Sodium

Sodium helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance. A normal blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L). Hypernatremia (high blood sodium levels) is when your blood level is above 145. Hyponatremia (low blood sodium levels) is when your blood level is below 135. Diagnosing either hypernatremia or hyponatremia is done with lab work. Urine testing can also be done, but is generally not considered necessary.

Hypernatremia

The main symptom of hypernatremia is excessive thirst. Other symptoms are extreme fatigue, lack of energy, and possibly confusion. Advanced cases may also cause muscle twitching or spasms. With severe elevations of sodium, seizures and coma may occur. Severe symptoms are rare and usually found only with rapid and large rises of sodium in the blood plasma.

Certain medical conditions increase your risk for hypernatremia, including:

• dehydration
• severe, watery diarrhea
• vomiting
• fever
• delirium or dementia
• certain medications (eg, diuretics, antidepressants, and antiepileptics)
• poorly controlled diabetes
• larger burn areas on the skin
• kidney disease
• a rare condition known as diabetes insipidus

Correcting hypernatremia is done by giving your body more fluids. In mild cases, this will be done by having you drink more fluids. In more severe cases, they will do this with an IV. In either case, the additional fluids will dilute the sodium in your blood and decrease your blood levels.

Preventing hypernatremia largely focuses on keeping your body well hydrated, but it is also important to limit the amount of sodium you take in every day. Knowing what caused your blood levels to become high will help you prevent high blood levels in the future. Addressing the underlying cause is essential.

Hyponatremia 

Hyponatremia signs and symptoms may include nausea, vomiting, and headache in mild cases. More advanced cases can cause confusion, loss of energy, drowsiness, fatigue, restlessness, irritability and muscle weakness, spasms or cramps. In severe cases there can be seizures or coma. However, severe cases are uncommon as the majority of individuals consume more sodium in their daily diet then they need.

Many possible conditions and lifestyle factors can lead to hyponatremia, including:

• Certain medications (diuretics, antidepressants and pain medications)
• Heart, kidney and liver problems. 
• Syndrome of inappropriate anti-diuretic hormone (SIADH). 
• Chronic, severe vomiting or diarrhea and other causes of dehydration. 
• Drinking too much water.
• Hormonal changes. 
• The recreational drug Ecstasy. 

Treating low sodium levels is done by giving the person more sodium. In mild cases this can be done by increasing the sodium in their diet or with sodium tablets. In more severe cases, the sodium will be given by IV.

Preventing hyponatremia focuses largely on making sure that you are taking in adequate amounts of sodium every day to maintain your blood level. Knowing what caused your blood levels to become low will help you prevent low blood levels in the future. Addressing the underlying cause is essential.

Low Blood Pressure

There are times that sodium is used to manage low blood pressure. This is because where there is sodium, water is drawn to follow. When we increase the amount of sodium we take in as well as the fluids that we are consuming, we can increase the amount of fluid in our blood stream and thus raise our blood pressure. This is a blood pressure management strategy frequently used when treating Postural Orthostatic Tachycardia Syndrome (POTS) and other forms of autonomic dysfunction.

Using sodium, whether in your diet or a supplement, to increase your blood pressure does not come without risks. That being said, there are risks to not treating your low pressure. There are also risks for using medications to increase your blood pressure. It becomes important to talk to your doctor about the risks and benefits of the various possible treatments and not treating your condition. But a high sodium diet is associated with more then a high blood pressure.

Sodium and Diet

Whether you are looking to increase or decrease your sodium levels, you will need to become aware of the sodium levels in your diet. Most processed foods are high in sodium. When buying food, checking the food labels can help you figure out what foods are good choices for you. A low sodium food is one with less than 140mg sodium per serving. High sodium foods are ones with more then 400mg per a serving.

The easiest way to control your sodium intake is to do your own cooking. That way you can choose not to add any salt or to add in as much as you need to. Another good way to take control of your sodium is with the salt shaker. If you are looking to reduce your salt intake, removing the salt shaker from your table can dramatically reduce the amount of sodium you take in. On the other hand, if you are looking to increase your salt, the salt shaker can be a strong ally by adding salt to everything you eat.

