Hyponatremia

Hyponatremia is a condition where sodium levels in your blood are lower than normal. In many cases, too much water in your body dilutes sodium levels. It’s also possible to lose too much sodium. You may have a short-term treatment plan or a long-term plan.

Hyponatremia is a term for having a blood sodium level that is lower than normal. If you have blood tests, you’ll see it listed as “sodium” or “Na+” in your lab results.

Sodium and potassium levels in your blood are important. The correct ratio of these elements to the amount of total water in your body needs to stay in balance to make sure you stay healthy.

Actually, the main problem in a vast number of situations is too much water that dilutes the Na+ value. As a result, water moves into body cells, causing them to swell. This swelling causes a major problem in brain cells, which is a change in mental status that can progress to seizures or coma.

Many diseases and medications can cause hyponatremia. Most people recover fully with their healthcare provider’s help.

Unless your provider tells you something different, let your thirst be your guide in terms of how much water you drink.

Hyponatremia is very common. It’s actually the most common chemical abnormality seen among people who are in the hospital and seen in outpatient clinics. Rates of hyponatremia are higher among people admitted to hospital care units or with the medical conditions mentioned earlier.

Hyponatremia causes neurologic symptoms ranging from confusion to seizures to coma. The severity of the symptoms depends on how low the sodium levels are in the bloodstream and how quickly they fall. In many cases, blood sodium levels fall gradually, producing only mild symptoms as the body has time to make adjustments. Symptoms are more serious when blood sodium levels fall quickly.

Other signs and symptoms of moderate to severe hyponatremia include:

• Muscle cramps or weakness.
• Nausea and vomiting.
• Lethargy, or low energy.
• Headache.
• Mental status changes.

Hyponatremia is very dangerous for many organs, but especially for the brain.

Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your

• blood glucose is too high
• blood pressure is too high

African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.

You are also more likely to develop kidney disease if you have diabetes and

• smoke
• don’t follow your diabetes eating plan
• eat foods high in salt
• are not active
• are overweight
• have heart disease
• have a family history of kidney failure

Your provider will do a diagnostic workup if your blood sodium is low. The workup will include measuring urine sodium, potassium and creatinine concentrations. It will also include blood tests that indirectly show your total body water, your levels of sodium (Na+) and, in some case, levels of hormones that regulate water uptake by the kidneys. Your provider will also take a medical history and ask you questions, as well as do a physical exam. These steps will help them find out how low your sodium level is and why you have hyponatremia.

Your provider may ask you:

• What kind of sports you participate and how you train.
• What kind of prescription medications you take.
• What kind of medical conditions and surgeries you have or have had in the past.
• How much alcohol you drink, especially beer.
• Whether you take illegal substances like 3,4-methylenedioxymethamphetamine (MDMA, but also called Molly, E or Ecstasy).

You and your provider will work together to find the best treatment for the low blood sodium levels. Treatment depends on the underlying cause and the severity of your symptoms.

If you have mild symptoms, your provider makes small adjustments to correct the problem. Treatment may be short-term or long-term. A short-term treatment includes:

• Limiting water intake.
• Adjusting or stopping medications.
• Treating underlying causes.

A long-term treatment plan may include:

• Limiting water intake.
• Adjusting or stopping medications, or adding newer medications.
• Adding salt to your diet.

If you have moderate to severe hyponatremia, you probably will need to go to the hospital for thorough medical evaluation and treatment. People with most serious cases of hyponatremia will probably get replacement sodium intravenously (straight into a vein). They’ll also have to limit their water consumption.

Your provider may prescribe a medication like tolvaptan (Samsca®) or conivaptan (Vaprisol®) to correct blood sodium levels.

Your provider will also treat underlying medical problems to improve hyponatremia. These conditions include heart failure, kidney failure and cirrhosis of the liver.

In many cases, hyponatremia causes extra water to move out of the bloodstream and into body cells, including brain cells. Severe hyponatremia causes this to occur quickly, resulting in swollen brain tissue. If left untreated, complications can include:

• Mental status changes.
• Seizures.
• Coma.
• Death.

If you have certain underlying medical conditions, you may be more likely to have low blood sodium levels. You can lower your risk for hyponatremia by following your treatment plan and restricting your water intake to levels recommended by your healthcare provider.

You should always tell your provider about any new symptoms right away. If your provider is monitoring your blood sodium levels, you’ll need to take blood tests.

Here are some tips that may help you prevent hyponatremia:

• Don’t drink too much beer and/or other forms of alcohol.
• Drink enough water, but not too much water.
• Don’t take MDMA.
• If you’re an athlete, don’t forget to include electrolytes when you’re hydrating during sporting events.
• Take care of yourself by managing your medical conditions consistently and well.
• Eat a balanced diet, including food with high value protein content.

With treatment, many people recover fully from hyponatremia. Your healthcare provider can help even if you have long-term hyponatremia.

Older adults and people who are in the hospital for a long time may have worse outcomes.