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Family Medicine (Expert Forum)
Low Sodium Serum and Orthostatic Hypotension: Need Advice
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Low Sodium Serum and Orthostatic Hypotension: Need Advice
by margos, Aug 04, 2005 12:00AM
White FM, 37, lacto-ovo-pesco vegetarian for 13 years, healthy weight, very active (hot yoga, weight training, outdoor gardening, etc.). I do have GERD and have been taking Pepcid for 9 years, allegies and have been taking Claritin/Clarinex, and on bc pill.
I went to see a nutritionist yesterday – who was alarmed when I brought 8 years of full blood tests including one 2 weeks ago. No one seems to have ever been concerned that my sodium serum is low (133) and has been since 1998. (It’s slowly dropping). As well, low Osmoality (266) and A Gap – this time my A Gap is 0. Also low ALP. Conversely, my Glucose level (after 12 hour fast) was high at 107.
There is no way that I am over hydrating or over drinking anything, and I certainly don’t restrict sodium, I love it. So why would my sodium serum be low and getting lower over the years?
Now I’m worried about two things – first, a history of blood tests that show this low sodium, osmoality, A Gap, etc., AND a Dr. who doesn’t seem to be concerned, and now the high Glucose. I asked if it could be an artifact, but the nutritionist said it never is with Glucose.
The nutritionist also confirmed his suspicion that I have orthostatic hypotension – my blood level dropped more than 10 points going from lying down to standing up. He suspects adrenal insufficiency? He said wait a month after following his diet (cut out dairy, add high quality vegan plant-based vitamins, minerals and enzymes) and then retake blood tests.
I have, however, no symptoms and feel great.
I’m wondering, diet? Can that be the factor? Too much protein? Acidosis? Diabetes does not occur in my family and I should be at a very low risk for it. Or could it be adrenal deficiency, or some other hormonal imbalance? Or from prescription drugs?
My question to you is, what specialist should I go to, and what tests should I ask for?
Endicinologist? or Gasterenterologist? or other?
Do I need to direct my pirmary care physisian to be concerened, and what to test for now?
Thanks!
I went to see a nutritionist yesterday – who was alarmed when I brought 8 years of full blood tests including one 2 weeks ago. No one seems to have ever been concerned that my sodium serum is low (133) and has been since 1998. (It’s slowly dropping). As well, low Osmoality (266) and A Gap – this time my A Gap is 0. Also low ALP. Conversely, my Glucose level (after 12 hour fast) was high at 107.
There is no way that I am over hydrating or over drinking anything, and I certainly don’t restrict sodium, I love it. So why would my sodium serum be low and getting lower over the years?
Now I’m worried about two things – first, a history of blood tests that show this low sodium, osmoality, A Gap, etc., AND a Dr. who doesn’t seem to be concerned, and now the high Glucose. I asked if it could be an artifact, but the nutritionist said it never is with Glucose.
The nutritionist also confirmed his suspicion that I have orthostatic hypotension – my blood level dropped more than 10 points going from lying down to standing up. He suspects adrenal insufficiency? He said wait a month after following his diet (cut out dairy, add high quality vegan plant-based vitamins, minerals and enzymes) and then retake blood tests.
I have, however, no symptoms and feel great.
I’m wondering, diet? Can that be the factor? Too much protein? Acidosis? Diabetes does not occur in my family and I should be at a very low risk for it. Or could it be adrenal deficiency, or some other hormonal imbalance? Or from prescription drugs?
My question to you is, what specialist should I go to, and what tests should I ask for?
Endicinologist? or Gasterenterologist? or other?
Do I need to direct my pirmary care physisian to be concerened, and what to test for now?
Thanks!
Doctor's Answer
by Kevin Pho, MD, Aug 04, 2005 12:00AM
, Aug 04, 2005 12:00AM
The easiest answer would be volume depletion. This can cause orthostatic hypotension, a low serum osmolality as well as the low sodium. Rechecking the lab tests after fluid repletion would be the first thing to do.
A sodium of 133 is only borderline low - considering normal is 135. However, checking for things like SIADH (syndrome of inappropriate secretion of ADH) can be considered and treated for (a discussion of water restriction would be the appropriate treatment).
A low anion gap can be caused by hyperkalemia, hypercalcemia, hypermagnesemia, or severe lithium intoxication. Multiple myeloma can also lead to a low anion gap - this should be evaluated by your physician (a serum protein electrophoresis would be the inital test for this).
I would discuss these options with your primary care physician. A referral to a kidney specialist can be considered if the sodium continues to be low.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
A sodium of 133 is only borderline low - considering normal is 135. However, checking for things like SIADH (syndrome of inappropriate secretion of ADH) can be considered and treated for (a discussion of water restriction would be the appropriate treatment).
A low anion gap can be caused by hyperkalemia, hypercalcemia, hypermagnesemia, or severe lithium intoxication. Multiple myeloma can also lead to a low anion gap - this should be evaluated by your physician (a serum protein electrophoresis would be the inital test for this).
I would discuss these options with your primary care physician. A referral to a kidney specialist can be considered if the sodium continues to be low.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
