We've all heard the saying since childhood: "Don't eat too much salt, it's not good for your body." In fact, we know that too much salt, or sodium, can increase blood pressure and lead to heart disease. But have you ever thought that too little salt in the body can be just as dangerous, and sometimes even more dangerous? That's what we call hyponatremia in medicine. Although this may seem like a complicated topic, today we'll talk about it in a very simple way that you can understand.
Simply put, what is Hyponatremia?
Hyponatremia is when your blood sodium (the main component of the salt we eat) level is lower than normal. Normally, a healthy person's blood sodium level should be above 135 milliequivalents per liter (135 mEq/L). If this value falls below 135, we call that condition Hyponatremia.
Now you might be thinking, "Oh... what happens if we lose a little salt?" But it's not that simple. For everything in our bodies to function properly, everything needs to be in balance. The balance between water and sodium is especially important. If this balance is lost, that is, if the amount of water in the body increases and the sodium becomes diluted, the excess water starts to enter our body's cells. Then those cells swell. Although this can happen anywhere in the body, swelling of brain cells is especially dangerous.
Imagine you are making tea. What happens if you add a little sugar and a lot of water? The sweetness of the tea is lost, right? That's how it is. When the amount of water in the body is greater than the amount of sodium in the body, the sodium concentration in the blood decreases. If our kidneys are working properly, this condition usually does not occur even if we drink a little too much water. However, due to some diseases, medications, or if we sweat a lot, such as running a marathon, and drink only water at that time, we do not have the electrolytes that our body needs.
Are there main types of Hyponatremia?
Yes, doctors divide Hyponatremia into three main types to make it easier to find the cause of this condition. It is determined by the total amount of water and sodium in the body. Let's understand it simply like this.
| Type of Hyponatremia | Simply put, what happens? |
|---|---|
| Euvolemic Hyponatremia (dilutional) | What happens in this is that while the amount of sodium in the body is at a normal level, only the amount of water increases. To be precise, the salt is diluted. |
| Hypervolemic Hyponatremia | In this, both water and sodium in the body increase. But the amount of water increases is much greater than the amount of sodium. This also dilutes the sodium. You may notice swelling in the body. |
| Hypovolemic Hyponatremia | In this, both water and sodium are lost from the body. However, the amount of sodium lost is greater than the amount of water lost. This can often occur when there is severe vomiting or diarrhea. |
Once your doctor finds out which of these types you have, it will be much easier to determine what the cause is and what the best treatment is.
What are the symptoms of this condition?
Symptoms of hyponatremia can vary depending on how low the sodium level is and how quickly it drops. Sometimes, when sodium levels drop slowly (Chronic Hyponatremia), there may be no major symptoms. But if the drop happens suddenly (Acute Hyponatremia), the symptoms can be severe.
These are the symptoms that can be seen in general:
- Muscle twitching or weakness.
- Nausea and vomiting .
- Extreme fatigue and lethargy. Feeling like you can't do anything.
- Headache .
- Confusion: Forgetting where you are, what you are doing, and getting confused about what you are saying.
- Seizures are the occurrence of convulsive-like conditions.
Why does this happen? Causes of Hyponatremia
In most cases, the main cause of Hyponatremia is a medical condition that causes the body to retain too much water, diluting the sodium. Apart from that, it can also be caused by excessive sodium loss from the body (which is a bit low).
Here are some of the main reasons that affect this situation:
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion): This is a hormonal disorder. In this, a hormone (ADH) that controls the excretion of water from our body is secreted in excess. This reduces the excretion of water from the kidneys, causing water to accumulate in the body and diluting sodium.
- Heart Failure: When the heart is weak, blood circulation in the body is not good. This can cause fluid to accumulate in the body.
- Kidney Failure: One of the main functions of the kidneys is to filter out excess water and waste products from the body. When the kidneys become weak, this process does not work properly, and water accumulates in the body.
- Liver Cirrhosis: This condition can occur when the liver function is severely impaired.
- Certain medications: This condition can be caused by certain "water pills" (diuretics) especially those used for high blood pressure and certain medications used for mental illness (SSRIs).
- Severe diarrhea or vomiting: During this time, a large amount of water and sodium is lost from the body.
- Excessive drinking (Polydipsia): It can also be caused by the urge to drink excessive amounts of water for no reason, which can accompany some mental health conditions.
- Drinking too much beer or liquor.
- Use of drugs such as MDMA (Ecstasy).
Is this a serious, life-threatening condition?
Yes, absolutely. Especially if sodium levels drop suddenly and to a very low level, it can be life-threatening.
As I mentioned earlier, when the sodium in the blood decreases, more water moves into the cells. If this happens to the brain cells, the brain swells (cerebral edema). Our brain is enclosed in a box made of bones called the skull. So the brain doesn't have much room to swell. When the brain swells like this, it presses against the skull. This can cause permanent brain damage, coma, or even death.
Therefore, Hyponatremia is never a condition to be taken lightly.
How does a doctor find this?
When you go to see a doctor, he will first ask you about your symptoms. He will then examine you and order several tests to confirm the condition and find the cause.
- Blood tests: This is the most important test. It can check the levels of salts in your blood, such as sodium and potassium, and how well your kidneys are working.
- Urine tests: By looking at the sodium level and concentration in the urine, you can guess what the cause is.
- Other tests: If necessary, depending on the cause, things like a chest X-ray or a brain CT scan may be done.
The doctor may also ask you about things like:
- What medications do you take?
- What other illnesses do you have?
- Do you drink alcohol?
- How much water do you usually drink per day?
How is Hyponatremia treated?
Treatment depends on how low your sodium level is, how severe your symptoms are, and what caused it.
- Treating the cause: The first step is to control the underlying medical condition that is causing the condition. For example, if it is caused by a medication, the medication can be stopped or changed.
- Limiting water intake: Often, especially if your sodium levels are not very low, your doctor will advise you to limit the amount of water you drink per day.
- IV saline: If your sodium levels are very low or your symptoms are severe, you may need to be hospitalized and given sodium through a vein (saline).
- Special medications: In some cases, special medications, such as tolvaptan, are given to help remove excess water from the body.
A special point to be careful about during treatment!
This is very important. When treating hyponatremia, doctors are very careful.
Very important: It is very dangerous to bring sodium levels back to normal levels too quickly, as they have dropped too low. Doing so can lead to a condition called ``Central Pontine Myelinolysis'' or ``Osmotic Demyelination Syndrome'', which can permanently damage the brain. Therefore, this should only be treated in a hospital, under medical supervision. Never try to fix this yourself at home by drinking salt water or eating salt capsules.
When should I see a doctor? When should I go to the ETU?
This is something you should know for sure, because acting on time can save a life.
| If you have any of these symptoms, see a doctor immediately: | |
|---|---|
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| If these symptoms are present, immediately take the patient to the ETU (Emergency Treatment Unit): | |
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Take-Home Message
- Hyponatremia is a condition where the body's salt (sodium) levels are low. This is not something to be taken lightly or played with.
- Most of the time, this is caused by too much water in the body, rather than eating less salt.
- Symptoms can range from muscle twitching, fatigue, and headaches to more severe conditions like confusion and seizures.
- If you see any serious symptoms, such as confusion or a fit, do nothing else and immediately take the patient to the hospital's Emergency Treatment Unit (ETU).
- This should only be treated under the supervision of a doctor. Do not attempt to treat this at home, as raising sodium levels too quickly can cause brain damage.
- If you have another medical condition that puts you at risk of developing this condition, talk to your doctor about it and follow the necessary instructions.
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