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How Does Low Sodium Levels Affect The Overall Electrolyte Balance?
Question: How does the SAIDS condition (Diabetes insipidus) affect the overall electrolyte balance? My father has had a crisis, hospitalized with dangerously low sodium levels. He has had his fluids restricted to 1 litre per day, and is taking salt pills, but is still very weak, with very little appetite. His face and hands & feet are puffy. We are concerned about levels of other electrolytes, particularly potassium, magnesium, and calcium.
My father writes:
"Sodium seems to be targeted in the syndrome which I have – SIADH.
Yes, I still have perodic boughts of restless legs. That seemed to let up for awhle but I still have it—maybe not as severe.
No problem with iron. I fact, my bowell action is better than before. I haven’t had to take my pruins since I started the iron. I take Ferrous Gluconate 300 mg a tablet with each meal. It should not be taken less than a hour from any other medications.
I will ask my doctor about magnesium suppemtation for me. My face looks puffy and my feet seem a bit swollen too."
He is having weekly blood tests for sodium, and the requisition now includes potassium as well.
On August 24 he wrote:
"My sodium had gone up from the 130 which it was when I left the hospital to now 141, within the normal range of 135 to 145!
As a result he loosened up on my fluid restriction of 800 ml/day and reduced my salt capsules from 4x 1 gram capsules/day so now I get 1000 ml liquid /day and take only 3 one gram capsules / day. I will work hard to keep my sodium level within the normal range and exercise as my strength permits to try to regain my strength."
My father writes:
"Sodium seems to be targeted in the syndrome which I have – SIADH.
Yes, I still have perodic boughts of restless legs. That seemed to let up for awhle but I still have it—maybe not as severe.
No problem with iron. I fact, my bowell action is better than before. I haven’t had to take my pruins since I started the iron. I take Ferrous Gluconate 300 mg a tablet with each meal. It should not be taken less than a hour from any other medications.
I will ask my doctor about magnesium suppemtation for me. My face looks puffy and my feet seem a bit swollen too."
He is having weekly blood tests for sodium, and the requisition now includes potassium as well.
On August 24 he wrote:
"My sodium had gone up from the 130 which it was when I left the hospital to now 141, within the normal range of 135 to 145!
As a result he loosened up on my fluid restriction of 800 ml/day and reduced my salt capsules from 4x 1 gram capsules/day so now I get 1000 ml liquid /day and take only 3 one gram capsules / day. I will work hard to keep my sodium level within the normal range and exercise as my strength permits to try to regain my strength."
Brief Answer:
Sodium
Detailed Answer:
Sorry to learn about your father's bothersome symptoms.
SIADH is one of the causes of a low blood sodium level. Diabetes insipidus does the opposite.
SIADH and low blood sodium can b e perplexing disorders to diagnose and manage. It is important to try and find the cause for this such as a medication or a lung / brain disorder. Sometimes no cause can be found despite thorough evaluation.
When I see someone like him in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Serum Osmolality by direct method
Uric acid
Urine Osmolality
Urine Sodium
8 am serum cortisol
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting
Correct diagnosis and treatment requires the opportunity to examine the patient so your father must see an endocrinologist in-person.
Sodium
Detailed Answer:
Sorry to learn about your father's bothersome symptoms.
SIADH is one of the causes of a low blood sodium level. Diabetes insipidus does the opposite.
SIADH and low blood sodium can b e perplexing disorders to diagnose and manage. It is important to try and find the cause for this such as a medication or a lung / brain disorder. Sometimes no cause can be found despite thorough evaluation.
When I see someone like him in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Serum Osmolality by direct method
Uric acid
Urine Osmolality
Urine Sodium
8 am serum cortisol
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting
Correct diagnosis and treatment requires the opportunity to examine the patient so your father must see an endocrinologist in-person.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for your detailed answer. I will try to find out how much of this has been done, and will get back to you with what I find out.
Both my father and I live in Canada, but there is a long distance between us. I am in XXXXXXX and he is in British XXXXXXX My brother from Alberta (neighbouring province) will be visiting him in a few days, and we hope that he can persuade Dad to ask for a referral to an endocrinologist.
I plan to keep you informed of his treatment and how he is doing whenever I am given an update. I must be tactful and not demanding, as I am so far away. My father can be stubborn if he thinks he's being pushed (especially by a daughter!). My mother and father and four siblings are in regular e-mail contact, and I'm happy to have found a specialist (even a distant one) to be part of our "team".
Thank you for your help so far,
Aleta
Both my father and I live in Canada, but there is a long distance between us. I am in XXXXXXX and he is in British XXXXXXX My brother from Alberta (neighbouring province) will be visiting him in a few days, and we hope that he can persuade Dad to ask for a referral to an endocrinologist.
I plan to keep you informed of his treatment and how he is doing whenever I am given an update. I must be tactful and not demanding, as I am so far away. My father can be stubborn if he thinks he's being pushed (especially by a daughter!). My mother and father and four siblings are in regular e-mail contact, and I'm happy to have found a specialist (even a distant one) to be part of our "team".
Thank you for your help so far,
Aleta
Brief Answer:
Best wishes
Detailed Answer:
for his good health
Best wishes
Detailed Answer:
for his good health
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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