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Hyponatremia: Understanding Low Blood Sodium
Hyponatremia is diagnosed when there is too little sodium in your blood. It can be caused by a variety of factors.
Sodium is an essential electrolyte that helps maintain the balance of water in and around your cells. It's important for proper muscle and nerve function. It also helps maintain stable blood pressure levels.
Insufficient sodium in your blood is known as hyponatremia. It occurs when water and sodium are out of balance. In other words, there's either too much water or not enough sodium in your blood.
Normally, your sodium level should be between 135 and 145 milliequivalents per liter. Hyponatremia occurs when your sodium level goes below 135 mEq/L.
Symptoms of low blood sodium can vary from person to person. If your sodium levels fall gradually, you may not experience any symptoms at first, but they will eventually manifest. If they drop very quickly, your symptoms may be more obvious and severe.
Common symptoms of hyponatremia include:
Severe symptoms of hyponatremiaLosing sodium quickly is a medical emergency. It can cause:
If you or someone you know seems to be losing consciousness or is having a seizure, call 911 immediately.
Many factors can cause hyponatremia. Your sodium levels may get too low if your body loses too much water and electrolytes. Hyponatremia may also be a symptom of certain medical conditions.
Causes of hyponatremia include:
Certain factors increase your risk of hyponatremia, including:
If you're at risk for low sodium, you may need to be more careful about your intake of electrolytes and water. Make sure to talk to your doctor about your risk factors and if there are any steps you can take to lessen your risk.
If hyponatremia is not treated, it can lead to serious complications, including:
If you are at a higher risk for hyponatremia due to preexisting conditions, it's important to take any new symptom seriously and talk to a doctor as quickly as possible.
A blood test can help your doctor check for low sodium levels. Even if you don't have symptoms of low blood sodium, your doctor may order a basic metabolic panel. This tests the amounts of electrolytes and minerals in your blood.
A basic metabolic panel is often part of a routine physical. It may identify low blood sodium in someone without any symptoms.
If your levels are abnormal, your doctor will order a urine test to check the amount of sodium in your urine. The results of this test will help your doctor determine the cause of your low blood sodium:
If your doctor is still unsure of a diagnosis, they may order a few other tests to check for hyponatremia, including:
Treatment for low blood sodium varies depending on the cause, how severe the symptoms are, and how low your blood sodium levels are. It may include:
Keeping your water and electrolyte levels as balanced as possible can help prevent low blood sodium.
If you're an athlete, it's important to drink the right amount of water during exercise.
You may also want to consider drinking rehydration beverages. These drinks contain electrolytes, and help replenish sodium lost through sweating. These drinks are also helpful if you lose a lot of fluids through vomiting or diarrhea.
Staying hydrated throughout the day can help manage any wild swings in blood sodium. When you're adequately hydrated, your urine will be pale yellow or clear, and you won't feel thirsty.
It's important to increase your fluid intake if:
Don't forget that it's possible to drink too much water too quickly. This is another reason to maintain good hydration throughout the day.
Hypernatremia is a condition that is closely related to hyponatremia.
What is hypernatremia?While hyponatremia involves low levels of sodium in the blood, hypernatremia occurs when there is too much sodium.
When a person doesn't get enough water, either because of limited access to water or an impaired thirst mechanism, they can develop hypernatremia. It's caused less commonly by diabetes insipidus.
Hypernatremia occurs when your serum sodium level exceeds 145 milliequivalents per liter (Eq/L).
Hypernatremia can cause:
Hyponatremia is diagnosed when there is too little sodium in your blood. It can be caused by a variety of factors, from conditions like Addison's disease or Cushing's syndrome, to excessive vomiting or diarrhea.
Hyponatremia can be mild, and cause no symptoms, or it can be very severe and life threatening.
Typically, if hyponatremia is caught in the mild stage and treated, or treated swiftly in the severe stage, it can be reversed.
Sodium And Potassium: What We Need To Know About The Signs And Risks Of Their Imbalance
53-year-old Susheela Sinha was rushed to the hospital when she suddenly got delusional. The family panicked and rushed her to the emergency, where it was found that her sodium levels had dropped. While we often talk about nutrients like calcium, iron, Vitamin B12, Vitamin K and more, two electrolytes that seem to get ignored are sodium and potassium. Dr. Atul Bhasin, Director, Internal Medicine, BLK Max Super Speciality Hospital shares, "Both the electrolytes are important for the human body. Any imbalance needs to be diagnosed early and treated aggressively. Patients of cardiac disease, diabetes, renal failure, and elderly on hypertension medicine need to be very vigilant to these symptoms."
According to Dr. Veenu Gupta, Senior Consultant, Department of Internal Medicine, Amrita Hospital, Faridabad, "Sodium and Potassium are two of the very important minerals in the body, the other being calcium, magnesium, chloride, bicarbonate and phosphate. An electrolyte imbalance occurs due to alterations in the body's water content. Several factors like excessive sweating, not eating or drinking enough, medications, heart or kidney diseases, vomiting or diarrhea, can affect our fluid and electrolyte balance in the body. Any drop or increase in the electrolyte levels below/above the normal range can have deleterious effects on the body depending upon how acute and how severe the changes are."
What are the normal levels?
The normal sodium levels in the adult human body are—136-145 meq/l. The maximum recommended daily intake for sodium is 2,300 mg.
The normal potassium levels in the adult human body are—3.5-5.2 meq/l. Maximum of 2,600 mg for adult females and 3,400 mg for adult males per day.
