The 31-year-old patient’s sodium level of 120 mEq/L indicates a diagnosis of hyponatremia and a diagnosis of a manic episode was made upon assessment in the ED. The hyponatremia, sodium level of 120 mEq/L, would immediately be treated to prevent further decline in the serum sodium level, to decrease intracranial pressure, to relieve hyponatremia related symptoms, and to prevent an overcorrection of hyponatremia. In patients with serum sodium less than 130 mEq/L, who are symptomatic, it is recommended that the hyponatremia be addressed to rule it out as the cause of the symptoms. The necessity and determination of treatment to raise the serum sodium level should be based on the severity of symptoms, the acuity of hyponatremia, the level of the serum sodium concentration, and the patient’s underlying condition. The goal of the immediate correction is to raise the sodium concentration by no more than 4 to 6 mEq/L in a 24-hour period to prevent overcorrection and to avoid the possibility of osmotic demyelination syndrome to occur. The initial treatment to address the hyponatremia would be a 100 mL bolus of 3 percent saline IV over 10 minutes, followed by a remeasurement of the serum sodium level, and, if indicated, up to two more additional boluses, for a maximum total dose of 300 mL of 3 percent saline IV (Sterns, 2020).
The patient presents with a typical manic episode and meets the DSM-5 Diagnostic Criteria for Manic Episode by having a “distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity, or energy, lasting a least 1 week and present most of the day, nearly every day” (Gabbard, 2014, p. 215). Additionally, during this time period, three, or more, of the following symptoms are present: inflated self-esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal-direct activity, excessive involvement in activities that are dangerous or high potential for painful consequences. The mood disturbance is also severe enough to caused marked impairment in social functioning or hospitalization is necessary to prevent harm to self or others, or psychotic features are present. Lastly, the episode is not related to the physiological effects of a substance or to another medical disorder (Gabbard, 2014, p. 215). One disorder that would be considered with this patient is Primary psychogenic polydipsia (PPD), which is frequently found with patients diagnosed with mania and is characterized by a disturbance in thirst control, resulting in an excessive amount of water intake; however, PPD is typically seen in patients with schizophrenic symptoms due to the dopamine levels being elevated (Parag & Espiridion, 2018).
In addition to treating the hyponatremia, the mania would be addressed with Risperidone 3 mg PO daily and titrated in doses of 1mg/day every 24 hours as needed, up to a maximum dose of 8 mg/day (Stovall, 2021; RisperiDONE, 2021). Prior to initiating Risperidone, a urinalysis, a full renal function panel, and a full liver function panel would be completed. If the patient were obese, as evidenced by a Body Mass Index greater than 30, an alternative medication would be considered, such as Haloperidol or Olanzapine (Stovall, 2021; Hruby & Hu, 2015).
References
Gabbard, G. O. (2014). Gabbard’s Treatments of Psychiatric Disorders (Revised) (Revised) (Fifth ed.). Washington, DC: American Psychiatric Publishing.
Hruby, A., & Hu, F. B. (2015). The Epidemiology of Obesity: A Big Picture. PharmacoEconomics, 33(7), 673–689.
Parag, S., & Espiridion, E. D. (2018). Hyponatremia Presenting with Recurrent Mania. Cureus, 10(11), e3645.
RisperiDONE (Lexi-Drugs). (2021). Retrieved February 10, 2021, from
Sterns, R. (2020). Overview of the treatment of hyponatremia in adults. Uptodate.com. Retrieved 8 February 2021, from .
Stovall, J. (2021). Uptodate.com. Retrieved 8 February 2021, from .
The definition of health has been interpreted throughout history and by all cultures with an overall common theme centered around the well-being of a person. The World Health Organization’s (WHO) definition of health is well known throughout the world as the only accepted definition and has not changed since 1948 stating that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2021). This idea of health is limited, static, and antiquated as it does not offer any fluidity or flexibility that would allow one to truly identify with their health in an honest way. The idea that “complete…well-being” defines health leaves no room for the person that has chronic illness, terminal illness, or is dealing with the inevitable changes of aging. Human health and life in general were quite different when the WHO definition was adopted. Life expectancy has risen, definition and criteria of disease has been altered, child mortality has reduced significantly, and elderly population has sky-rocketed (Fallon & Karlawish, 2019). It is obvious that the way we look at health today is vastly different from how we viewed it back then.
We need a new definition of health that can adjust to the everchanging landscape of human health. What health means to one person can be completely different than another. As a hospice nurse, I learned that the definition of health for a patient at end-of-life could be as simple as having an acceptance of their terminal disease and peace of mind knowing they will be comfortable in their last days. Is it acceptable to deem a dying cancer patient as unhealthy because they have cancer and they will die soon? What if that patient is content with their life and physical status? In my opinion, you do not need complete well-being physically, mentally, and socially to have health. I consider myself extremely healthy in that I do not take any medications, can work and provide for my family, eat healthy, exercise regularly, and have limited stress in my life. If I have a headache, does that mean I am no longer healthy?
A new definition may be that there is no one way to define health. The definition of health must rely on who is defining the term, how it will be used or interpreted, and to whom it will pertain. Leonardi (2018), highlights a new way to define health based on it being a process and not a state. He compiled 9 features that every definition of health should have to be considered valid. These include but are not limited to the following: “health must be beyond the absence of disease or infirmities and the biophysical parameters to avoid the old well-established reductionism of medicine”; “health must be seen as an ongoing, iterative, and dynamic process, not as a state to reach…”; and, “health must be potentially achievable for everyone in real life, in all circumstances, at every age, regardless of cultural or socioeconomic status, race, or religion, to avoid becoming utopia” (Leonardi, 2018, p. 740-741). Leonardi (2018) defines health based on his 9 features as “the capability to cope with and to manage one’s own malaise and well-being conditions” (p. 742). I like the flexibility in his definition which can potentially fit within any individual’s or group’s idea of health. Health, in my opinion, is based on how you adapt yourself physically, mentally, emotionally, and spiritually to your environment to promote your own idea of well-being. I am not sure there will ever be an agreed upon definition of health. However, I know we as humans all have our own definition of health. As healthcare professionals, we need to know our patient’s definition and develop their plan of care around this definition.
References
Fallon, C. K., & Karlawish, J. (2019). Is the WHO definition of health aging well? Frameworks for “health” after three score and ten. American Journal of Public Health, 109(8), 1104–1106.
Leonardi, F. (2018). The definition of health: Towards new perspectives. International Journal of Health Services, 48(4), 735–748.
World Health Organization. (2021). What is the WHO definition of health?.
