Low Sodium and How to Prevent Osmotic Demyelination Syndrome

[@Gustav.J]

I'm not even in the medical field - I just enjoy how well he explains medicine. Communication skills aren't just useful and important, but also an art to be enjoyed. The distinguishing characteristic of an educator is the ability to communicate well.

[@suhailym4116]

I agree, he is very good at presenting the information and speaking very clearly.

[@OttoBoy]

Wholeheartedly agree. Like you, I am not a medical professional. But Dr. Seheult’s ability to explain just about any aspects in the medical arena to where even I can grasp things must be gold to anyone in his profession. 🙏

[@FriendlyPharmacy5]

@@Gustav.J 💯

[@Systematiclol]

Yeah, im no doctor either but all through covid i watched his vids for info. Turns out old sunlight and exercise were huge. Love medcram

[@MB-vu3ow]

It seems Ms. Harris missed her calling.

[@justsayin3600]

The doctor found the perfect occupation. What an incredible teacher! Not all doctors are equal, just like mechanics, and master mechanics have gaps in knowledge, experience, and applied knowledge. What a great doctor!

[@GrahamTodd-ca]

Your communication skills are spectacular. Not only are you educating a broad audience about the particular topic, you are demonstrating that the ability to make complicated information accessible to non-specialists is an important part of the profession - perhaps all professions. Everybody should be working to up their game in this way. 👍🏼

[@GrahamTodd-ca]

I'll admit that sometimes I watch just see how you're going to do it.

[@DW-ry7sy]

I appreciate you putting this out, my aunt has dementia and is on Lithium. She's constantly thirsty and can't remember when she's drank water last. Because of this she sometimes she drinks too much water and ends up in the hospital with Hyponatremia. My mom is her primary caregiver and has had to really educate some folks at the emergency room as they'll try to increase her sodium too quickly.

[@tuvoca825]

Ask your healthcare professional. Most people can probably have Gatorade with half water instead, assuming their kidneys and everything else work okay and they don't already have electrolyte imbalances. Again, ask your doctor.

[@martinklawinski2933]

I don't know a lot of medicin and i don't know what type of demtia she has but if it where a member of my family i would put her an a ketogenic diet and a lot of vitamin d3, coemzyme Q10 at least if she is on statins and watch every video from Dr. Ben Bikman and all the videos from Low Carb Down Under.

[@jamesalles139]

@@tuvoca825 the sugar is not beneficial for anyone.

[@jamesalles139]

Will she drink water from a container? add the equivalent of 1/8 teaspoon table salt to 8-12 ounces of water to a quart dispenser. It will taste slightly sweet, not salty.

[@RichRich1955]

Is it possible that she breathes through her mouth? How much water does she drink daily? Why not use enough containers to use for the day's water? How is her sodium in the bloodwork?

[@JR-kk6ce]

I have gone on several expeditions to explore the deep Amazon jungle. It is incredibly hot and humid in the jungle and one becomes quickly drenched in sweat. The more a person sweats, the more they drink water. Soon the terrible headache hits, the dizziness, cramps, and the person becomes disoriented. It gets worse and worse, becoming dangerous. So, you always take plenty of salt and put it in your water when exploring the jungle.

[@jimatsydney]

Finally someone talking about the danger of low sodium. I’m a whole plant based older athlete. It is common for health conscious people to be also low salt (as I was once). I was struggling with low performance, brain fog, dizziness thinking that extra training was the answer. It was only when I understood that salt wasn’t a poison to be avoided but an essential nutrient that should be consumed to the RDI did my symptoms disappear. It is doubly scary hearing this, that catching viral gastro whilst on a low salt diet could be life threatening or cause brain damage.

[@carl13579]

I'm also an older plant-based athlete and have wondered about whether I need to add electrolytes during longer periods of exercise outdoors when it is hot and humid. Some of the plant-based doctors say no, but now I'm not sure.

[@Medcram]

It’s rare for somebody on a low sodium diet to have low sodium in their blood. This is because sodium regulation is tied very closely to water regulation.

[@stavokg]

@@Medcramthank you for this clarification. The video frightened me as well, as I eat so little salt.

[@jimatsydney]

@@Medcram However as your example given clearly shows in the case of viral gastrointestinal a person with low sodium reserves has little wriggle room. If they don’t keep hydrated correctly it might result in a trip to the ED. I have been in endurances races where significant number of people have been hospitalised because they have depleted their salt reserves by sweating and only rehydrating with water. This seems to rarely happen to people who maintain their salt levels to the RDI either through food or beverages. I hydrate only with water and don’t have a problem because I ensure my food contains enough salt.

[@jimatsydney]

@@Medcram As a health educator do you recommend people stick to the published RDI for salt? Or do you feel these recommended levels are wrong?

[@FirstnameLastname-pe5ib]

I ended up in the hospital with low sodium before because when I had covid, I was eating 0 salt, (thinking this would lower my blood pressure) & was drinking lots of water. The ammount of sodium in my blood was almost 0. Obviously I would never do that again but thought i'd share. The dehydratuon becomes severe pretty quickly, despite drinking 10-20 glasses of water a day. You need adequate sodium.

