Sodium is one of the principal mineral ions that are present inside the body, any insufficiency in its excretion and any excess secretion or retention will lead to its hyper state. The kidney is the main organ that regulates the excretion of sodium. The hormone aldosterone facilitates the retention of sodium inside the kidney. Our body excretes almost 8 grams of sodium per day in the form of urine by glomerular filtration. There can be a variety of causes that can lead to hypernatremia and thus sodium toxicity. The most important of them are these two causes mentioned as follows:
Excessive sodium intake by the person
Deficiency of water inside the body
When the body faces water stresses such as dehydration, there are compensatory mechanisms of the body to overcome this stress with the least impact on the body. The other important causes for the toxicity of sodium are as follows:
Hyperactive adrenal cortex
Prolonged administration of the hormone cortisone
Insensible loss of water from the skin and respiratory ventilation
Rapid intake of the sodium salts
Vomiting
Diarrhea
Use of lactulose
Burns
Excessive sweating
Cushing’s syndrome
Intravenous (IV) sodium injection in high doses
Water loss during pregnancy
Renal diseases
After vigorous exercise
A trans-cellular shift of water from extracellular fluid to the intracellular fluid
Heavy intake of drugs leading to a disrupted mechanism of renal concentration
Signs and Symptoms of Sodium Toxicity
The excess sodium concentration in blood has worse effects almost all over the body, but it has the worst effects on the brain cells. The neurologic impact of hypernatremia is the most severe symptom of sodium toxicity, which are as follows:
Alteration in mental status
Weakness
Neuromuscular issues such as irritability
Seizures
Focal neurological deficits
Encephalopathy
Coma
Abnormal speech
Nystagmus
Lethargy
Obtundation
The death rate of this neurological impact of sodium toxicity is high as 50% of the total patients. These episodes result from shrinkage caused in the brain cells due to the transfer of water from the intracellular matrix to the extracellular matrix due to increased ionic concentration in the extracellular fluid. The other effects of the hypernatremia that is sodium toxicity are as follows;
The decrease in the contractility of the left ventricle of the heart
Hypertension
Edema
Disturbance in the utilization of the glucose even if the digestion is proper
Cramps in muscles
The Treatment Approach of Sodium Toxicity
The treatment of sodium toxicity is entirely focused on decreasing the elevated level of sodium present in the plasma up to the normal level or in the normal range of the sodium level. The process should be in optimum intensity because a sudden rise or fall in any ionic concentration will lead to serious complications. The management of the toxicity should focus upon the following important factors:
The rate of the ionic correction should be optimum
Selecting an appropriate method to do the same
Never ignore the predisposing conditions of the patient, such as diabetes
The most important measure that should be taken is the oral or nasogastric administration of water to compensate for the water loss that has taken place inside the body. For correct compensation for the water loss, the total body water should be calculated. It is calculated by multiplying the bodyweight of the person by 0.6. The reason behind this is that two-third of the bodyweight of a person is the normal weight of water. This Total body weight should be 50% for the females and 60% for the males. Apply the corrective measures to maintain the levels in their appropriate range.
