Low Sodium/Chloride

I guess it is obvious I just got my monthly labs back. In addition to my cholesterol problems, I had a low sodium (133) and chloride which I have never had before. What is most ironic is that I run at a higher than normal sodium (142) to keep my conductivity up, so have absolutely no idea what is happening to my sodium. I actually think it is accurate, not a lab error, as the chloride was also low (should go hand in hand) and I have symptoms of low sodium including muscle cramping, twitching, headaches and nausea.

Anyone have any idea what might cause this?? I do not eat a very low sodium diet, I do eat Subway/Togo sandwiches with processed meat and do eat canned chili and soups once or twice a week, and eat out at least twice a week.

We are rechecking in a couple of weeks and if still low I may try running at an even higher sodium.

You must be using a HIGH FLUX dialyzer right? Long term use of high flux dialyzers cause this problem…

I had the same problem as you had before…I just had them to either reduce time on dialysis or decrease the dialyzer size…

I can’t reduce time as my clearances are only at 65%. Also, I did reduce from 5 hours a day to 4 hours and this is the month the sodium/chloride dropped. I do use a high flux, but again, need it for the clearances. I have asked to up my bfr to 350 in an attempt to up my clearances. I found it interesting that my clearances didn’t really change with the drop from 5 hours to 4 hours, however, my creatinine was up to 8 for my predialysis number, BUN only 44.

Guess I just thought my numbers would be better with daily dialysis.

I did run at a 144 sodium last night.

PS, I’ve only been on dialysis since September.

Heck, your numbers look better than mine! …but I feel good with my numbers…the biggest improvement is my blood pressure…

Really, I’ve never run high BUN, when I started dialysis it was only in the high 50s, but my creatinine is higher than when I started which is frustrating, but must say makes me wonder how high they are for the patients on 3x a week!!

My b/p is amazingly low, runs in the 110/75 range with no medication, so that has been great too, however, my pulse rate increased with the start of dialysis which I do not like, it is now in the 90s sitting and 110s to 120s standing. They don’t seem concerned, but I hate it and I think it is a cause of my continuing fatigue.

Well, keep in mind that being on dialysis is not a cure but a support. The lab results will always be high compared to a normal healthy person. However, we maintain and comply to our prescriptions which keeps us in a safe zone for us patients. I think the most important aspect of your treatment is how you feel and not what the numbers show.

I think your pulse is high is because your getting too much off of you…my pulse also goes high or even rises a bit when I get too much off from my body. Perhaps an adjustment in your dry weight should correct that.

You’d think that would be the problem, but the reality is that it is rapid even if my weight is up as much as 6 pounds (and would probably be even higher but I never am up more than that) and we all know that if I was taking my weight that much too low I would have other symptoms, such as cramping and low blood pressure. Also at my dry weight I still get a tiny bit of edema if I am on my feet all day so I don’t think it is too low.

Originally when I still had as much as 20 extra pounds of fluid on they thought the rapid heart rate was just nerves from starting, then they thought it was my body adjusting to the reduced weight, then they thought it was the low iron or low hgb, since all those issues have resolved, now they just ignore it

Oh my, perhaps your stressed out? Do you live alone? :roll:

Just trying to help…many things can contribute to high pulse…even chocolate, capuccino, coffee, cafein products and such…sugar…

Sometimes it will just take time till you pinpoint the cause but don’t give up on that.

Not quite alone, I have a 10 year old who lives to drive me crazy lol!! But no, I don’t think I’m all that stressed, plus I allowed my neph to put me on Paxil to “prove” that it wasn’t the cause and there has been no improvement.

Cathy,
I had a similar problem of a high pulse. Mine would climb even higher than yours beginning around the last few bps of my in-center 4 hour tx and spiking when I stood up to take the standing bp. The highest one I ever had was about 147! It really concerned me, but my nurse said it was normal for some patients. My doctor said it showed I was dehydrated and I should up my dw .5, or even 1.0. But I knew “me”, and if anything, I had a concern that there was still fluid onboard that was resisting coming off.

Interestingly, when I transferred to another unit, a different setting was used for my tx. The very high pulses never occured again. Additionally, you may have noticed my posts about the Critline machine and where I asked how others in home programs were trained to assess for dw and goal. I got to experience the Critline in my new unit and it confirmed my intuitive feelings that I had more fluid onboard that needed to come off. I could never release that fluid until, with the UF techniques used with the Critline, it finally came off- about .9. I never felt so good since I started dialysis as I did that tx. I could breath in and out deeply- something I had been unable to do for years. And I felt so well that I wanted to celebrate by going out to supper after dialysis where I enjoyed a good meal and had more than I normally do to drink.

Eventually, I put the fluid back on again as my unit does not use the Critline every tx, but only as an assessment tool. I am totally compliant with fluid- that is not the problem. The problem is, my body will not release all the fluid on the particular machine setting my unit uses.

I have found in all the units I have been in, neither my doctors or staff have known much about the machine’s programs and how they can be set to individualize the tx to the patients’ requirements. In fact, some doctors have told me txs can not be individualized in-center due to time constraints.

I have heard that, in the future, Critlines will be built into machines. The UF can be manually adjusted throughout the tx by one who is skilled, without a Critline, but not many know how this is done. That is why I asked how patients on daily or nocturnal are trained to assess for dw and goal. Because I wondered if they would have issues with hidden fluid just as in-center patients do. There is more to running a dialysis tx then is genrally known/done- it makes the difference in dialysis adequacy and patient comfort.

Very interesting read there about the Critline, I never used that before but certainly I’ve had the same problems when doing 3x a week in center…I was never ever was able to get all the weight off until starting daily…!

First thing is I did is gather information on my true weight based on my height…then from there determine how fat I am, then take into consideration what your wearing when weighing…

On each dialysis, I weigh without shoes, shirt, and take in consideration on what I may have eaten…for me it’s just careful planning that helps me put the right UFR goal in. Another factor that has to do alot is nutrition…if I’m weak or anemic then certainly I can’t take it all out…

Also, each morning after restroom use I weigh before starting the day. That gives me an idea how much I will weigh later at the end of the day…it’s alot of thinking and keeping track but it’s well worth the effort …

and this is the first time I ever heard of that word Critline… :roll:

Here’s an article by a nurse on how her UT clinic uses the Crit-line.
www.ikidney.com/iKidney/InfoCenter/Library/CDN/Archive/BloodVolume0403.htm

Now that we know about this, “I WANT ONE!” 8)

http://www.hemametrics.com/Products.jsp

I hope to see smaller lightweight models for home use…