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Hypovolemic POTS patients should take 150-250 mEq sodium? (10-20 g salt)

Discussion in 'Problems Standing: Orthostatic Intolerance; POTS' started by ahimsa, Mar 6, 2014.

  1. ahimsa

    ahimsa Senior Member

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    [Update - Oops! I typed in the wrong amount of sodium in my electrolyte mix. Correct amount is much higher, see later post on this thread]

    I was looking through a bunch of different research studies and found the following recommendation for patients with low blood volume (hypovolemic patients) in a review of POTS - http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8167.2008.01407.x/pdf :
    Wow, that's a lot of sodium! I thought I was taking a reasonable amount but it's nowhere near this.

    I looked it up and 1 gram salt has 387.6 mg sodium.

    So that means (please check my math!) that 10 grams of salt = 3876 mg sodium or 168.52 mEq sodium. (Note: I used http://www.nafwa.org/convert1.php to convert the units from mg to mEq). That's on the low end of the recommendation. Double everything to get the high end of 20 grams of salt.

    I know I don't get this much. My guess is that I get maybe 2000 mg of sodium daily (maybe more?). This guess comes from adding up salt tablets (180 mg x 5 tablets = 900 mg), a liter of electrolyte solution (my home made version has about 450 mg sodium) and whatever is in my diet. I think my diet is fairly low in sodium because I don't eat a lot of fast/processed food other than some canned beans.

    Does anyone out there take 10-20 grams of salt? Comments?

    I'm just curious whether I should try increasing my sodium a bit more.
    Last edited: Mar 7, 2014
  2. Martial

    Martial Senior Member

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    If you do be sure to raise your potassium as well, as that much salt can deplete levels especially with the ecessive peeing so common with POTS
  3. xchocoholic

    xchocoholic Senior Member

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    If you're interested, this was discussed on the Dinet forum. Most of couldn't do this and the dangers of high sodium intake were discussed. Tc .. x
    SOC likes this.
  4. Calathea

    Calathea Darkness therapy

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    If you're making your own electrolyte drink, a cheap and easy way to include some potassium is to put in some low-sodium salt (mix or sodium and potassium) or salt substitute (potassium only). My electrolyte drink is a mix of ordinary salt and low-sodium salt, so it's more sodium than potassium, but still a good amount of potassium.
  5. ahimsa

    ahimsa Senior Member

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    So sorry if my post was confusing. I didn't mention it but I take both extra sodium and potassium.

    I was so focused on the question about sodium that I didn't mention potassium. I didn't realize that would make it look like I wasn't taking any potassium.

    If nothing else I need extra potassium because I'm on Florinef (fludrocortisone). This drug makes the body more likely to hold on to sodium and excrete potassium. So even my doctor agrees that I need extra potassium. She also measures my electrolyte levels at least once a year.

    My potassium supplementation comes in two forms. First, my doctor prescribed a time-released potassium supplement (Klor-Con). It contains 10 mEq (about 750 mg) potassium.

    My other source of potassium (other than food, of course) is the electrolyte drink that I make. See http://forums.phoenixrising.me/index.php?threads/puzzling-reaction.25992/#post-397705 for the recipe that I've been using.

    But I just looked back at the calculations in my first post. I was completely wrong about the amount of sodium that is in the electrolyte drink that I make!

    One liter has about 1584 mg sodium = about 69 mEq. That means my sodium intake is higher than I thought. Oops. :oops:

    So after all that, I'm probably closer to the low end of that recommendation than I realized. :rolleyes: Sigh. Never mind.
  6. Calathea

    Calathea Darkness therapy

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    Oh, it was just a general recommendation to anyone making their own electrolyte drink! I suspected you were putting more than simply salt in yours, otherwise you'd probably have called it salty water.

    Interesting proportions in your drink. I've had a nasty experience with too much bicarb of soda leading to diarrhoea, and it tastes vile, so I've never really bothered with it in electrolyte drinks. I used d-ribose for a while, and then found the most revolting mould in my water bottle. Plus I don't seem to get on well with d-ribose. So now it's just a mixture of ordinary salt and low-sodium salt, i.e. sodium and potassium. There's a low-sodium salt being sold quite cheaply at my health food shop that contains a bit of magnesium as well as the sodium and potassium, so I am planning to try that.

