Sodium

L.V. Rao, PhD

Full name: Sodium, Plasma or Serum
Other names: Na
Normal range:
135145 mmol/L; Critical Values: <121 or >158 mmol/L
Definition
Sodium is the major extra cellular cation and exerts a major influence on plasma osmolality. It
plays a central role in maintaining the normal distribution of water and osmotic pressure.
Changes in serum sodium most often reflect changes in water balance rather than sodium balance. It is adjusted by antidiuretic hormone secretion (ADH) and the thirst receptors to maintain plasma osmolality and volume. Aldosterone causes tubular reabsorption of sodium. Atrial
natriuretic peptide hormone decreases sodium reabsorption.
Use
Diagnosis and treatment of dehydration and overhydration. If a patient has not received large
load of sodium, hypernatremia suggests need for water, and values <130 mEq/L suggest
overhydration.
Electrolyte, acidbase balance; water balance; water intoxication.

Increased in
conditions associated with water loss in excess of salt loss through skin, lungs, GI tract and
kidneys;
dehydrationinadequate fluid intake to replace dermal, respiratory, or GI loss of fluid;
GI causes: vomiting or diarrhea;
cutaneous causes: burns or excessive sweating;
drugs: infusion of hypertonic sodium salts, hypertonic saline, Na-bicarbonate; hypertonic
dialysis;
hyperaldosteronism, Cushing syndromerare causes;
diabetes insipididus (DI);
post-traumatic :caused by tumors, cysts, histiocytosis, TB, sarcoidosis;
idiopathic: caused by aneurysms, meningitis, encephalitis, GuillainBarre syndrome;
renal failure & other renal causes: loop diuretics, osmotic diuresis (glucose, urea, mannitol),
postobstructive diuresis, polyuric , phase of acute tubular necrosis, Intrinsic renal disease

Decreased in
Hyponatremia (defined as serum sodium <135 mmol/L after the exclusion pseudohyponatremia). This can be classified as three types depending upon extracellular fluid (ECF) status.
Hypovolemic hyponatremia (reduced ECF)
Renal Loss of Na and water: caused by diuretic use, salt wasting nephropathy, cerebral
salt wasting, adrenal insufficiency, renal tubular acidosis.
Extra renal loss of Na and water with renal conservation: caused by burns, GI loss, pancreatitis, bowel obstruction, blood loss.
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2 Sodium
Hypervolemic hyponatremia (expanded ECF and ICF but reduced effective arterial blood
volume): caused by CHF, cirrhosis, nephrotic syndrome.
Euvilemic hyponatremia (expanded ECF and ICF without edema: caused by thiazide
diuretic use, hypothyroidism, adrenal insufficiency, Syndrome of inappropriate antidiuretic
Hormone secretion (SIADH).
Limitations and Interferences
Plasma Na levels depend greatly upon the intake and excretion of water and, to a some what
lesser degree the renal regulation of Na.
Determinations of blood sodium and potassium levels are not useful in diagnosis or in estimating net ion losses but are performed to monitor changes in sodium and potassium during
therapy.
Hyperglycemiaserum sodium decreases 1.7 mEq/L for every increase of serum glucose
of 100 mg/dL).
Hyperlipidemia and hyperproteinemia, which cause spurious results only with flame photometric but not with specific ion electrode techniques for measuring sodium.
Pseudohyponatremia caused by water exclusion effect observed on Indirect ISE (Ion Selective Electrode) measurements due to the dilution of samples and transfusion of blood products due to infusion of i.v. immunoglobulins.

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