A pinch of salt.

Pregnant women in labour are generally encouraged by their carers to continue taking plenty of oral fluids. This is sometimes supplemented by intravenous fluids either due to a clinical necessity or in preparation for a caesarean section. It is important that there is clear documentation of the amount of fluids received by pregnant women in the perinatal period as excessive maternal fluid has been associated with low serum sodium in neonates. This often goes under-recognised; therefore it is important to consider this in a neonate presenting with hyponatraemia in the first day of life. Presented here is a case of neonatal hyponatraemia secondary to excessive fluid taken in the perinatal period.

When they drink too much. Nursing interventions for patients with disordered water balance.

Disordered water balance affects as many as 60% of severely psychiatrically disabled persons. Most patients do not progress to the point of a medical emergency, but are in a state of mild chronic intoxication, making them unavailable for treatment and requiring nursing care to treat the effects of the chronic intoxicated state. Interventions depend on the severity of the disordered water balance and vary from teaching fluid intake control to controlling all patient access to fluids. Nursing management of water intoxication is a trial and error approach. Through a thorough assessment and close observation of the patient, the nurse can determine which interventions would be most appropriate for the patient.

Early detection of water intoxication.

1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.

Patients with disordered water balance. Innovative psychiatric nursing intervention strategies.

1. Patients with disordered water balance (DWB) have difficulty with fluid intake/output and osmoregulation. These difficulties are characterized by polydipsia, polyuria, significant variation in pattern of excretion, abnormal diurnal weight gain, and behavioral changes. 2. Therapeutic milieu-management strategies for patients experiencing acute and chronic phases of DWB are the cornerstone of long-term management of these patients. 3. Implementation of the intervention and milieu-management strategies described in this article resulted in a reduction of patients requiring acute medical treatment subsequent to an acute phase of DWB.

A target weight procedure for disordered water balance in long-term care facilities.

1. Water intoxication is a severe complication of disordered water balance. Hyponatremia precedes water intoxication and can be identified through abnormal diurnal weight variation. 2. The St. Louis Target Weight Procedure (STWP) is a nonintrusive method that includes a client's baseline weight, frequent weights throughout the day, a target weight of 5% above the baseline weight, and restricted fluids if the target weight is exceeded. 3. The STWP was positively related to an increase in urine concentration; thus it is successful in restoring normal fluid balance.

Understanding water intoxication. Part I in a II-Part series.

While knowledge exists concerning the symptoms and possible causes of water intoxication, the exact etiology remains unclear. If proper nursing strategies are to be developed, it is crucial to carefully assess each patient with polydipsia and plan interventions related to what is known about that patient.

Issues in the nursing management of patients with water intoxication.

The syndrome of water intoxication, experienced by a small percentage of hospitalized chronically mentally ill patients, is a two-stage process, usually beginning with polydipsia. In some patients the physiological ability to excrete excess free water is lost, and polydipsia progresses to hypervolemia and hyponatremia. The hyponatremia responds to fluid restriction. Nevertheless, nursing intervention associated with limiting a patient's fluids is complex, including psychodynamic, social, and behavioral factors. Because of the complexity of nursing care, and because of the unanswered questions about etiology and treatment of water intoxication, the area is fertile for nursing research.

The water-intoxicated patient.

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.

Understanding water intoxication. Part 2. Nursing care for the patient with self-induced water intoxication.

Responding to the patient with self-induced water intoxication is a particularly challenging aspect of nursing care. Nurses may have little information other than personal experience from which to plan care. An overview of nursing care methods, using a nursing process approach for patients in either a 1-1 or group setting, has been presented. Effective intervention needs to include control, monitoring, psychoeducation, and ongoing evaluation.

Polydipsia and hyponatremia in psychiatric patients: challenge to creative nursing care.

Among patients with psychiatric disorders, especially schizophrenia, a pattern of extreme polydipsia and polyuria sometimes emerges, usually without readily identifiable medical causes. Hyponatremia may develop and progress to water intoxication, with symptoms including restlessness, confusion, seizures, or even death. We review the clinical features and pathophysiology of this syndrome and discuss nursing roles in identifying and managing patients with polydipsia and hyponatremia. While the causes of polydipsia and hyponatremia are unclear, relevant factors seem to include a possible dysfunction in central nervous system (CNS) thirst and osmoregulatory centers, the inappropriate secretion of or sensitivity to antidiuretic hormone (ADH), and psychoactive drugs. Management techniques for affected patients concentrate on careful observation, fluid restriction, and the minimization of possible exacerbating factors such as high neuroleptic dosage and cigarette consumption.

Nursing program to meet the challenge of caring for patients with water intoxication.

This article describes a program that is effective in working with psychiatric patients who have trouble with excessive water intake. The purpose of the program is to provide consistent treatment in a controlled and therapeutic environment in which the special needs of these patients can be met. We incorporate a variety of nursing interventions suggested by the literature to help meet the goals of the program. As a result of the program, disruptive behavior has decreased and patients have learned skills to help them manage their illness. An additional benefit of the program is that working with water intoxication patients is no longer stressful for staff.

Water intoxication: one nursing staff's response and intervention.

Water intoxication is a significant problem for psychiatric nurses, especially those in long-term care settings. Water intoxication can cause psychological and physiological symptoms which can lead to death. The programme described in the paper can significantly modify and change patient behaviour and assist patients in controlling their own impulses to participate in self-limiting fluid and their own self-care satisfactorily.