Hyponatremia as a cause? Salt deficiency, dehydration, too much peeing

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Has anyone looked at hyponatremia/salt-deficiency as an (intermediate) cause of their fatigue and confusion?

After extensive research I eventually found that I could manage my fatigue symptoms to a large extent through drinking a great deal of water. I realised that I was permanently dehydrated, sometimes not drinking anything all day and sweating all night - but I had no thirst. The problem was, though, that I was unable to hold onto water for more than 5 minutes. Water in, water straight out. If I was drinking lots of water I couldn't go far from a loo, and I'd have to get up many times in the night.

I solved this by consuming a lot of salt and electrolyte mixtures with the water. After a few days my brain returns and I sleep all night. As soon as I stop drinking so much, my symptoms return within days. I think the dehydration also explains my recurrent fevers, as the body heats up when dehydrated.

I'm wondering, now, why I can't hang on to my water. Hyponatremia (and article on salt/CFS here) seems like it may be an issue, but I don't recognise any of the suggested medical causes.

The thing is, back when I started getting ill, I was training in the gym fairly enthusiastically, had cut out almost all salt (having bought into the 'low-salt' medical message) and was drinking quite a lot of coffee. So, we have sweat salt-loss, low salt intake and further caffeine-induced salt-loss. Add to that a lot of emotional stress (given that the adrenal hormones also help regulate salt levels), and we have a problem.

So, I'm hoping that by staying watered, salted and relaxed, I may come back into hormonal balance. I'd much prefer that it was a balance issue rather than a virus...

Does this ring a bell with anyone else?
 

Cort

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That's very interesting because once I start drinking water - it just pours out of me. I can't hold it in either. If I don't drink much I don't pee much but if I do - and I generally feel better when I do - then I'm going all the time. I also have urinate with amazing frequency when I get cold.

I also crave salt - I feel like I need it on almost everything I eat - and my blood pressure is fine. Maybe I should really try to boost my electrolytes.......
 

richvank

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Hi, GlosGirl.

Many people with ME/CFS have diabetes insipidus as part of their illness. This is not the same as the more common diabetes mellitus. Diabetes insipidus (DI) is caused by too low a secretion of antidiuretic hormone by the hypothalamus/pituitary. There are about three hypotheses for why this occurs in ME/CFS. Mine is glutathione depletion in the hypothalamus/pituitary. Dr. de Meirleir has suggested that D-lactate from dysbiotic bacteria impacts the hypothalamus. Dr. Shoemaker connects it to his "biotoxin pathway."

Usually DI is accompanied by excessive thirst. The fact that you don't experience this suggests that the osmotic sensor in the hypothamus that causes the thirst sensation is not operating properly in your case. This can be another cause for hypovolemia (low blood volume because of insufficient water in the body), and it complicates things, because the person can be unaware of their need for more fluids. The fact that you have polyuria indicates that you do have DI in addition to a problem with the osmotic sensor.

At least one person has reported that their DI resolved after they had been on the Simplified Treatment Approach for lifting the partial methylation cycle block for a while. One of the effects of this treatment is to cause glutathione to come up to normal. You can get more information on this at www.cfsresearch.org by clicking on CFS/M.E and then on my name.

I hope this is helpful.

Best regards,

Rich
 
Get your adrenals checked, you probably have adrenal fatigue. Get a 24 hour cortisol saliva test (from a holistic doc/naturopath). I take a solution of magnesium, sea salt and vitamin C, three times a day, in addition to adrenal cortex extract. My naturopath said I could have as much salt as I wanted. I notice it works a lot better if the salt is dissolved in water, vs. just putting it on food.

You can do the morning cortisol blood test too, just to make sure you don't have Addison's, but it may come back as "normal" when you actually still have adrenal problems, so don't really solely on that.

I've also been doing the methylation protocol for a good while, and it hasn't helped the problem.
 

CBS

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No offense intended but salt loading seems like a stop gap to me. I did it for years and it did next to nothing to stop fluid loss..

