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Hyponatremia: A Common Treatable Condition That Can Go Deadly When Acute

The prevalence of Hyponatremia in India is 27%. People are more likely to have it in the warm humid months.

The term Hyponatremia may be relatively unknown. But the outcome is common knowledge for many. That's right, it is a familiar electrolyte (minerals with electric charges) imbalance. A condition that you will most certainly know by its colloquial name ‘sodium fall’.

Low sodium in the blood can have several trigger points. Rising temperatures, regular no-salt diets, and many more. But one thing that can help you fight it better is your prior awareness of the situation. So, let's get into the specifics. And try to sort out the ideal approach to Hyponatremia to prevent or limit its occurrence.


What is Hyponatremia?

For you to perform at an optimal level, the desired range for blood sodium is between 135 to 145 milliequivalents per liter (mEq/L). When that amount falls under 135mEq/L, the condition is defined as Hyponatremia. During this, the human body tends to retain too much water. This dilutes the sodium content, making it go below the required quantity. The situation can get life-threatening if the levels steep further down to 125 mEq/L or less.


Types of Hyponatremia

There are different categories of Hyponatremia. Understanding the subtle differences can aid in determining the appropriate treatment for Hyponatremia.


Euvolemic Hyponatremia

In this case, the level of sodium remains unchanged. It is the water content that increases resulting in sodium dilution.


Hypervolemic Hyponatremia

Here, there is more increase in the total body water than that of the total body sodium.


Hypovolemic Hyponatremia

In this regard, the decrease in total body water is more than that in total body sodium.


Dilutional Hyponatremia

Also known as ‘water intoxication’, it refers to excess water intake. And that too without including important minerals like sodium, calcium, potassium, etc.


Hypoosmolar Hyponatremia

Here, the body has low amounts of proteins, nutrients, and electrolytes (including sodium). This condition is also termed Hypotonic Hyponatremia.


Hyponatremia Symptoms

Knowing the Hyponatremia signs and symptoms beforehand drives a better reaction. And many times, that is all it takes to prevent the condition from getting worse. Make sure you consult a doctor if you notice the following symptoms.



  • Nausea

  • Vomiting

  • Confusion (disoriented thoughts)

  • Lack of energy/ fatigue

  • Sleepiness

  • Headaches

  • Irritation or restlessness

  • Weak muscles

  • Muscle cramps/ spasms

  • Seizures (causes abnormality in movement, behavior, or state of awareness)

  • Coma


Hyponatremia Causes

Sodium is a key component in our body. Why? Well, it helps with the following:

  • Regulates blood pressure

  • Maintains a fluid balance

  • Aids the muscles and nerves to perform at their very best

An unnatural reduction in sodium levels can be influenced by various factors. Some of the most common reasons behind Hyponatremia are as follows.

  • Diuretic therapy (This treatment uses diuretics or water pills. They help remove excess fluid by assisting the kidneys to add extra salt and water into your urine)

  • Undiagnosed diarrhea

  • Severe vomiting

  • Medications like antidepressants and pain medications (They often disrupt kidney and hormonal functioning. This further interferes with sodium levels)

  • Having diets devoid of salt

  • Drinking excess water or fluids

  • Addiction to alcohol (chronic drinking)

  • Warm climatic conditions (The risk of hospitalization increases at temperatures above 15 °C).


Who Is At More Risk Of Having Hyponatremia?

The above-mentioned Hyponatremia causes apply to all individuals. But it is the aged adults who are most vulnerable. The reason is pretty straightforward. They usually take more drugs (pain relief medicines for instance). Also, they face a greater chance of having disorders that carry the potential to lead to sodium falls.


Talking about diseases, here is a list of disorders that may cause Hyponatremia:

  • Congestive Heart Failure (Heart is unable to pump blood adequately)

  • Syndrome of Inappropriate Antidiuretic Hormone (SIADH makes your body hold onto water)

  • Cushing’s Syndrome (Here the body makes an excess of the steroid hormone cortisol)

  • Addison's disease (It damages the adrenal gland)

  • Kidney failure (When the kidneys are unable to remove extra fluid from the body)

  • Primary Polydipsia (Causes excessive thirst leading to too much water intake)

  • Diabetes Insipidus (A rare disease where the body makes too much urine)


Treatment for Hyponatremia

The process of treating Hyponatremia differs from person to person. Here is a list of elements that play their part in the doctor's instant approach to Hyponatremia:

  • The kind of Hyponatremia signs and symptoms present

  • The gravity of the situation (whether mild or acute)

  • Identifying the underlying cause

  • Determining the presence of Hypotension (low blood pressure) of any degree

Mild Hyponatremia Treatment

The following cures can both be short-term and long-term as per the needs of the patient.

  • Limiting the amount of water intake

  • Adjusting the dosage of medications or stopping them for a certain time

  • Treating the potential underlying issue

Severe Hyponatremia Treatment

Chronic cases of Hyponatremia call for immediate hospitalization and more aggressive remedies. The options may include the following:


Intravenous fluids

The doctor can recommend an IV sodium solution to increase the blood's sodium content. It is a gradual process and requires constant monitoring. That’s because a rapid increase in sodium levels may be fatal.


You may have to take drugs to manage the Hyponatremia symptoms. Some familiar Hyponatremia medications are:

  • Loop Diuretics such as Furosemide (Used to treat Congestive Heart Failure and Kidney issues, that lead to Hyponatremia)

  • Arginine Vasopressin (Treats Diabetes Insipidus, one of the potential causes of Hyponatremia)

  • Receptor Antagonists such as Tolvaptan (Helps treat heart failure and SIADH)

  • Urea (Controlled usage helps with brain swelling and water excretion)

  • Salt tablets


How to Prevent Hyponatremia?

Hyponatremia medications and other forms of therapy are crucial to treating the issue. But there’s no better alternative to preventing the condition altogether. Here are some home remedies to stay on the right track.

  • Treat the underlying conditions without any delay.

  • Educate yourself to detect the symptoms of Hyponatremia early.

  • While doing high-intensity exercises (like races), try to limit fluid intake. Keep the amount at par with how much is lost due to sweating. You may also consult doctors to go for electrolyte-containing beverages instead of water.

  • Avoid excessive drinking of water. Consider your thirst and urine color to determine your body’s need for water.

  • Do not feed infants with plain water. Their kidneys cannot concentrate urine effectively.


Will Hyponatremia Go Away?

Is Hyponatremia curable is a common query I get to hear from my patients. The good news is while rapid sodium decrease is fatal, such scenarios are less common. In most cases, if you cut excess water sources, the kidneys work their way out to stabilize sodium levels. Hence, Hyponatremia is treatable unless too acute.


Final Thoughts

Hyponatremia can lead to seizures, and in severe cases, coma and even death. So, try to track the early symptoms and contact your primary care physician without delay. They can provide the initial treatment and advise you on your next step. In the meantime, try to maintain a balanced lifestyle. This will improve your overall well-being and help reduce the chances of Hyponatremia.

 

The Author :

Dr. Sunil Khattri

sunilkhattri@gmail.com

+91 9811618704



Dr Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practicing Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi.

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