Sodium chloride Tablets USP

A 91- year old patient. Admitted to the hospital from the ED. Patient was seen for altered mental status. Labs, CT of brain head, CXR XR of left Tib/Fib were performed.

Presumed meningioma in the left middle cranial fossa was noted. Sodium was critically low at 114. Nephrologist was consulted and hyponatremia is of unknown etiology. Patient also has uncontroled hypertension.
Comorbidities: Coronary artery disease, Diabetes, Dementia, hypothyroidism, hyperlipedemia, neuropathy.

Patient will need physicain oversight for hyponatremia, normal saline routinely, and medication management for hypertension.

Rx: Sodium Chloride USP 1.0 gram

Use 
1. Hyponatremia
2. Preparation of normal isotonic solution of sodium chloride
3. As an electrolyte replenisher for the prevention of heat cramps, due to excessive
 perspiration
4. any alternate use as directed by a physician

Each tablet contains: sodium 394mg


Hyponatremia is a common electrolyte disorder encountered in geriatric population undergoing an orthopedic surgery and is associated with adverse clinical outcomes. There is a paucity in literature comparing the effects of chronic- and new-onset hyponatremia on patient outcomes.

Hyponatremia is decrease in serum sodium concentration < 136 mEq/L caused by an excess of water relative to solute.
Common causes include diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate ADH secretion (SIADH).

Clinical manifestations are primarily neurologic (due to an osmotic shift of water into brain cells causing edema), especially in acute hyponatremia, and include headache, confusion, and stupor; seizures and coma may occur. Diagnosis is by measuring serum sodium. Serum and urine electrolytes and osmolality and assessment of volume status help determine the cause. Treatment involves restricting water intake and promoting water loss, replacing any sodium deficit, and correcting the underlying disorder.  ( Source: Merck manual)

Important basic lab tests are the serum sodium and potassium levels, renal function tests with blood urea nitrogen (BUN) and creatinine, and liver function tests. 

TBW: Total Body Water

Hypovolemic hyponatremia

Decreased TBW and sodium, with a relatively greater decrease in sodium	GI losses*	Diarrhea Vomiting
	3rd-space losses*	Burns Pancreatitis Peritonitis Rhabdomyolysis Small-bowel obstruction
	Renal losses	Diuretics Mineralocorticoid deficiency Osmotic diuresis (glucose, urea, mannitol) Salt-losing nephropathies (eg, interstitial nephritis, medullary cystic disease, partial urinary tract obstruction, polycystic kidney disease)

Euvolemic hyponatremia
Increased TBW with near-normal total body sodium	Drugs	Thiazide diuretics, barbiturates, carbamazepine, chlorpropamide, clofibrate, opioids, tolbutamide, vincristine 3,4-Methylenedioxymethamphetamine (MDMA [ecstasy]) Possibly cyclophosphamide, NSAIDs, oxytocin, SSRIs

	Disorders                                       Adrenal insufficiency as in Addison disease Hypothyroidism Syndrome of inappropriate ADH secretion Increased intake of fluids	Primary polydipsia
	States that increase nonosmotic release ofvasopressin(ADH)	Emotional stress Nausea Pain Postoperative states

Hypervolemic hyponatremia
Increased total body sodium with a relatively greater increase in TBW	Extrarenal disorders	Cirrhosis Heart failure
	Renal disorders	Acute kidney injury Chronic kidney disease Nephrotic syndrome