To Salt or Not to Salt – that is the question

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A normal level of sodium is 135 – 145  mEq/L. When Mom first fell four years ago and severely broke her ankle, the hospital put her on a sodium drip immediately as her blood test revealed a critically low sodium level – 121. But her ankle was the focus, so after weeks in the hospital on strong pain medication and 3 months in residential rehab, she returned home unaware she needed to address an ongoing problem with sodium loss.

A year later Mom fell again, this time breaking her knee, and once again the hospital determined her sodium was way too low. They restored it to a safe level, kept her for a few weeks to repair her knee, and then sent her off for another 3-month stint in rehab.

Eat Potato Chips

I spoke with the attending physician when she was discharged from the hospital to ask what we could do to keep her sodium at a safe level, and he laughed and said “eat potato chips”.  Not helpful, but what we took from that was there was nothing to be done other than increase her daily intake of sodium through diet. And that is what we set out to help her with.

One year later Mom fell and broke her femur, then this past winter, while straining to tie up her shoes, she fractured her L1 and L2 vertebrae. She finally received an osteoporosis diagnosis with this event, but that is another story told in a previous blog post.

With both of these events her sodium readings were low (127) but not low enough for the hospital to treat. We battled with the ER doctor to not just send her home without a referral. He sent us to an Internist, who referred us to the Osteoporosis Clinic and a Urologist. Both of these appointments were enormously helpful, but did not address her chronic problem with sodium retention.

Looking back at her history we now see evidence low sodium was the likely culprit to each of her falls. When Mom’s sodium is just low, she doesn’t vomit, but she has no appetite. She doesn’t have diarrhea, but her stools are loose, and she is tired, irritated, and confused. Is this because she isn’t sleeping?  Is it because by now she is almost 90 years old. Most seniors get addled and forgetful at some point, don’t they, and just run out of poop? It’s all scary, confusing, and discouraging.

According to Science Daily

” Older adults with even mildly decreased levels of sodium in the blood (hyponatremia) experience increased rates of fractures and falls, according to a study presented at the American Society of Nephrology’s 43rd Annual Meeting and Scientific Exposition. Falls are a serious health problem for the elderly and account for about 50 percent of deaths due to injury in the elderly.”

Some Common Symptoms

The important thing here is to notice symptoms, and share them with your doctor just in case immediate action is necessary. Inattention can lead to seizures and coma, even death.

• Nausea and vomiting
• Headache
• Confusion
• Loss of energy, drowsiness and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps

Be Aware of Possible Causes

• Drinking too much water
• Certain medications and recreational drugs such as Ecstasy
• Heart, kidney, or liver problems
• Syndrome of inappropriate anti diuretic hormone (SIADH)
• Chronic or severe vomiting or diarrhea, as well as other causes of dehydration
• Hormonal changes

In research I discovered Hyponatremia is indeed common in older adults, especially if hospitalized or living in a care facility, and might be masked by other physical limitations or disabilities. In other words, Hyponatremia may not be obvious, especially in seniors, and can easily be attributed to other health conditions.

An American study reports only 1.7% of people have this condition, perhaps a reason it is not more commonly recognized.

More Statistics

• 15-20% of hospitalized patients have sodium deficiency as the most common chemical abnormality
• Sodium deficiency is proven to lead to falls
• Up to 30% of elderly in nursing homes suffer from low sodium.

Our Family’s Management Plan

While awaiting an appointment with an Endocrinologist to determine the underlying reason why Mom’s body cannot retain sodium, these are the steps we’ve taken to keep her sodium at a healthier level:

• Increase sodium rich whole foods into her breakfast and snacks, which she prepares herself. Canned and frozen foods are high in sodium, but not nutritious.
• Mom takes a saltshaker of good salt to her lunch and dinner meals prepared by her care home. Bonus, the food also tastes better!
• Added an over-the-counter daily sodium supplement.
• Reduced her daily water intake to 500 ml.
• Monitor sleep and bathroom habits.
• Be proactive with her health, pushy if necessary. I cannot stress this enough as ER and family doctors are time crunched and specialist help can be hard to see in a timely manner.
• Mom’s family doctor provided a standing order for blood and urine tests so Mom can go to the lab whenever she feels symptoms cropping up.
• Provide lots of love and encouragement. This is a disheartening and miserable condition, even without the broken bones.

Our Seniors are Most Vulnerable

My intention here is to share how our family came to understand Hyponatremia, and it’s my hope others will be helped by sharing our experience. As Mom’s Osteopathic specialist said “quality of life is important at any age”

What I learned is not to assume age is necessarily the reason for declining wellness, either mental or physical. It’s enormously gratifying to see significant improvement in our own Mom’s well-being, and kudos to her for not giving up.

To salt or not to salt is a diabolical question, and one best answered by looking closely at individual health needs.  Make no assumptions based on popular thought or unaccredited internet advice. See a doctor right away if any of these symptoms manifest. A simple blood test might be the first step to returning to a happy, active life.

There are reliable internet medical sites to help families become informed for the doctor’s visit. The Mayo Clinic was enormous help in my research on Hyponatremia.

Blessings on your journey.

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