I agree with Rich than many people with ME/CFS have a relatively mild form of diabetes insipidus (trust me, you'd know it if your case was florid). I suggest either treating whatever is causing it (one of the methods Rich presents - this seems preferable if you can find something that works) or treating the DI by replacing the deficient ADH (desmopressin). Chronic infections are know to be associated with DI.
 
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Hi All

Gosh, some interesting responses!

Cort - interesting that you have similar fluid issues - I wonder how many CFS/ME sufferers do? Curious that you pee more when you're cold! I assume you mean from outdoor temperatures, rather than an unhealthy basal temperature drop? My blood pressure often got very low before this, and I'd often feel faint, but they just told me I had a 'very healthy low bp...'. I wonder if salt is better dissolved than sprinkled, as caledonia suggested?


Jenny - how far have you taken this? Have you tried eating lots more salt?

Richvank - mmm, does sound like it, except for the thirst thing. On the other hand, there have been times when I've been desperately, unquenchably thirsty and nothing has come out the other end at all! Which rather supports the water-disruption idea of it, perhaps. Too much, too little. Sometimes I wonder if I'm actually thirsty all the time, but have come to disregard that feeling as irrelevant because it never goes away. Like I feel thirsty now, but I also have a glass of cold water still sloshing around in my stomach. Hmmmm. Is this where I find out that Diabetes Insipidus is another disease the docs don't understand?

What riles me is that I had a dozen symptoms relating to salt-deficiency (cramps, faintness, excessive peeing etc) but not one doctor has asked me about hydration. Sometimes I wonder how ANYONE gets to hospital via their doctors.

Caledonia - oh, I've had salivary cortisol tests done, which showed I was flatlining, but the docs dismissed them. Their tests show I'm just fine, with energetic adrenals, so I must be fine. Curiously, none of them test for secondary hypoadrenalism. My adrenals may work fine in response to ACTH, but no-one checks to see if they're receiving any! I'll try dissolving the salt - I've just been eating sea salt with a glass of water.

I also got these useful links from someone in a private email:

There's a bit of information in a recent article (check out Cort's comments following the article): http://forums.aboutmecfs.org/content...-the-Tests-CFS

DI may be a big part of orthostatic hypotension and POTS. It is quite possible that the 500 ml of fluid was actually what made you feel better: http://davidsbell.com/LynNewsV3N2.htm >>"I have no idea of why this [INTRAVENOUS FLUID] treatment works. At first I thought it was because of correcting the low circulating blood volume, but we have been able to correct that with other measures (dDAVP) without the same results. Whatever the saline is doing, it should be possible to reproduce the effects without intravenous fluids if we only knew the mechanism."
 

Sushi

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Hi, GlosGirl.

Many people with ME/CFS have diabetes insipidus as part of their illness. This is not the same as the more common diabetes mellitus. Diabetes insipidus (DI) is caused by too low a secretion of antidiuretic hormone by the hypothalamus/pituitary. There are about three hypotheses for why this occurs in ME/CFS. Mine is glutathione depletion in the hypothalamus/pituitary. Dr. de Meirleir has suggested that D-lactate from dysbiotic bacteria impacts the hypothalamus. Dr. Shoemaker connects it to his "biotoxin pathway."

Best regards,

Rich
Hi Rich,

I reported this on another thread, but it is relevant here too, so I'll jump in. I was definitely one of the diabetes insipidus gang (3.4 liters of urine in 24 hours), and yes, have been low in glutathione and have a partial methylation block.

Taking LDN seems to have rectified the diabetes insipidus symptom--I haven't done a 24 hour urine for a while, but am peeing-out less and only need to get up once in the night. This history is also true for another patient friend.

Do you have any idea how LDN could impact diabetes insipidus?

We always come to you with our perplexing questions...but then you have the knowledge to figure out good answers!

Best wishes,
Sushi
 

*GG*

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GlosGirl;13794 What riles me is that I had a dozen symptoms relating to salt-deficiency (cramps said:
I just saw a piece on the news station around here on Chronicle, it was a story on how a child died due to dehydration, I believe, I believe the parents sued the hospital and then used the money to educate Drs etc.. on how important this subject is!

