whole system may be impacted by management plans.
Hope this helps!
Please make videos on nutrition basics
For the recommendations on "not doing it too quickly", the recommendations are lower than that of 1/2NS (77mEq/L) which I often see being used to correct sodium levels. Should 1/2NS not be used?
Good question!
We chatted with a neurointensivist to get a clearer answer for you, and this is what they said:
Presuming you’re speaking about hyponatremia, ideally, you would start with the etiology of the hyponatremia and a baseline serum sodium level. Typically 3% NaCl is used with the rate being adjusted to avoid over correcting (no more than ~8-10 mEq/L increase in serum Na levels in 24 hrs). Normal saline will typically not raise serum Na levels quick enough. And 1/2 NS would make the low serum Na worsen, providing additional volume without enough sodium.
Oh, I misread that as the amount of sodium that could be given, not the rise in serum levels! Okay, that makes much more sense now. I have seen NS and 1/2 NS used in hyponatremia, but I am wondering if that has been to slow down the increase with 3%NaCl when they may have just provided too much. I don't order IVF so I'll have to pay more attention in the future. Thank you for the response!
Please make video anthropometric measurements
Video on conducting NFPE's :)