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[3] [27] The final step in treatment is to calculate the patients free water deficit, and to replace it at a steady rate using a combination of oral or IV fluids. [3] [27] The rate of replacement of fluids varies depending on how long the patient has been hypernatremic. Lowering the sodium level too quickly can cause cerebral edema. [27]
Lower levels of plasma sodium are associated with more severe symptoms. However, mild hyponatremia (plasma sodium levels at 131–135 mmol/L) may be associated with complications and subtle symptoms [14] (for example, increased falls, altered posture and gait, reduced attention, impaired cognition, and possibly higher rates of death). [15] [16]
The fractional excretion of sodium (FE Na) is the percentage of the sodium filtered by the kidney which is excreted in the urine. It is measured in terms of plasma and urine sodium , rather than by the interpretation of urinary sodium concentration alone, as urinary sodium concentrations can vary with water reabsorption .
The sodium–potassium pump, a critical enzyme for regulating sodium and potassium levels in cells. Sodium ions (Na +) are necessary in small amounts for some types of plants, [1] but sodium as a nutrient is more generally needed in larger amounts [1] by animals, due to their use of it for generation of nerve impulses and for maintenance of electrolyte balance and fluid balance.
Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. [3] Severe symptoms typically only occur when levels are above 160 mmol/L. [1] Hypernatremia is typically classified by a person's fluid status into low volume , normal volume, and high volume . [ 1 ]
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Hypoosmolar hyponatremia is a condition where hyponatremia is associated with a low plasma osmolality. [1] The term "hypotonic hyponatremia" is also sometimes used.[2]When the plasma osmolarity is low, the extracellular fluid volume status may be in one of three states: low volume, normal volume, or high volume.
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