GG
 
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Dehydration News

I just saw a piece on the news station around here on Chronicle, it was a story on how a child died due to dehydration, I believe, I believe the parents sued the hospital and then used the money to educate Drs etc.. on how important this subject is!

GG
No, really?!!! Any chance you have a link for it?

Pen x
 
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Hi, GlosGirl.

Many people with ME/CFS have diabetes insipidus as part of their illness. This is not the same as the more common diabetes mellitus. Diabetes insipidus (DI) is caused by too low a secretion of antidiuretic hormone by the hypothalamus/pituitary. There are about three hypotheses for why this occurs in ME/CFS. Mine is glutathione depletion in the hypothalamus/pituitary. Dr. de Meirleir has suggested that D-lactate from dysbiotic bacteria impacts the hypothalamus. Dr. Shoemaker connects it to his "biotoxin pathway."

Usually DI is accompanied by excessive thirst. The fact that you don't experience this suggests that the osmotic sensor in the hypothamus that causes the thirst sensation is not operating properly in your case. This can be another cause for hypovolemia (low blood volume because of insufficient water in the body), and it complicates things, because the person can be unaware of their need for more fluids. The fact that you have polyuria indicates that you do have DI in addition to a problem with the osmotic sensor.

At least one person has reported that their DI resolved after they had been on the Simplified Treatment Approach for lifting the partial methylation cycle block for a while. One of the effects of this treatment is to cause glutathione to come up to normal. You can get more information on this at www.cfsresearch.org by clicking on CFS/M.E and then on my name.

I hope this is helpful.

Best regards,

Rich
I just found out today that my latest blood test revealed my glucose is too high. I have no idea why! (No one else can either)... I am not overweight, AT ALL...and I eat very healthy. And, there is no diabetes in my family.

I also have low blood pressure, and crave salt constantly. I was drinking salt water for a while...and my blood pressure went up. My doc made me stop though... and now it's back to "below normal."

Sigh... I just want to feel better!
 

*GG*

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No, really?!!! Any chance you have a link for it?

Pen x
Friday, November 12: Medical Journal
POSTED: 5:33 pm EDT November 3, 2010
UPDATED: 6:27 pm EST November 12, 2010

In January of 2001, 18 month old Josie King was admitted to the hospital for treatment of burns suffered climbing into a hot bath. She never came back home; a medical mistake killed her. Now her mother is on a mission to make sure others don't suffer the same fate. Also tonight … colonoscopies are recommended for those over 50. But a disturbing trend might have doctors re-thinking that approach. And, the superbug comes to a Boston hospital. Should patients be worried?

Click To Comment

Show Resources:

U Mass. Medical School
55 Lake Avenue North
Worcester, MA
508-856-8985
U Mass. Medical School

Josie King Foundation
info@josieking.org

"Josie’s Story"
by Sorrel King

"The Best Practice"
by Charles Kenney

Dr. Robert Moellering
Beth Israel Deaconess Medical Center
330 Brookline Avenue, Boston, MA 02215
617-667-7000
Beth Israel Deaconess Medical Center

Dr. Randy Zusman
Dr. Hopper
Massachusetts General Hospital
55 Fruit Street
Boston, MA 02114
Phone: 617-726-2000
Massachusetts General Hospital


Copyright 2010 by TheBostonChannel.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

http://www.thebostonchannel.com/chronicle/25625319/detail.html

Hopfully this helps?!

GG
 

xchocoholic

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I have a theory on DI too ... I think sometimes it's from our bodies sensing a UTI infection, however slight, and this feeds our need to urinate. If we're constantly in this state, it's hard to know what it feels like not to have a slight infection. Eventually our bodies run out of the hormones that control these urges. The same concept applies to vomitting, diarhea, blood clotting when we cut ourselves, etc ... our bodies are ALWAYS trying to fix itself.

