Hyponatremia

i am a CAPD dialysis patient.
My sodium level is 128 mmol/L resulting in too low blood pressure and tremors in hands and legs.
My salt intake is 4 gm/day plus indirect intake as well.
use of diuretics {Frusemide} promotes hyponatremia{low sodium level}?
night dwell increase sodium loss?

Shivashanker, there is a warning on furosemide (Lasix®) about it’s ability to cause loss of electrolytes. Sodium is an electrolyte. So, please talk with your doctor about these symptoms–you may need a different dose of furosemide or a higher salt intake. I’m not a doctor–you need to talk to yours, who knows you best.

Here is a link to the information on furosemide from the RxList.com website: http://www.rxlist.com/cgi/generic/furos_ad.htm

I don’t know about night-time dwell and sodium loss, but will try to find out. In the meantime, please call your doctor or PD nurse as soon as possible. Loss of electrolytes can be very dangerous.

Me again. This is what I heard about sodium from one of my PD experts:


Furosemide lowers sodium, but it depends on your residual renal function. The more function you have left, the more sodium you would lose in your urine.

Long dwell time removes more sodium than short dwell time.

Sodium loss also depends on the peritoneal equilibration (low transporters lose less than high transporters).

With a sodium of 128, you will not lose much sodium through dialysis, since sodium in PD dialysis solution is 132–unless you have some special kind of dialysis solution (or it is different in India).

I do not know why you have a sodium of 128. You may have so-called “reset osmostat.” In people who are not on dialysis, the reset osmostat leads to compulsive water drinking with subsequent hyponatremia.

I had patients with low sodium on dialysis. In most of them, I could not determine the reason, but suspected that their water intake was higher than their sodium intake. I was trying to manipulate the exchanges in various ways.

You need to talk to your doctor.


So, there you have it.

Hi dori u r right .
my neph has reduced my water intake and increased my salt intake.
i m feeling well now and my BP is back to normal.
Dialysis fluid bag{baxter} is same as in USA.
i have anothe problem of having low serum albumin right now.
in oct 2006 it was 3.2 gm/dl,in Dec 2006 2.8 gm/dl,in jan 2.5 gm/dl and in feb 2007 it is 2.3 gm/dl{all time low since i started PD dialysis}. i was eating high potein diet but it kept falling.
i m having complete loss of appetite.i dont feel like eating anything.
right now i m taking amway nutrilite protein supplement,egg white ,cornflakes etc to increase my albumin level.
what else should i do to increase my albumin.
my neph is against transfusing me IV albumin.

If you don’t have a renal dietitian you can talk with you need to ask your doctor how you can increase your protein intake. If your appetite is low and/or meat tastes funny, your peritoneal dialysis may not be working well enough. Toxins in the bloodstream can cause those symptoms. Also, PD removes a lot of protein that must be replaced through diet or the albumin level falls placing the patient at great risk of infection, hospitalization and even death! Studies have shown that albumin should be 4 or higher and these risks increase when albumin is less than 3.5 and are even higher as the albumin falls lower.

I hadn’t heard of the protein powder you’re using so I looked it up. Each 10 gram scoop provides 8 grams of soy protein and is only 36 calories. I gather that some people use this for weight reduction. It may not be the best protein supplement you can get. For comparison, in the U.S. some dialysis patients drink Boost, a protein drink. It has 15 grams of high quality protein. Here’s an article from AAKP, one of the patient organizations, that discusses protein supplements:
http://www.aakp.org/aakp-library/what-protein-supplement-is-best/

It is urgent that you do what you need to do to get improve your nutrition quickly!

My creatinine level is undercontrol only problem is i m basically veg{occasional nonveg} but now i m force to eat lot of nonveg.
i need a good quality protein supplement.
i m trying to get it.
i m fine now.

[QUOTE=Beth Witten MSW ACSW;12619]If you don’t have a renal dietitian you can talk with you need to ask your doctor how you can increase your protein intake. If your appetite is low and/or meat tastes funny, your peritoneal dialysis may not be working well enough. Toxins in the bloodstream can cause those symptoms. Also, PD removes a lot of protein that must be replaced through diet or the albumin level falls placing the patient at great risk of infection, hospitalization and even death! Studies have shown that albumin should be 4 or higher and these risks increase when albumin is less than 3.5 and are even higher as the albumin falls lower.

I hadn’t heard of the protein powder you’re using so I looked it up. Each 10 gram scoop provides 8 grams of soy protein and is only 36 calories. I gather that some people use this for weight reduction. It may not be the best protein supplement you can get. For comparison, in the U.S. some dialysis patients drink Boost, a protein drink. It has 15 grams of high quality protein. Here’s an article from AAKP, one of the patient organizations, that discusses protein supplements:
http://www.aakp.org/aakp-library/what-protein-supplement-is-best/

It is urgent that you do what you need to do to get improve your nutrition quickly![/QUOTE]

Since you’re a vegetarian, this is all the more reason why you need to talk with a dietitian that knows how much protein a patient on PD needs and which plant protein sources are the best.

Some people that are vegetarians eat eggs. Do you eat eggs? Egg whites are a good source of protein. They come in powdered form, have a shelf life of a year and can be sprinkled on other foods or mixed with equal parts of water to reconstitute them. I’ve heard of people making meringue cookies with them. A tablespoon has about 11.5 grams of protein.

Another option is soy. Here’s an article that talks about soy and which soy sources are good choices for people with kidney disease.
http://www.aakp.org/aakp-library/Soy-Option/

My son is on ccpd and his sodium and chloride level was low yesterday. This happened before and his doctor seems to think he has too much fluid in his body. Then she has him use a stronger dextrose in his solution bag and he gets dehydrated and his pressure drops. It makes me feel uncomfortable because he’s ready to pass out in the morning. I don’t think he’s drinking more.He is taking a anti-seizure medication that has a warning that it could cause low sodium. I read it recently, i just wonder what it is causing this too.

It would be a good idea to talk to your son’s dietitian and his nephrologist. Could he possibly eat food with a bit more sodium if this is an ongoing issue for him? That’s a question I’d want to ask them if I were you.

well i m using 1.5% fluid bag in all my four exchange and i m feeling better now.
i have got back my appetite.
PD is a gr8 challenge. all these days i was thinking that i knew all about PD and nothing would happen to me but sodium taught me a tough lesson.
now i will always include test of serum sodium in my monthly test.
i was neglecting it.

Who prescribed the anti-seizure medicine? Tell that doctor what your son’s last sodium level was and when. Ask if there’s another drug you son could take that doesn’t have this side effect. Also, be sure to tell the nephrologist that the anti-seizure medicine has a side effect of hyponatremia and that using the stronger dextrose solution made your son feel like he was going to pass out. If there’s a blood pressure reading, the doctor will want to know that too. I suspect the nephrologist may not know about this side effect of that drug.