a. Severe low sodium diet
b. Loss of sodium containing secretions without adequate replacement (vomiting, diarrhea)
c. Use of potent diuretics
d. Excessive administration of sodium free IV fluids, such as D5W.
e. Tap water enemas, water intake with GI suctioning
f. Excessive perspiration (Sweat is ½ strength saline.)
g. Frequently occurs in the elderly and presents with confusion.
h. Water intoxication (May happen with heavy beer drinkers and psychiatric clients.)
i. Client's who take lithium or seizure medications especially in the summer.


a. Irritability, apprehension, confusion
b. Decreased gastrointestinal mobility
c. Tremors, seizures, coma
d. Postural hypotension
e. Cold, clammy skin, thready pulse
f. Finger printing edema over sternum (Fluid goes inside the cells and the cells swell. Happens all over the body, but is    most evident over the sternum.)

g. Decrease in nerve transmission

Associated Problems
a. Heat exhaustion
b. Excessive use of diuretics