EFFECT OF SALT LOADING ON BLOOD SODIUM AND POTASSIUM LEVELS IN MALES AND FEMALES

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RESEARCH PROJECT TOPIC ON EFFECT OF SALT LOADING ON BLOOD SODIUM AND POTASSIUM LEVELS IN MALES AND FEMALES

ABSTRACT

Introduction: Hyponatremia, defined as serum sodium level of less than 135mEq/L [1] , is the most common electrolyte abnormality in hospitalised patients. It is estimated to occur in 2-4% of hospitalised patients and in 15-30% of critically ill patients [2] . Mortality for patients with acute hyponatremia is quoted as high as 50% while that of chronic hyponatremia at 10- 20%[3,4] .

The principles of management of hyponatremia might not be applicable in many CCU cases creating the dilemma of what to do in situations where fluid cannot be restricted or the underlying condition is not responding to treatment fast enough. This together with the inconsistent supply of hypertonic saline and the unavailability of the newer drugs and slow sodium tablets has resulted in the use of enteral table salt in correcting hyponatremia at our UUTH CCU set up[5-10] .

There is paucity of data on enteral table salt as the sole agent in correcting hyponatremia especially in the critical care set up. In the management of syndrome of inappropriate ADH secretion (SIADH), Binu et al[11] and Rose BD[12] describe the use of oral salt and furosemide but not in a critical care setup, neither do they discuss the effectiveness. Another case report by Karen et al [13] also describes the use of oral sodium in hyponatremia but in an outpatient set up and does not discuss its effectiveness.

Objective: The primary objective was to determine the effectiveness of enteral table salt in correcting hyponatremia at the University of Uyo Teaching Hospital Main Critical Care Unit. The secondary objective was to determine the safety or associated side effects of enteral table salt at the University of Uyo Teaching Hospital Main Critical Care Unit.

Research Methodology: This was a prospective observational study. Patients with hyponatremia where table salt had been prescribed were included in the study. Serial plasma sodium levels were analyzed from the moment the table salt was prescribed using a standardized analyzer. Associated side effects were also documented as well as changes in the patients’ clinical status. The study utilised 40 consenting adult patients who fit the inclusion criteria during the course of their treatment. Data was entered into and managed in Microsoft Excel 2013 data entry sheet pre-coded to reflect the design of the data collection tool. Data cleaning was done continuously during data collection and the final dataset was exported to SPSS version 21.0 statistical software for analysis. The study findings were presented using tables and graphs.

Findings: 32 patients (80%) had normal sodium levels after 1 or 2 days of table salt administration while 4 patients (10%) had hypernatremia and 4 patients (10%) persisted with hyponatremia despite 2 days of table salt administration. This translates to 90% effectiveness in correcting hyponatremia within 48 hours. Of the 80% with normal sodium levels, 65% were corrected within 24 hours while the remaining 15% required 48 hours of table salt administration.

The overall mean change in sodium levels was 6.8mmol/L. The overall mean change in sodium levels per 104meq/L (equivalent to sodium content in 1 tea spoon of salt) intake of sodium was

1.7mmol/L. The average dosing frequency was 2.25 tea spoons of salt per day (ranging from 1 to 4 tea spoons of table salt per day).

Only 1 patient (2.5%) developed diarrhoea and 2 patients (5%) had deteriorating consciousness. No patient experienced any of the other associated side effects namely; Nausea/Vomiting, Convulsions, Abnormal posturing/Movement and Nystagmus.

Conclusion: We, therefore, conclude from our findings that enteral table salt is 90% effective in correcting hyponatremia in the critical care set up. We also conclude that it is relatively safe.

 

CHAPTER ONE

INTRODUCTION

1.0                          Background Information

Sodium is the principal extracellular cation. It is responsible for the generation of action potentials in muscle and nerves. Pathological increase or decrease of total body sodium is associated with corresponding changes in plasma and extracellular volume. Hyponatremia and hypernatremia result from relative excesses or deficits of water respectively. Regulation of sodium is by the renal and endocrine systems. Aldosterone, atrial natriuretic peptide (ANP) and antidiuretic hormone(ADH) amongst other effectors control the total body sodium[3] .

 

Normal serum sodium is within the ranges of 135 to 155meq/L. Hyponatremia, defined as serum sodium concentration of less than 135mEq/L [1] , is the most common electrolyte abnormality in hospitalised patients. It is estimated at 2-4% of hospitalised patients and 15- 30% of critical care patients[2] . In the majority of hyponatremic patients, total body sodium may be normal or increased. The commonest clinical associations of hyponatremia include post operative patients, intracranial diseases, malignancies, drugs including medications and pulmonary diseases[3] . The mortality for patients with acute hyponatremia is quoted as high as 50% while mortality for chronic hyponatremia at 10-20%[4] .

