Hi. I’ve been doing a huge diet/exercise thing since June 1, about 1 hour/day exercise (stationary bike) + calorie deficit (~1500 cal/day). I’m not a big person, 5’6" 59yo male so this is intense but not nuts. I’d lost 38 pounds in 3 months, which isn’t that crazy a rate. Intense, but not crazy. I’ve been eating good food in smaller quantities, no alcohol, no silly Keto or Paleo or whatever fad, just the old fashioned thing: eat less and exercise. I’m now at 150 pounds: a really good place.
So, anyway: I went for blood work 8/25 and had a sodium deficiency. 128/whatever the scale is. Google says this can happen if you overhydrate; I hadn’t been. I stopped the diet September 1 and started eating normally (probably 2500-3300/cal a day, I stopped measuring) and doing light (<40 min/day) exercise, not strenuous just activity. Little or no sweating, very measured.
Sept 7 I still had a sodium deficiency, about 128 again. I have not been over hydrating, I’m just drinking coffee, water when thirsty. I eat tons of salt on food so I get plenty of sodium.
My doctor today told me she wants to do one more blood test, and if I’m still deficient wants to do a CTI of my lungs and brain. I’m kind of freaked about this. The last time I got in shape at 52 (7 years ago) my PSA tested abnormal and I was eventually diagnosed with prostate cancer. I had surgery 3.5 years ago, so far I’m cancer free. Now this.
So, what freakout level should I be at here? Thanks in advance.
PS, I’m doing another ultra-sensitive PSA test on Friday, which would detect my cancer coming back. As of 6mo ago it hadn’t, so I’m not expecting surprises there
Since you Googled hyponatremia, you probably saw all the symptoms. Are you symptomatic? Why were you having blood work? Before you panic, you might wait until you go back and repeat the test. Remember that tests have normal ranges, but there’s the occasional outlier that’s still normal. If your Na is still low, you might ask your doctor what, exactly, she’s looking for on the scans.
Share your concerns with your physician. (I am a retired doctor, but I hope this doesn’t qualify as medical advice and overstep the SDMB rules.)
I was symptomatic on 8/25: extreme fatigue for a couple of days. Since then I’m fine.
I had high cholesterol and weird liver numbers and was following up after doctor told me to lose weight in May. Liver numbers are nominal now. Cholesterol I’m getting on next test (we had a miscommunication).
Only partially facetious, but maybe I should have clickbaited my thread:
My Doctor wants to CTI my lungs and brain
Because I had low sodium.
</boring details>
I mean, I seriously buried the lede in my OP. Who is going to read all the way down to " My Doctor wants to CTI my lungs and brain" near the end? Thanks for reading this far I guess
The lungs thing rings a bell. I had a series of marginally low sodium readings, and the doctors tried a series of things, including an X-ray of my lungs. I forgot what it was they were checking, but I assume they’re ruling out all sorts of possibilities, however remote.
(In my case, the specialists made some offhand remark about “restriction of fluids”, I cut back on the amount of tea I was drinking, and, lo and behold, the next blood test was back in the normal range. Are you sure your fluid intake isn’t the culprit?)
Pardon my pedantry, but ‘sodium deficiency’ is a pretty uncommon development in adults. Having a low level of sodium in the blood is almost always due to having an excess of water in the blood, i.e. the sodium has been diluted, but it is not ‘deficient’. As noted above, this is called hyponatremia.
There are many causes of hyponatremia but some of the more common ones include a side effect of medications that causes the body to hold on to too much water (but not to lose sodium), heart failure, and cirrhosis.
There is a condition called SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone) which causes hyponatremia. It has many causes including the use of certain medications and various types of lung disease.
It is possible to drink so much water that it dilutes your blood sodium but that is pretty hard to do - assuming your kidneys are normal and you’re on no meds that lead to your body holding onto water, you’d need to drink at least around 10 liters of in a day (over 10 quarts).
Another cause of low blood sodium (but not very common) is a grossly inadequate dietary intake of protein. This typically occurs in people who live on beer and not much else, or the proverbial little old lady who eats nothing but ‘tea and toast’.
Whelp, 3rd blood test(s) in 3 weeks. Sodium is still low at 129 mmol/L where 135-146 mmol/L is normal, and was about the same on three tests over three weeks. On the plus side my PSA is undetectable, so my prostate cancer hasn’t yet returned.
I see my doc this Thursday in person. Her office wanted to send me straight to specialists and CTI scans but I wanted to get a face-to-face and hear from her what the possibilities are. I’ve been somewhat fatigued, even dizzy at times, though perhaps that’s just being run down and unrelated.