Risks of low levels of sodium
Sodium regulates fluid balance and supports healthy neuron and muscle function. Dr. Atul explains, "Low levels of sodium are called hyponatremia. Hyponatremia can be due to excessive water retention in the body causing dilution of sodium in blood or less intake of sodium. It needs to be corrected under medical supervision. Patients develop nausea, headache, fatigue, muscle weakness, spasms. If not treated, it progresses to lethargy, disorientation, confusion and unconsciousness."
Low sodium levels are frequently discovered by accident during normal blood tests. Signs and symptoms of hyponatremia are generally related to the underlying cause, and degree of fluid loss or dehydration, the degree of hyponatremia and the rate at which it develops. Typically, the indications and manifestations of mild hyponatremia are vague, such as feelings of nausea and fatigue. People with mild, long-term hyponatremia are often asymptomatic. The occurrence of severe or rapid-onset hyponatremia may result in disorientation, agitation, unsteadiness, seizures, coma, and even death due to cerebral edema.
Hypernatremia (high sodium levels) is much less commonly encountered in general practice than hyponatremia but when it does occur it is associated with a high mortality rates. The signs and symptoms of hypernatremia are primarily neurological and can include lethargy, weakness and irritability. In cases of more severe hypernatremia or a sudden increase in sodium levels, there is a risk of developing muscle twitches, seizures, coma, and even death.
Risks of low levels of potassium
Hypokalemia can be due to drugs, renal diseases. Symptoms are weakness, muscle cramps, constipation and abnormal heart rhythm or feeling of skipped heartbeats or irregular heartbeat. This is easily diagnosed with Electrocardiogram abnormalities.
Treatment involves correction of imbalance by stopping the offending drugs, oral or intravenous supplementation under strict medical supervision, adds Dr Bhasin.
The occurrence of serum potassium imbalance is higher among the elderly population and individuals with co-existing medical conditions such as renal impairment and congestive heart failure. Patients may experience irregular, fast or slow heartbeats, fatigue, tremors, muscle spasms, tetany, constipation, respiratory distress, confusion, paralysis, or memory loss.
Hyperkalemia (raised serum potassium level) is most commonly caused as an adverse effect of a medicine or secondary to a disease process. Hyperkalemia is often asymptomatic. The presence of symptoms is often characterized by non-specific indications such as nausea, vomiting, and less frequently by muscle pain, weakness, paresthesia, or flaccid paralysis. Patients may also complain of palpitations and moderate to severe hyperkalemia can result in cardiac disturbances and fatal arrhythmias, adds Dr Veenu.
Signs and symptoms to know
Dr Veenu shares the common symptoms of electrolyte imbalance which a common person should know:
Paresthesias i.E. Experiencing numbness or tingling sensations in the hands or feet.
Nausea and vomiting.
Fatigue.
Confusion and irritability.
Diarrhea or constipation.
Fatigue.
Headaches.
Fast or irregular heart beat .
Muscle cramps or weakness.
Seizures, coma or sudden cardiac arrest in case of sudden or significant changes in electrolytes
How to ensure optimum levels
Everyone needs to ensure that people consume their recommended daily amount of electrolytes.
One of the important steps is to ensure proper hydration. So drink at least 7-8 glasses of water per day. Along with water, people should have fruit juices, milk, coconut water, buttermilk, lemon water etc.
Dr Veenu adds, "People with diabetes, heart disease, kidney disease or other comorbidities should take precautions regarding oral intake of adequate recommended fluid intake. Appropriate medications, and timely treatment of infections are essential. People should also avoid self-medication as many drugs can lead to electrolyte imbalances."
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Hyponatremia Is A Common Cause
I can only underline the study results reported by Zieschang et al. (1).
Patients in a confusional state who are mostly older and over 65 years of age are transferred by relatives, emergency physicians, but also other somatic wards to optional protected gerontopsychiatric wards because they "can't be controlled."
A very common cause is hyponatremia of unclear etiology. Clinically, the dominant symptoms in addition to pronounced cognitive deficits are agitation, fear/anxiety, perplexity/helplessness, and depressive symptoms.
The clientele of patients with hyponatremia is extremely heterogeneous and diagnoses at admission vary. In my opinion, however, one aspect of the etiology was not given enough room: pharmacogenic hyponatremia.
The authors did discuss that hyponatremia is often facilitated, or even triggered by (in many cases) inadequate pharmacotherapy (for example, with thiazide diuretics), but they did not provide a detailed list/explanation of the potentially risky medications. Especially antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), entail a fivefold risk for hospital admission subsequent to hyponatremia (2).
Antipsychotic drugs are also associated with an increased risk for hyponatremia—and they are used particularly often in geriatric and gerontopsychiatric patients (3).
Furthermore, diverse anticonvulsive drugs, analgesics (especially non-steroidal anti-inflammatory drugs), and cytotoxic substances range among the medications associated with a high risk. Rastogi et al. (4) summarize typical at-risk patients for hyponatremia as follows:
If we extend the spectrum to also include gerontopsychiatric patients, who may be treated with an SSRI or antipsychotic drug, the risk probably rises further.
For this reason, a careful risk-benefit analysis should be done in at-risk patients before initiating pharmacotherapy.
DOI: 10.3238/arztebl.2017.0289a
PD Dr. Med. Arnim Quante
Klinik für Psychiatrie und Psychotherapie
Friedrich von Bodelschwingh-Klinik, Berlin
a.Quante@fvbk.De
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