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Dr. Andrew Rynne

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Getting stomach discomfort. ECG showed increased sodium and chloride levels. Worrisome

Answered by
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Dr. Nsah Bernard

General & Family Physician

Practicing since :2012

Answered : 1704 Questions

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Posted on Mon, 6 May 2013 in Abdominal Pain
Question: hi, i am 36 years old. I had some kind of stomach attack and went to the ER thinking I was having a heart attack. My ecg always come up abnormal so they kept me in the heart observation unit to rule out heart and lungs. My ecg shows some kind of inverted t waves and short ones but they say that when compared to other ecgs it is a normal variant. I only showed 1 or 2 pvs. They said my heart is fine and my lungs. However, the only thing they found besides "gas" was that my sodium level was high 149 and my chloride 113. Also my adion gap was low at 4. However, they said I am fine and will live long? Should I be worried.
doctor
Answered by Dr. Nsah Bernard 4 hours later
Hello XXXXXXX

Thanks for posting on XXXXXXX

I am pleased to be able to help you with your health query,

I feel that you will be fine except for the fact that your sodium and chloride levels are a little increased so I suggest you go in for further testing with your kidneys to evaluate if they are functioning properly (i.e there is no kidney damage). The increase might just be physiological and/or temporary and you have nothing to worry about. Having abnormal EKG readings from time to time is normal (so I do agree with your health providers that you have nothing you should be worried about).

Hope this helps and wish you the best.
Dr. Nsah
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nsah Bernard 41 minutes later
hi to follow up here are my lab results
anion gap is low 4.0 Meq/l
glucose is 73
blood urea nitrogen is 10
bun ratio 13.7
creatine.73
gfr is 90
sodium 149
potassium 4.3
chloride 113
carbon dioxide 32
calcium 9.2
a/g ration is low 1.27
total protein 6.8
albumin 3.8
total bilirubin .6
alkaline phosphate 58
aspartate aminotransferas 17
alanine aminotransferase 12
doctor
Answered by Dr. Nsah Bernard 21 hours later
Hello XXXXXXX

Sorry for the delay.

Everything seems normal except the Sodium and chloride levels which are quite elevated. From your results, your doctor tried to evaluate your liver function(which is normal), your kidney function (which is normal), electrolyte balance (which shows that only sodium and chloride are in disorder).
Common causes of hypernatremia (elevated sodium which goes along with chloride) include:

-- Hypovolemia
- Inadequate intake of free water associated with total body sodium depletion. Typically in elderly or otherwise disabled patients who are unable to take in water as their thirst dictates and also are sodium depleted. This is the most common cause of hypernatremia.
- Excessive losses of water from the urinary tract, which may be caused by glycosuria, or other osmotic diuretics - leads to a combination of sodium and free water losses.
- Water losses associated with extreme sweating.
Severe watery diarrhea
-- Euvolemic
- Excessive excretion of water from the kidneys caused by diabetes insipidus, which involves either inadequate production of the hormone vasopressin, from the pituitary gland or impaired responsiveness of the kidneys to vasopressin.
-- Hypervolemic
- Intake of a hypertonic fluid (a fluid with a higher concentration of solutes than the remainder of the body) with restricted free water intake. This is relatively uncommon, though it can occur after a vigorous resuscitation where a patient receives a large volume of a concentrated sodium bicarbonate solution. Ingesting seawater also causes hypernatremia because seawater is hypertonic and free water is not available. There are several recorded cases of forced ingestion of concentrated salt solution in exorcism rituals leading to death.
- Mineralcorticoid excess due to a disease state such as Conn's syndrome usually does not lead to hypernatremia unless free water intake is restricted.
I suggest you consult with an XXXXXXX medicine specialist for counseling and management. Correcting hypernatremia requires careful fluid resuscitation with combination of dextrose and normal saline.

Hope this helps

Dr. Nsah

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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