    I used to think that a low-sodium salt that says it's 50% sodium chloride and 50% potassium chloride would give me equal amounts of sodium and potassium. Not so, as evidently they have different densities or something. I honestly can't remember the proportions now. I think you get a lot more sodium than potassium?
  7. ahimsa

    ahimsa Senior Member

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    Baking soda doesn't seem to bother me but I've played around with several recipes.

    I've seen some recipes with baking soda (NaHCO3) and others with sodium citrate (Na3C6H5O7). I understand the reasons for table salt (NaCl) and potassium chloride (KCl). I'm really not sure what the other ingredients do.

    Mainly I figured that the WHO standards for oral rehydration salts was a good starting point. The glucose/dextrose is included because it is supposed to help sodium absorption. Extract from http://rehydrate.org/ors/ort-how-it-works.htm :
    It may be overkill for Orthostatic Intolerance (POTS or NMH) patients since we're not having severe diarrhea. But I figured that it could not hurt, especially since there may be digestive and/or absorption problems.
    Yuck, that sounds awful. What a mess!

    I've not had this problem. I mix up one liter in a glass pitcher, put it in the fridge, and then drink it within one day. And then I always wash the pitcher after each use.

    I don't carry this drink mixture around with me when I go outside. I use my water bottle for water only.

    Thank heavens for my dishwasher (washable glass pitcher, wide-mouthed water bottle). Standing up at the sink to wash things is impossible. I have a kitchen bar stool to sit the sink. But it's still hard so I avoid it.
    That sounds interesting. I don't use any of the no-salt or low-salt powders. I buy plain, powdered potassium chloride (e.g., NOW is one brand name).

    If I have bottles that are only one ingredient then I can figure out the proportions and change them more easily. If there are 2 or 3 things (sodium chloride, potassium chloride, magnesium citrate?) in a single bottle then it would get too confusing for me. As it is I messed up the amounts in my first post.
  8. Ema

    Ema Senior Member

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    Sodium is a component of salt.

    Salt is sodium chloride. So in 10g of salt, you would get approx 4g of sodium...which is about 175 mEQ.

    I think that is what you are saying but it gets confusing...especially with salt tablets that list both sodium and sodium chloride content.

    I typically take in about 7-8g of sea salt a day and that helps me keep my blood volume and pressure up.

    Sea salt also usually has a larger grain and so it would weigh more...so you would get less sodium in 10g of sea salt than in 10g of iodized salt. Though I hope no one is eating iodized salt...:)
    ahimsa likes this.
  9. ahimsa

    ahimsa Senior Member

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    Yes, thanks, that is pretty close to what I posted in my first message:
    (I can never do the mg to mEq conversion properly so I used an online tool)

    The salt tablets that I take have 180 mg sodium per tablet. That means 180 mg of Na, not salt (NaCl).

    But I think I get your point. Patients need to be aware when doing these calculations that table salt is sodium chloride (NaCl) and not just sodium (which would be unstable, actually - see ).
    Thanks for your reply! It helps to have another data point.
    Ema likes this.
  10. ahimsa

    ahimsa Senior Member

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    Oops, forgot to respond to this part. I agree that using iodized salt is not a good option when we're talking about these large amounts!

    And I understand that the grain size matters when using volume measures (teaspoons/tablespoons). E.g, one tablespoon of kosher salt is not the same as one tablespoon regular table salt.

    However, when using weight measures like grams (e.g., using a kitchen scale), then wouldn't 10 grams of any kind of salt contain the same amount of sodium? (like the old joke of "what weighs more, 10 pounds of feathers or 10 pounds of lead?")

    Or are there enough other minerals in sea salt that it makes the actual salt (NaCL) content lower and therefore the sodium content lower?

    I thought the amount of trace minerals in sea salt was pretty small. Maybe not?
  11. Ema

    Ema Senior Member

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    I think you are right about the weight.

    I think I got myself confused with volume.
    ahimsa likes this.

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