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Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion?

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Oncologist, Radiation
Practicing since : 2007
Answered : 526 Questions
Hi, My Mom is 76 years old. She is having sodium deficiency. Mom was brought to see a Docter and he instruct the nurse to give NaCl 0,9% 500 ml and Kcl 50 mg transfusion. This transfusion for within 48 hours.
Her blood test result :
Natrium # 129
Kalium # 2.1
Hemaglobin 10.9
Hematocrit 30
Entrosit 3.5
Mcu 85
Moh 31
Mohc 37
Row 13.2
Leucosit 12.2
Basofil 0%
Eosofil branch 0%
Eosofil Segment 81%
Limsofit 13
Monosofit 4
Trombosit 304
Retikulosit 1.2
Led 1 hour 33
GOT 23
Gpt 23
Glucosa 225
HbA1a(A1c) Ngsp 5.3
Hb1c (A1c) lfcc 34
Cholestrol 209
Creatin 1.08 ELFG CHLORIDE 80Calcium 9
Magnesium 1.51.

Medicine she takes Norvasc;Cefspan 200, Nexium 20 mg, and Disflatvi 40 mg.

What is the cause of sodium deficiency ???fe
Posted Sun, 7 Jul 2013 in Cancer
Answered by Dr. Dipanjan Majumder 4 hours later
Thanks for posting your query at XXXXXXX forum.
Let me give you an information. Sodium deficiency means hyponatremia.
Normal serum sodium levels are between 135 and 145 mEq/L.
Hyponatremia is defined as a serum level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L.
So your mom has got sodium deficiency but it is mild.
Hyponatremia can be of three types-
1) Hypervolemic hyponatremia,
2)Euvolemic hyponatremia,
3)Hypovolemic hyponatremia

Those conditions can be differentiated. But at present your mom has got potassium deficiency which should be managed more carefully. Your doctor has advised KCl infusion. That will take care of her Potassium deficiency.
EKG should be done because potassium has role in myocardial conduction. Consult XXXXXXX medicine specialist. I will be available for follow up.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 3 hours later
The blood test above was the second blood test. the first blood test was worse. At that time Mom seemed not conscious. This is the SECOND TIME Mom has sodium Deficiency, 1. in March 2011 when He failed down and injured her spine at T12
2. Two weeks ago almost or considered not conscious. The first blood test
was worse than above blood test. Then a house nurse gave 8 bag of
infusion with out Doctor authorization which I have stopped it after 8
bags. After that we take a blood test as above and check by XXXXXXX
who instruct house nurse to infuses NaCl and KCL as mentioned

From the test above could we know the Condition of her Heart,Kidney and Liver ???
What cause Sodium and Kcl deficiency ???

Answered by Dr. Dipanjan Majumder 1 hour later
Actually causes of hyponatremia can be found out after some laboratory tests. Plasma Osmolality to be done first. causes like hyperglycemia, hyperproteinemia, hyperlipidemia can be ruled out. She is hyperglycemic. Plasma glucose 225 as written by you. The next step is calculation of urine sodium concentration.

The exact condition of kidney, heart and liver can not be commented from above reports.

Many a time malignancy is associated with hyponatremia called SIADH.

At present detailed biochemical examination can be done to find out the cause of potassium depletion.
Urinary potassium excretion should be measured. Depending on its value acid-base imbalance can be suspected also transtubular patassium concentration gradient should be calculated.

All these investigations can be done in a step wise manner depending on the clinical course of disease.
Your physician can guide you better.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 40 minutes later
She is not in hospital but staying at home. So I really need your guidance.
Answered by Dr. Dipanjan Majumder 4 hours later
I can understand your concern.
She is suffering from dyselectrolytemia. Specially the value of potassium is below the normal level. I have mentioned earlier that potassium has got enormous importance specially for normal cardiac function.

So please try to admit her at nearest hospital. Potassium supplement to be given under supervision. It is difficult to manage at home. EKG monitoring is essential.

Hope I have clarified your queries. I will be available for follow up queries.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 7 hours later
This is really hard situation to face. Even I never know about medical but I know
she is in bad shape. Thank you to advice me what suppose to be done as soon as possible.

Could you explain to me in detail what might be damaged by dyselectrolytemia ???
I read that dyselectrolytemia is electrolyte disorder and might damage Lung. I know Mom has liquid in lung and the Nurse steams/inhaler her nose. And seem like she has kind of chest pain and she loss weight 7 Kg within few days.

After infusion of NaCl and Kcl, another blood test is taken today, I would let you know soon. And on Monday I inform you about urine test as you suggested.

Answered by Dr. Dipanjan Majumder 7 hours later
Dyselectrolytemia comprises of hypo/hyperkalemia, hypo/hypernatremia, hypo/hypercalcemia, and altered magnesium concentration etc.

It is better to know that electrolyte imbalance is not disease itself rather manifestation.

As you have mentioned fluid in lung that means she has pleural effusion. The cause should have been found out.

Routine examination including biochemical examination of pleural fluid should be done to find out the nature of effusion like exudative or transudative.

