Seventy-year-old Babasaheb Malusare, who lives in Mahim, Mumbai, had been weaving baskets since he was a teenager. The five decades of experience meant his work was near-flawless. But that changed about two years ago: one day in April 2021, not only did Babasaheb struggle at his work, he also sat idly staring at a half-done basket for more than an hour.
“He showed a lack of interest, forgetfulness and personality changes too,” says Yashwant, his son.
A sodium blood test revealed a low sodium level of 120 mmol/L (millimoles per litre). Babasaheb had pronounced sodium deficiency or hyponatremia.
Sodium-water balance
Sodium and water exist in a balance in the blood. Sodium, which is an electrolyte (a mineral in the body fluids that carry electric charge), functions as a water regulator in the body. The body’s main source of sodium is through food and fluid intake.
“The daily recommended allowance of salt intake is 5gm, less than a teaspoon,” says Dr Murali Mohan S, senior consultant neurosurgeon and director, People Tree Institute of Neurosciences, People Tree Hospitals, Bengaluru.
Deficiency of sodium largely affects older people (those above 65 years), says Dr Shobha Subramanian-Itolikar, consultant physician, Fortis Hospital, Mulund, Mumbai. “A sodium level between 135 and 145 mmol/L is considered normal, 125-135 mmol/L is categorised as mild-moderate hyponatremia and below 125 mmol/L is acute sodium deficiency.”
Taking about sodium chloride absorption in the body, Dr Mohan says that human being are salt retainers. “If we increase our daily intake of salt, it will result in excess of sodium retained by the kidneys, which in turn gradually results in increased blood pressure,” he says. “The important organs that regulate the sodium levels are the brain and the kidneys. The brain releases hormones that directly influence the absorption and excretion of sodium through urine by the kidneys.”
Types of sodium deficiency
According to Dr Subramanian-Itolikar, the body develops a deficiency in one of two scenarios:
1. Excess water: Excess water in the blood dilutes the sodium and can lead to a deficiency. This condition is dilutional hyponatremia, a result of excess water retention. Water retention can be caused by:
- Compulsive and excessive water drinking.
- Syndrome of inappropriate anti-diuretic hormone (SIADH), a condition marked by excess anti-diuretic hormone (ADH) production. ADH, which is also called vasopressin, regulates water retention.
- Excessive consumption of vasopressin (in the form of medication).
Dr Subramanian-Itolikar recalls the case of Mahesh Deshpande, a 45-year-old financial consultant with an MNC in Mumbai, who was brought to the hospital in April 2022 with dizziness, vomiting sensation, excess fatigue and restlessness. He was profusely sweating as he had just completed a rigorous workout routine.
When Deshpande said he had consumed five litres of water before his workout, the doctor suspected sodium deficiency.
“His sodium count was 126 mmol/L,” says Dr Subramanian-Itolikar. “He suffered dilutional hyponatremia due to excess fluid in the blood. Compulsive water drinking is a major cause of deficiency among the younger population.”
2. Excess loss of sodium: Low sodium can also occur due to depletion of salt in the body. This condition, known as depletional hyponatremia, could be due to:
- Lack of enough salt in food and fluids.
- Comorbid conditions such as long-term consumption of diuretics (water pills often administered for high blood pressure that remove excess water and salt from the body through increased peeing) or kidney dysfunction (wherein excess water is accumulated in the body) or severe vomiting or diarrhea.
Aamani Joseph (62), a retired schoolteacher from Palakkad, Kerala, was told to undergo dialysis (a procedure which removes waste from the blood) due to her failing kidneys. But she experienced immense fatigue, lethargy and vomiting after every session of dialysis.
“She had developed sodium deficiency, hence she was hospitalized for IV (intravenous) saline treatment after every dialysis,” Shaila (45), her daughter, tells Happiest Health.
Symptoms of low sodium
Being thirsty mostly suggests high levels of sodium or a low level of water in the blood.
On the other hand, according to Dr Shobha, the early signs of sodium deficiency include:
- nausea and vomiting
- lethargy or excessive fatigue
- irrelevant talk and mental confusion
- anxiety and restlessness
- muscle weakness or cramps.
In severe cases, sodium deficiency can lead to seizures and coma.
Govind Pai (82), a retired businessman from Udupi, Karnataka, has been experiencing episodes of low sodium since March 2021.
“Every few months, he experiences sudden exhaustion and the shivers,” says Nirmala (42), his daughter. “His speech becomes incoherent and his skin, pale. Based on the doctor’s advice, as soon as he shows these symptoms, we give him lemon water mixed with salt and sugar. He then gets better in a few minutes.”
Early detection and treatment
Sodium deficiency can be checked through a sodium blood test (also known as serum sodium test).
For cases of depletional hyponatremia, saline is administered, intravenously or though saline-water consumption.
If it is dilutional, the excess water is removed through medicines. Babasaheb’s case was of depletional hyponatremia. Hospitalised for four days in 2021, he was administered IV saline treatment.
Dr Mohan warns that care must be taken to administer the saline solution in small quantities.
Dr Subramanian-Itolikar emphasises that too much or too little of anything can be dangerous. “Not consuming enough salt or substituting salt with potassium-based salt to prevent blood pressure can also cause sodium deficiency,” she says.
Takeaways
- People above the age of 65 are vulnerable to sodium deficiency.
- Sodium-deficient people should get themselves checked once in 15 days.
- The daily recommended allowance of salt intake is 5gm.
- Consuming excess fluids is harmful.