 

Low serum sodium indicates excess total body water per solute in the absence of hyponatremia associated with normal or increased tonicity. This is otherwise known as dilutional hyponatremia. In normal individuals, this would trigger a compensatory mechanism to excrete the excess water and restore balance. In persistent hyponatremia there is a pathological inability to excrete the excess water. Dilutional hyponatremia is seen in three clinical situations where the extracellular volume is low, normal or high[5] .

 

Hyponatremia may present with minor signs like decreased mentation and nausea or more severe symptoms including deteriorating of consciousness, seizures, stupor, coma, hyponatremic encephalopathy and osmotic demyelination syndrome[5,14,10] .

 

Evaluation of hyponatremia includes assessment of serum sodium concentration, serum osmolality, urine sodium, urine osmolality, urine to sodium electrolyte ratio, fractional excretion of sodium, serum uric acid and urea concentrations, acid-base and potassium balance, hormonal profiles, saline infusion test and imaging modalities chest x-ray, computerised tomography scan and magnetic resonance imaging.

The management of hyponatremia is determined by the severity of the hyponatremia, acuteness of onset, presence or absence of symptoms, volume status and the etiology of the hyponatremia[5, 6,7,8] . Severe or symptomatic hyponatremia is rapidly corrected with hypertonic saline while mild to moderate, asymptomatic or chronic hyponatremia is managed by total body water correction and treatment of underlying causes amongst other newer medications. However this might not be practical in many CCU cases creating the dilemma of what to do in situations where fluid cannot be restricted (patients on endogastric feeds, total parenteral nutrition or high fluid state requirement) or the underlying condition is not responding to treatment fast enough. This together with the inconsistent supply of hypertonic saline (with its feared complication) and the newer drugs has resulted in the use of enteral table salt in correcting most cases of hyponatremia at UUTH CCU.

 

1.1                          Research Questions

  1. What is the effectiveness of enteral table salt in correcting hyponatremia at the University of Uyo Teaching Hospital Main Critical Care Unit.
  2. What are the associated side effects of enteral table salt in correcting hyponatremia at the University of Uyo Teaching Hospital Main Critical Care

 

1.2                          Research Objectives

The general objective of this study was to determine whether enteral table salt is effective in correcting hyponatremia at the University of Uyo Teaching Hospital Main Critical Care Unit.

1.2.1                      Specific Objectives

  1. To determine the effectiveness of enteral table salt in correcting hyponatremia at the University of Uyo Teaching Hospital Main Critical Care Unit.
  2. To determine the safety or associated side effects of enteral table saltat the University of Uyo Teaching Hospital Main Critical care

 

1.3                  Justification

The UUTH CCU Protocol does not provide a comprehensive guide on management of hyponatremia, neither does it include the role of enteral table salt yet it is routinely used.

The recognised modes of correcting hyponatremia include fluid restriction in normovolemic and hypervolemic hyponatremias, parenteral normal saline in hypovolemic hyponatremia andparenteral hypertonic saline otherwise known as 3% Saline in severe or symptomatic hyponatremia.

At the University of Uyo Teaching Hospital Intensive Care Unit, the supply of hypertonic saline is inconsistent and slow sodium tablets are not readily available hence the use of enteral table salt has been the norm. Most cases of hyponatremia are not severe or symptomatic hence hypertonic saline is not indicated. Fluid restriction cannot be practically applied because most patients’ nutritional requirements are administered in fluid states which cannot be restricted due to the compromise on caloric intake and other nutrients.

 

However there is limited data to support the use of enteral table salt, as the sole agent, in correcting hyponatremia especially in the critical care set up.

This study therefore aimed to assess the effectiveness ofenteral table salt in correcting hyponatremia in the critical care set up.

1.4                  Study Assumptions

The study assumed that the primary physician prescribed the adequate amount of enteral table salt for correcting hyponatremia.

The study assumed that the subjects had a normal enteral absorptive capability.

The study assumed that table salt was administered by the primary nurses as prescribed by the primary physician.

KEYWORDS; sodium and potassium relationship, potassium sodium ratio, sodium potassium balance in human body, sodium and potassium supplements, how do sodium and potassium work together in the body, effect of salt on uric acid, sodium and potassium levels in human body, how to increase sodium and potassium levels

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