I’ve gotten low sodium readings, too. My doc said to cut back on water. I drink a lot of coffee, though, to keep me awake. My answer is a sugar-free electrolyte drink called Body Armor. I don’t use a lot of it: usually half a bottle a day, unless exertion makes me sweat more than usual. I eat a low-sodium diet aside from that, and it balances out.
I would not jump to a CT scan from the beginning. First thing would be to calculate the blood osmolality and second thing in low sodium is to look for physical signs of excessive blood volume, or normal or low blood volume (as might be suggested by dizziness with lower blood pressure readings). These all have different causes.
Measuring the sodium and electrolyte level in the urine would also be useful. Blood tests should include other electrolytes, glucose, urea and creatinine. A heart tracing might help depending on the history and symptoms.
This and a medication review should determine more common causes; if not there may be a role for imaging, hormone levels and more esoteric tests.
Though only your doctor can evaluate you, sodium levels around those stated are of concern if causing symptoms. Levels in the 125-135 range are not necessarily something to lose sleep over but the cause should be determined if possible.
First thing that jumped into my head was diabetes insipidus - where you basically pee, nonstop, because basically the body doesn’t have enough of the hormones that tell the kidneys “Whooooah, slow down there!”. Though a quick google suggests that hyponatremia doesn’t usually accompany that, but in some cases it might depending on the cause.
DI can be triggered by issues with the pituitary gland, the hypothalamus, or a head injury, which would explain the request for a cranial CT. Dunno about the lungs though.
Oh, and I suspect you do not have DI - you’d know it, from what I understand - basically it’s really hard to keep yourself hydrated due to the constant output.
My dad had a near fatal case of low sodium a few years ago. Bear in mind, he was over 80 years old and had just experienced a terrible case of the flu. He became so weak he could barely move. He had to take salt pills, and it took him a month to recover.
Hyponatremia would never occur in untreated DI. In fact, it’s the opposite with DI causing hypernatremia.
It is possible that treated DI might cause hyponatremia, when the prescribed desmopressin (a synthetic analog of ADH) has led to too much water retention, which in turn dilutes the sodium in the bloodstream and causes hyponatremia.
I do not want to discuss possible causes or my best guess. Your doctor should do appropriate blood and urine tests. A lot of things can cause low sodium and few of them are due to tumours. Accordingly, at these levels you should probably have a moderate level of concern and your doctor should look for common causes before less likely ones. Cancer should be more concerning in the presence of weight loss and night sweats, and with symptoms like blood in the urine or urinary difficulties given the history. While possible, chances are another cause is much more likely. A chest radiograph is cheap and easy, so reasonable, but might not help much unless there is more to the story. A head CT would not be my initial choice.
I spent a couple of years with low enough sodium levels to make my doctor fuss and worry about my medication. She didn’t bring up doing a CTI, though. I’m on high blood pressure meds that work very nicely IMO, but she blamed those and made me take salt tablets for a while so I wouldn’t need to change the meds that were working so well otherwise.
A while later, I got tired of taking salt tablets and quit. My next blood work was normal, and the issue hasn’t come back since.
I know it’s not much help, but maybe my experience will help you feel not so worried?
My sodium levels trend low, and because my father and paternal grandmother had similar issues that were serious enough to put them in the hospital, I eat extra sodium and will continue to do so unless and until something happens to contraindicate it.
Interesting - and counterintuitive, to non-medical me (as opposed to KarlGauss, who knows what he’s talking about).
Merck has some interesting discussion on some of the potential causes and treatments. Some of the stuff mentioned there, I could sort of see how imaging of your innards might provide interesting info, but it seems like other steps (like additional bloodwork) might be faster / easier / cheaper as a first step.
What time of day has the bloodwork been done? Are you fasting? If you’re testing first thing in the morning and haven’t had much to drink, I wonder if that might have an effect on the results - I know occasionally I’ve had some bloodwork marker or another be slightly outside the norm and the doc says it’s likely due to the timing.
OP here. I saw my family doc/GP. She basically said she can order a bunch of imaging and look for something unusual, or I could see an endocrinologist who would approach from whatever direction endocrinologists approach things. She recommended the latter, so that’s what’s next and I have a referral.
My GP knows what meds I take and there’s nothing suspicious there, or on other parts of my last metabolic panel including creatinine. My liver numbers are good, so she doesn’t suspect cirrhosis (phew). I don’t have blood in my urine or anything like that, and I feel fine. I did ask about electrolytes in urine, blood osmolality etc and she said the endocrine person would look at all that.
She basically characterized this all as “not alarming, but worrying and you must follow up”.
Endocrinologist juggled my blood pressure meds, now my sodium is nominal.
Two specialist visits @ $595 each, > $1200 with blood tests. US medicine is such bullshit. I should have told my GP told nod off when this came up. I can’t believe I fell for this nonsense.