Those who are looking to add salt to their diets often struggle to add salt while not eating unhealthy foods. There are salty foods that are also good for you! Consider adding: pickles, olives, nuts, seeds, nut butters, fermented foods, canned sea foods, cottage cheese, and canned beans.

Sodium Supplements

Sodium is almost exclusively supplemented with sodium chloride. Before trying any other type of sodium supplement, be sure to talk with your health care provider.

When talking about sodium supplementation, it is also important to talk about water consumption. First, know why you are taking a sodium supplement. If it is to increase the sodium levels in your body, it is important that you don’t increase your fluid intake when you increase your sodium intake. A general guideline is to monitor the color of your urine. Increasing your salt intake will make you feel thirsty even when you don’t need more water. If you think you need more fluids, first check the color of your urine. If your urine is pale yellow then your fluid intake is good and you don’t need to increase your fluid intake.

There are times that sodium supplements are used to help individuals increase their blood pressure. If you are taking a sodium supplement for this reason, it is important that you increase your fluid intake along with the increased sodium intake. Without increasing your fluid, you will not see an increase in your blood pressure. Consuming 400 milligrams of sodium, the amount in a single gram of table salt, causes your body to retain an extra 4 cups of water, which equals roughly 2 pounds. Drinking more water flushes out the extra sodium, returning water levels to normal. It can be helpful to monitor a daily weight for a few days while you figure out how much fluid and salt you need to get the water retention that you need for the increased blood pressure.

There are some things to keep in mind when you are adding a salt supplement to your regime. It is important to start with a small amount and increase the dose over time until you get to the desired amount. This will allow your body to get used to the increased sodium in a more gradual way. Sodium tablets generally come in 1 gram doses. It’s a good idea to start off by taking a quarter tab then increasing by a quarter tab every 2 weeks until you have reached the full 1 gram. Your pharmacist is a great resource for titrating up on your dose when you are first starting out.

If you are having loose stools after starting a sodium supplement, it means that your body is not absorbing the sodium and it is being flushed out of your gut with water. To improve your body’s ability to absorb the sodium, break up the total daily amount into smaller doses spread out over the day. This will also make it less likely that you will increase your thirst drive. Adding in fiber or Imodium may reduce your loose stools, but neither will change the fact that you are not absorbing the sodium that you are taking. You may also need to look at the other medications that you are taking as they might effect your body’s ability to absorb the sodium. Your pharmacist is a great resource for trouble shooting this problem.

It is not uncommon for sodium to cause nausea or vomiting. If you have problems with this, first try taking the sodium with food. Again, dividing the total daily amount into smaller doses through out the day can be helpful with this side effect. If you continue to have problems with nausea you can try dissolving the tablet into a small amount of warm water and then mixing the salt solution with a flavored beverage. This will allow you to slowly sip on the drink over several hours , making it less likely to irritate your stomach. If this method works for you, consider Gatorade zero as an alternative to a salt tablet. Each bottle of Gatorade zero has 270mg of sodium along with 80mg potassium. This method of having liquid with your sodium supplement is a great option for those using the sodium to increase their blood pressure, but should be used with caution when trying to increase a low sodium level. For some, taking a nausea medication is required to get past the nausea side effect of sodium supplementation. Again, consider consulting your pharmacist if you are having trouble with nausea as it might be an issue of what medications you are taking with the sodium supplement.

Your PCP

Your Primary Care Provider (PCP) really will be your best ally when managing a supplement. They will be the person that will be ordering your monitoring lab work to make sure that your supplementation is meeting your goals. They will also be the ones that will help you make sure that you are taking the right amount of the supplement. Not to mention it is most likely going to be your PCP who is helping you manage those underlying conditions that is causing you to have to take a supplement in the first place. It is also possible that your supplements could interact with medications that you are taking. Your PCP and your pharmacist are your best allies for monitoring for these possible interactions. So it is super important to keep your doctor in the loop whenever you are adding in supplements.