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Thread: SCI Nurse - Low Sodium, What'a good source?

  1. #1
    Senior Member NWC4's Avatar
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    SCI Nurse - Low Sodium, What'a good source?

    SCI Nurses (or others),

    I have a chonically low sodium level. It usually ranges from 122 - 128 and has been as low as 118.

    What's a good source of sodium? Doc keeps telling me to cut back on my fluid intake, but I need to keep S/P catheter flowing and preferably UTI free. V8, orange juice, tea, and water are what I drink the most. (In reverse order by quantity.)

    I've tried Gatoaide and other "power drinks", but I usually feel lousy when I do so.

    Is bullion, chicken and/or beef, in hot water?

    Any foods other than patato chips and Friedos? Consentrated Campbell's Chicken Noodle soup?

    Thanks for any suggestions!

  2. #2
    Eat chinese food! Even top ramen is loaded with sodium. Also, most canned foods (especially soups) contain a great deal.

    Sandi

  3. #3
    NWC4,

    Sodium is ordinary table salt. You can sprinkle more salt onto your food or eat salt pills. However, before you take any corrective measure, it is important to determine why you have low serum sodium (hyponatremia). Serum sodium levels are normally maintained under very precise control by thirst (which regulates fluid intake), antidiuretic hormone (which regulates fluid output by the kidney), and kidney handling of sodium (which is regulated by aldosterone secreted by the adrenal glands).

    How much fluid are you drinking? It takes a huge amount of fluid to dilute your sodium from normal levels of about 140 mM to 122-128. If your kidneys are working properly, you should be able to pass enough fluid to bring sodium (Na) levels to normal. Normal kidneys can pass up to 14 liters a day. The only way that you would cause low serum sodium from drinking too much water is if you are drinking so much fluid that you are exceeding the water output capacity of your kidneys. If you are indeed doing this, it suggests that your kidneys are retaining more water than they should or you are losing sodium. Let me discuss each of these in turn.

    Retaining water. The pituitary hormone ADH (anti-diuretic hormone) regulates the amount of water passed by the kidney. As its name implies, excessive ADH would stop diuresis (loss of water) by the kidneys. Inappropriate ADH syndrome can result from some diuretic medications, hormonal conditions, congestive heart failure, cirrhosis, or renal failure.

    Sodium Loss. But, you may be losing sodium through the kidneys as a result of use of diuretics (some blood pressure medications), kidney damage, or hypoaldosteronism (aldosterone is a hormone that tells the kidneys to conserve sodium). It is possible that you may be losing sodium through vomiting, diarrhea, wound drainage, sweating, ascites, or peritonitis, but you would probably know and be complaining of these conditions.

    How do you tell what you have? You need to have three tests.
    • Measure serum osmolality. Serum osmolality is usually about 175-290 mOsm, i.e. 140 mM sodium, 4 mM potassium, 135 mM chloride, and 10-15 mM of calcium, magnesium, glucose, urea, and other osmotic substances. Most people with hyponatremia (low serum sodium levels), particularly in the range of 125-130 mM, have low serum osmolality. If serum osmolality is high, i.e. hyperosmolar hyponatremia, the most common cause is high glucose from diabetes.
    • Measure urine osmolality after a water load. This is a measure of total solutes in the urine. Normally, after a water load, you should have dilute urine with urine osmolality of 50-100 mOsm/kg or less. If you have impaired renal water secretion, you may have urine osmolality or 200 mOSm/kg or greater. Note that if you have inappropriate ADH syndrome where there has been a resetting of your osmostat to maintain your serum sodium between 125-130 mEq/L, you will have dilute urine.
    • Measure urine sodium concentration. Urine sodium should be around 10-20 mM. Inappropriate ADH syndrome will result in high urine sodium. Incidentally, high urinary sodium (>30 mM) may be associated with pain, cortisol deficiency, and hypothyroidism. Low urine sodium (<10 mM) may be due to congestive heart failure, cirrhosis, and renal failure.

    Treating hyponatremia
    • The first step is to eliminate common causes of hyponatremia, such as medication. A number of blood pressure and other medications can cause hyponatremia and inappropriate ADH syndrome. Likewise, hypothyroidism can cause hyponatremia. Adrenal insufficiency may also cause hyponatremia (low aldosterone). If you are taking drugs that cause hyponatremia, you should obviously change or adjust them. If you have hypothyroidism or adrenal insufficiency, these need to be treated.
    • Water restriction and increasing dietary sodium. If the above causes are not present and you are drinking in excess of 4 liters of water per day, you should consider reducing your water intake. You may want to add sodium (salt) to your diet.
    • Loop diuretic. If the cause of the hyponatremia is due to renal retention of water, a loop diuretic such as furosemide (Lasix) may be indicated.

    Care should be taken to correct chronic hyponatremia slowly over a period of several days or even weeks. Use of hypertonic saline (i.e. saline with higher than 145 mM NaCl) should be avoided as a treatment for chronic hyponatremia. The reason is that rapid correction of serum sodium may cause central pontine myelinolysis.

    If you want to read more about this subject, try http://www.postgradmed.com/issues/2000/05_00/fall.htm

    Wise.

    P.S. I am concerned that your doctor is not more concerned. You need a second opinion, by somebody who is more experienced with hyponatremia.

  4. #4
    You can take sodium tablets. Check with your physician on this. Gatorade and most "sports" drinks are also high in sodium. Limit your water intake. If your sodium is chronically low, your renal (kidney) function needs to be checked.

    (KLD)

  5. #5
    Senior Member Van Quad's Avatar
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    I've increase my sodium intake by having a nice warm mug of miso every morning after breakfast. Based on a doctor's suggestion to raise my BP.

  6. #6
    Senior Member NWC4's Avatar
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    Thanks Dr Young! I'll address this with my Urologist. On the same blood test my Creatinine Serum was 0.5 mg/dl.

    Does this suggest renal problems?

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