If she has fever then a blood culture is also essential.

Regular monitoring of serum electrolytes, blood sugar and kidney function test to be done.

Dyselectrolytemia may be responsible for neurological and cardiac problems. To better understand that I have to use some medical terms.

As your mother has hypokalemia, she may have to face the problem like delayed ventricular repolarisation. That is difficult to understand.

Anyway, she should be kept under close medical supervision. Consult your physician.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 10 hours later
I failed to convince my brothers and sister to take Mom to hospital. They all see Mom is getting much better and think I am totally wrong about Mom condition.

The Blood test result as follow :
Hemaglobin 10.7 Entrosit 3.41 Hematokrit 31 Trombosit 271
Leucosit 13.52 Basofil 0 Eosinofil 2 Neutrofil Branch 2
Neutrofil Segmen 82 Limfosit 10 NATRIUM 128.5 KALIUM 2.8
Calcium Total 9.2 Chlorida 84.2

Yesterday the Doctor instructed to infuss NaCl 2000 ml (4 Bags) and Kcl 50 XXXXXXX for two days (till Tuesday).

Looking at previous and recent Natrium,there is no improvement after 1000 ml NaCl
infusion. Kcl has improvement from 2.1 to 2.8.
What is the effect of too much Nacl and Kcl infusion to her body ????
Am I right if I assume the previous NaCl and Kcl infussion was wasted in Urine ???
One week ago I remember her Hemaglobin was 12 Now 10.7. Seem it decrease slowly.
Answered by Dr. Dipanjan Majumder 35 minutes later
Her condition is better now.

potassium infusion works. The sodium is also acceptable because rapid correction of sodium is not required. But the diagnosis can not be done if home based management is to be continued.

Have an EKG if possible. You may repeat the blood reports after 24 hours.

I will be available for follow up. Hemoglobin is within acceptable limit. But leucosite count is high. May be there is an infective etiology. Antibiotic can be considered.

Take care of your mom.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 13 hours later
I asked that is it possible that sodium from her body carry out through urine ??? If it is then what would be the effect giving her more and more NaCl 0.9% 2000 ml and Kcl 50 meg???
From previous and recent blood report there is no significant increase in NATRIUM ????
Answered by Dr. Dipanjan Majumder 5 hours later

Let me assure you that hyponatremia (less sodium in blood) can be a serious event when the value decreases severely. Lower normal value of sodium 135 mmol/L. As you have stated, sodium value is 129. That is mild hyponatremia. The management in this case can be simple oral salt addition by mouth or by Ryle’s tube. But the other causes of sodium depletion like heart failure, chronic renal failure, and hepatic diseases to be ruled out.

Na+, K+ has special channels for excretion from our body located at nephrons (in kidney). If there is no hormonal cause like inappropriate secretion AVP (related to control of water reabsorbtion) the balance between solute and solvent will be maintained.

To answer your specific query, the concentration of fluid that is given to correct the electrolyte imbalance is such that renal excretion can not affect it.

For your better understanding I can add
Renal excretion of potassium is [Glomerular filtration rate. plasma K+ concentration] and 90 % of it is reabsorbed by proximal tubule (part of nephron).

So KCl infusion will take care of hypokalemia independent of renal loss. Normal saline has minimal role in correction of hyponatremia but at this stage her hyponatremia correction is not the primary endpoint. It will be better to treat the infection first. The sodium will be normalised.
Hope I have answered your queries. Thanks for asking me.
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Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 29 minutes later
Four weeks ago She fall down and injured her elbow.Now her elbow still has bruises.
Do you think elbow injury could initiate the infection ??? Before She fall down, She was just fine.
Answered by Dr. Dipanjan Majumder 13 minutes later
Elderly people has less resistance than normal young. Mild trauma can even precipitate infection. But any injury if at all infected has got typical features that can give the clue of underlying infection. But bruises are not infective.

Probably the source of infection is not the elbow injury. Her blood sugar is raised so there is a chance of easy infection if any open wound is there.

In my opinion urine routine and microscopic examination followed by culture sensitivity should be done.

Take care of your mom.
Above answer was peer-reviewed by
Follow-up: Having sodium deficiency. Take norvas and nexium. Done with blood test. Suggestion? 4 hours later

I like to ask about myself. I always suffer pain during period. Sometimes I could not stand the pain and has to take pain killer.
Docter said I has Endometeosis. It could take 1 or 2 days suffering such pain in the tummy.
Could you advice ????
Answered by Dr. Dipanjan Majumder 21 minutes later
You have got endometriosis. It means growth of endometrium ( inner lining of uterus) in the abnormal position.

Ovarian hormone causes endometrial growth that sheds off during menstruation. But abnormally placed endometrium can not do so resulting in pain.

Anyway, the treatment is of two types mainly. Medical and surgical.

During pain you can take NSAIDS like ibuprofen. You have to take hormonal agents like oral contraceptive pills on long run. That can help to stop the disease progression. Pain in lower abdomen is a common symptom of this disease also.

You should be checked by an experienced gynaecologists.
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