I got the idea from passing a couple of kidney stones. When I was in the process of passing these, my body couldn't urinate fast enough. Every tiny sip of water went through me instantly. So in order to flush out the stones, I drank cranberry juice continuously until this feeling stopped. I'd say it was at least 2 - 4 quarts within a couple of hours ...

I decided to see if my need to urinate frequently was due to my urinary tract needing to clean itself out ... I took 2 AZO with probiotics twice a day for a few weeks and my DI stopped. Now I take 2 once a week. I also figured out that B2 caused that feeling. Caffeine is known to do this too ...

Not that I don't still need plenty water and salt but I'm only going to the bathroom every 3 - 6 hours now. Not everytime I turn around. AND my bladder is full when I do ...

A bacteria called o.forminges is always missing in those who have kidney stones, so I suspect we'll find it's missing in those who have DI or frequent UTIs ... jm2c .. x
 

rlc

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Hi the hormone that contols salt and water levels in the body is Aldosterone which is made in the adrenal glands. Needing alot of salt and not being able to hold on to liquids is a sign of major adrenal problems, Adrenal insufficiency, Addisons, hypoaldoteromism etc low blood pressure is also a sigh of these conditions, along with a huge amount of other symptoms atributed to CFS, POTs, orthostatic drop, fatigue, fever, etc, etc.

The difference between these conditions and Diabetes insiupidus is that in DI the increased urination is caused by taking in huge amounts of liquid due to excessive thirst, with adrenal problems your not able to hold on to liquids.

Testing for these conditions should begin with morning cortisol, aldosterone and ACTH, blood and saliva cortisol tests can be unreliable, so if theres any doubt then an ACTH stimulation test needs to be done. I'v put links to information on these test and conditions on page 4 of the know cases of CFS misdiagnosis thread.

Hi JAXinthecity although most of your symtoms appear to match with these conditions, high glucose is unusual for them but could still be possible, there are over 100 causes of high glucose. One that would fit all of them is hemochromatosis (ironoverload) because it can damage the adrenals and cause diabetes, if you havn't already might be worth getting your iron studies done. information on hemochromatosis is also on page 4 of the misdiagnosis tread.

all the best
 

CBS

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Sorry of this seems a bit abrupt but there are some misunderstandings in earlier posts that I feel are important to correct.

I have a theory on DI too ... I think sometimes it's from our bodies sensing a UTI infection, however slight, and this feeds our need to urinate.
While a UTI can result in the need to urinate frequently, it is not the same thing as diabetes insipidus. The need to urinate frequently with a UTI differs from DI in the underlying cause (see below) as well as the small amounts of urine passed with each void. DI patients urinate a large volume and they do it frequently.

Hi the hormone that contols salt and water levels in the body is Aldosterone which is made in the adrenal glands. Needing alot of salt and not being able to hold on to liquids is a sign of major adrenal problems, Adrenal insufficiency, Addisons, hypoaldoteromism etc low blood pressure is also a sigh of these conditions, along with a huge amount of other symptoms atributed to CFS, POTs, orthostatic drop, fatigue, fever, etc, etc.

The difference between these conditions and Diabetes insiupidus is that in DI the increased urination is caused by taking in huge amounts of liquid due to excessive thirst, with adrenal problems your not able to hold on to liquids.
Aldosterone and adrenal issues can cause fluid imbalance issues but the cause of DI is not drinking excessive amounts of water. In DI, the loss of fluid drives the significant increase in thirst (in most cases - sometimes the thirst mechanism in the hypothalamus can be damaged and when that happens dehydration will not be accompanied by an increase in thirst).

Excessive consumption of fluids is called polydipsia. When this occurs without an underlying physical cause it is known as psychogenic polydipsia. Psychogenic polydipsea is an important differential diagnosis for DI.

DI can be tested for using 24 hour urinary fluid volume, osmolality and creatinine levels. If these measures are inconclusive, a water deprivation test may be needed.

