5.LOW SODIUM / HYPONATREMIA

Collected,Compiled,Edited and Presented by :-

DR.V.JAGANNATHAN

Hyponatremia is a condition that happens when we don’t have enough sodium in our blood.                                                                                                                         We often try to limit how much salt (sodium) is in the foods we eat, but it’s important to remember that our body needs a little bit of Sodium for normal functioning 

We need some sodium to control how much water is in and around the cells in our body. When we have low sodium in our blood, the amount of water in our body rises and causes cellular oedema. This can lead to some mild and other serious and even life-threatening problems.

Hyponatremia can happen because of certain medical conditions, some medicines, or by drinking  too much water.

Normal sodium levels. Our blood sodium level is normal if it’s 135 to 145 milliequivalents per liter (mEq/L).

If it’s below 135 mEq/L, you have hyponatremia.

Hyponatremia is a condition that means we don’t have enough sodium in our blood. It can happen because of certain medical conditions, some medicines we might be taking, or if we drink too much water.

Types of Hyponatremia

There are a few types of hyponatremia:

• Euvolemic hyponatremia happens when our total body water increases but our sodium level stays the same.
• Hypovolemic hyponatremia is when our body loses more water than sodium. 
• Hypervolemic hyponatremia happens when your body gains both, but gains more water than sodium.

Other types of hyponatremia include:

• Dilutional hyponatremia is when we drink too much water that is not fortified with electrolytes and salts. 
• Hyposmolar (or hypotonic) hyponatremia happens when we don’t have enough electrolytes. It can be caused by other forms of hyponatremia.

Hyponatremia Symptoms

There may not be any symptoms in case of MILD hyponatremia.                       Symptoms usually appear when our level of sodium suddenly drops.

Moderate to severe signs of hyponatremia may include:

• Nausea with vomiting
• Fatigue or low energy
• Headache
• Confusion
• Cramps or spasms in muscles
• Crankiness and restlessness
• Weakness

Causes of Hyponatremia

There are a lot of reasons why our sodium level might get too low. These include:

• 1) Medications. Diuretics and some antidepressants and analgesics can cause excessive sweating and more urination and that can affect our sodium level.
• 2) Health problems. Heart failure and kidney or liver disease can affect the amount of fluids in our body, and in turn, the level of sodium.
• 3) Chronic, severe diarrhea or vomiting can deplete our body of fluids and sodium.
• 4) Hormone imbalances. Some hormones affect sodium levels. A condition called SIADH (syndrome of inappropriate antidiuretic hormone) can cause water retension.                                       
• And Addison’s disease can affect the hormones that help keep our electrolytes in balance.                                 
• If  thyroid hormone is too low, it can also affect sodium level.
• 5) Drinking too much water. It can dilute the amount of sodium in blood. It usually happens when people drink too much during endurance events like marathons or triathlons and also lose sodium through their sweat.
• 6) Drinking too much alcohol. Alcohol is a natural diuretic, and lose sodium when you vomit.
• 7) Amphetamine has been linked to serious cases of hyponatremia.
• 8) Severe burns on a large part of the body. Loss of water from a burn wound can affect the balance of water in the body.

Risk Factors for Hyponatremia

Hyponatremia can happen by certain drugs. And  also more likely with certain conditions, including:

• Kidney disease
• Recent surgery
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Heart failure
• Diabetes insipidus
• Cushing’s syndrome
• Primary polydipsia, a psychiatric condition that makes you want to drink lots of water 
• Cirrhosis

Other things that may increase the risk of hyponatremia include:

Age. Older adults are generally more likely to get hyponatremia because they're more prone to develop chronic conditions that can result in a sodium imbalance. Changes related to aging and taking certain medications also play a role in the risk of hyponatremia in older adults.

Climate. The climate can also affect your risk of hyponatremia. For example, warm weather can cause  to sweat, which affects our sodium levels.

Physical activity.  When we drink too much water when doing something that’s physically very hard – like running a marathon –  may be more likely to get hyponatremia.

DIAGNOSIS

Some common tests include: 

• Basic metabolic panel,which includes a sodium blood test that looks at the concentration level of sodium in the blood
• Blood osmolality test, which looks at dissolved particles in your blood and can confirm imbalances
• Urine osmolality, a test that helps measure the concentration of chemicals in urine, with lower osmolality results confirming low blood sodium levels
• Urine sodium tests, which can find out the cause of abnormal sodium blood levels and can confirm whether our kidneys are causing sodium removal from your body

Usually, healthy sodium levels in the blood are 135-145 mEq/L (or mmol/L).

Hyponatremia Treatments

Since so many things can cause hyponatremia,  treatment depends on the cause of the condition and the severity

If we are on  diuretics or other drugs that can cause fluid imbalances or hyponatremia, the treatment plan has to be changed so that to avoid hyponatremia and the sodium in the blood can go back to a normal level.

If the low blood sodium was caused by a medical condition, then your best bet is to manage that condition.

If  hyponatremia occurs suddenly and it’s severe, emergency treatment is needed to boost the sodium level. Never try to treat yourself at home:

Rebalancing sodium and water levels is a delicate process, and medical staff need to monitor the process to make sure it happens safely. Hospitalisation may be needed to have:

• An IV with a sodium solution to slowly raise levels of Sodium in the blood over a few days
• Prescription medications to control symptoms like headaches, nausea, or seizures

Hyponatremia Complications

In cases of chronic hyponatremia, sodium levels are likely to drop very slowly over a few days and  symptoms and complications will be milder.

With acute hyponatremia,  sodium levels drop very quickly. This can cause:

• Rapid Cerebral oedema due to brain cell oedema
• Seizures
• Coma
• Death

There is a higher risk of getting brain damage from hyponatremia in people who  haven't gone through menopause. It is thought this may be because of how female sex hormones affect sodium levels.  

Some research suggests that hyponatremia, both chronic and acute, can also increase risk for bone osteoporosis.and fractures

Hyponatremia Prevention

There are several ways to prevent hyponatremia:

• If you have a condition that can lead to low blood sodium, like adrenal gland insufficiency, make sure you get it treated.
• Know the symptoms of hyponatremia. Watch for them if you take “diuretics
• Pay attention to how much water you’re taking in, especially if you take part in high-intensity physical activities. There are two reliable ways to know how much water you should have: your thirst and the color of your urine. You’re probably getting enough water if you don’t feel thirsty and your urine is a pale yellow color.

We should increase our water intake under certain conditions:

• 1) Hot weather and high altitudes. Being in the heat or in humid weather can cause you to sweat and increase the need for more fluid, and being at a high altitude can cause you to be dehydrated.
• 2) Health concerns. When we have diarrhea, a fever,  or are vomiting, our body loses fluid. Bladder infections and urinary tract stones also require an increase in fluids.
• 3) During pregnancy and while breastfeeding. We need more water during pregnancy or breastfeeding, as these conditions can also cause to be dehydrated.
• 4) Before, during, and after a workout. We lose fluid when we sweat, so it's important to stay hydrated while exercising. If necessary you  should drink sports beverages instead of water while doing intense physical activities. These drinks have electrolytes that include sodium.
• BE AWARE OF HYPONATREMIA AND BE SAFE

 

DR.V.JAGANNATHAN