[FONT=Verdana, Arial, Helvetica]http://www.diabetesinsipidus.org/faqs.htm[/FONT]
[FONT=Verdana, Arial, Helvetica]
[/FONT]
[FONT=Verdana, Arial, Helvetica]There are four (4) fundamentally different types of Diabetes Insipidus (DI). Each has a different cause and must be treated in a different way. These four forms are:[/FONT]​
[FONT=Verdana, Arial, Helvetica]Neurogenic, also known as central, hypothalamic, pituitary or neurohypophyseal is caused by a deficiency of the antidiuretic hormone, vasopressin. [/FONT]​
[FONT=Verdana, Arial, Helvetica]Nephrogenic, also known as vasopressin-resistant is caused by insensitivity of the kidneys to the effect of the antidiuretic hormone, vasopressin. More information about Nephrogenic DI can be found at the Nephrogenic Diabetes Insipidus Foundation.[/FONT]​
[FONT=Verdana, Arial, Helvetica]Gestagenic, also known as gestational is also caused by a deficiency of the antidiuretic hormone, vasopressin, that occurs only during pregnancy.[/FONT]​
[FONT=Verdana, Arial, Helvetica]Dipsogenic, a form of primary polydipsia is caused by abnormal thirst and the excessive intake of water or other liquids.[/FONT]​
 

Emootje

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I always thought that Diabetes Insipidus is associated with hypernatremia and not with hyponatremia.
Maybe high atrial natriuretic peptide is causing the hyponatremia. Juan Rodriguez-Soriano and Alfredo Vallo published a case studie of an 11-year-old boy who presented with high atrial natriuretic peptide and mildly hyponatremic extracellular fluid volume depletion.

http://www.springerlink.com/content/rfhe9gb7dbat6ye8/fulltext.pdf

The symptoms of the boy:
  • tiredness
  • headache
  • blurred vision
  • abdominal pain
  • vomiting

Atrial Natriuretic Peptide is increased by:
  • pro-inflammatory cytokines
  • endotoxin (leaky gut)
  • hypoxia
  • low vitamin D
  • low vitamin A
  • oxidative stress
  • endothelin-1
  • atrial wall stretch
 

IntuneJune

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My legs have been progressively swelling, have questioned the cause with a number of my doctors. They squeeze my ankles and say "I am not worried about that." (Since they do not believe this is pitting edema.)

Well, it's not just my ankles, it is my entire leg. I have gained weight. I track calorie intake and am around 1300-1500 q.d. So my PCP says, "cut down on your salt" without asking me "how's your salt intake."

On LiveStrong, when you record your food intake, one of the items calculated is the sodium. The library of foods on that site is awesome. When I salt my food, I measured the salt in a measuring spoon, end result was I was only consuming 1/2 the allowable amount.

My question is, can you be dehydrated......and have SIGNIFICANT leg swelling. Echocardiogram ruled out heart failure.

The swelling is causing additional stiffness and pain, my knees are sporting three knee caps.

Any ideas? June

I went to a new rheumy last week, he did start a diuretic.
 

xchocoholic

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x said ... I think sometimes it's from our bodies sensing a UTI infection, however slight, and this feeds our need to urinate. If we're constantly in this state, it's hard to know what it feels like not to have a slight infection. Eventually our bodies run out of the hormones that control these urges. The same concept applies to vomitting, diarhea, blood clotting when we cut ourselves, etc ... our bodies are ALWAYS trying to fix itself.

Hi CBS,

I can see why this was confusing ... I copied in the whole paragraph because I thought it made more sense. What I was trying to say here is that I think DI results when our bodies are constantly fighting UTIs. Even if our labs don't show UTIs ... I say this because treating this is how I got rid of my constant need to run to the ladies room ...

FWIW ... I'm not one to believe everything medical literature has to offer since it's obvious that most of the time looking for a cause wasn't considered ... tc ... x

PS. I've found that drinking 16 - 32 oz of water at one time helps if I feel dehydrated. Not sure why ... I guess, my body is really low by the time it registers.