[@DIABETESHEALTHS]

Thanks

[@jac1161]

Na level of 0 = impossible, even when we're dead ;) Yes, I did the same during severe covaids in march 2020. I could't eat (I forced it but then I was dying/passing out. I did have a seizure...I NEEDED to be admitted to the hospital but they refused to admit me when I refused the vent that I did not need. I was so out of it that I didn't remember what I learned as a nurse that we give IV fluids with ...SODIUM and so I was drinking (contaminated, no less) so much water to prevent dehydration.....what happened? I wasn't holding onto water due to not adding the salt!! Healthcare system ALSO caused this problem with thinking..."low sodium diet"....SICK, evil.

[@FirstnameLastname-pe5ib]

@@jac1161 Yup, that was my line of logic as well. They kept drilling this misinformation that salt is the cause of high bp that I believed it as a kid. Whole family would regurgitate the same thing etc. But I took it a step further. I strained all of my food, so there was 0 sodium in it. Compounded by probably 20 waters a day, it didn't take long to deplete it all

[@celestialstar124]

Isn't almost all food is loaded with the sodium in this era? 0 sodium is impossible even when we die. I have especially avoid all added sodium for a decade and never have i once end up with low sodium. My doctor say that's because i didn't over drink water.

[@crowdancer5]

@@celestialstar124 all processed packaged foods in the supermarket.....eat real food!

[@chuck3441]

It just amazes me on the knowledge that Dr's have, I've been a mechanic for nearly 50 years and feel like I don't know much after presentations like this.

[@twelvesmylimit]

I find the more you learn, the more you realise you don't know!

[@blissss0]

Actually I don't think many doctors know about this. Dr. Seheult does deep research to help his patients, and puts the info out via these videos, so other medical professionals can be aware. Doctors are massively overworked and therefore don't take the time to do the level of research Dr. Seheult does. Grateful for the info and heading out to get some salt (which I've been avoiding) and coconut water (for hydration and electrolytes)

[@robdawg828]

Ugh. My mom had low sodium levels and they over corrected her sodium levels. She was never the same after. She immediately became dementia-like. It was crazy. She recently passed away. RIP Mom.

[@bferrell1797]

So sorry for your loss.

[@KMx108]

Seems like a screw up that could easily be blamed on your mom and not the hospital or doctor. I'm so sorry for your loss.

[@jumpnsmashbadminton3948]

I m sorry for your loss

[@Gamma-jl4ib]

Really sorry for your loss

[@hippopotamusanonymous1580]

I’m sorry for your loss but her soul is eternal.

[@arleenm7367]

Thanks for this. This is definitely a problem in many long-distance runners (marathons, ultramarathons) who are told to drink drink drink to keep hydrated.

[@Medcram]

Well said!

[@orion9k]

Too complicated for the average Joe to even take into consideration on a daily water/sodium consumption. Few years ago I went complete cold turkey on salts and from one day to another, I stopped adding salts into my diet, because Dr. Gabor Maté said something about stopped consuming salts because it was unhealthy. At the time I had burn out from stress and my health was far from optimal, so I was desperate to try anything to improve my health, and I remember how the first week going no salts, I could barely bend my joins and my muscles became completely stiff. After a month with heart palpitations and constantly feeling dreadful and dizzy, I went back to salts and my heart and muscles slowly got better again.

[@Medcram]

Again this video has little to do with salt intake and more to do with the management in the hospital.

[@noelbrown6771]

I have similar concern about the perceived conflicts with sodium in the diet. I've actually been increasing my sodium intake in order to combat low blood pressure.

[@AlphaGeekgirl]

1:36 it’s not complicated at all. You just need to pay attention.

[@mesomebody5017]

@@Medcram Yes==but you can’t always trust hospital management with short staffing, staff from training outside the US, and just stupid doctors….some training hospitals might touch on this very lightly and some might do better job This can happen to someone IN the hospital for other factors--I think this happened to my senior sister-in-law whose dr was always restricting her fluids-she got dehydrated-had to go to hospital-and think they probably didn’t watch her sodium levels very well-if they gave her Dextrose that would hurt vs help her….and she did have issues with her thinking/organizational skills after that time that were not apparent before that episode.

[@jac1161]

Gabor is good but not in everything. Like every one. No one has it all, and there are some flaming contradictions, that's for sure, with medical advice. Stress depletes SO much. Been there - decades of abuse I shouldn't have taken, working in healthcare is a version of that to boot, etc.

[@vibolyong]

That's a very clear explanation! Thanks Dr. Sehult!

[@annasutton8078]

I am an older person who is interested in how my body works. This happened to my elderly neighbour, who was drinking lots of water due to a dry throat. Historically, we have been told salt is bad for you. Now I make sure I take some sea salt if I need it.

[@rolandovivar6864]

Ditto!

[@marcelotemer]

I’m impressed how bad this homeostasis works, opposite to what we were told in school. Thank you Dr Seheult for this valuable info.

[@biodivers5294]

The body knows things that we hardly understand. Beautiful!

[@rise4329]

Awesome! More like this please! (Common clinical pathways for some of the most common disorders/Dx that come through the Emergency Dept.) Thank you!

[@juergenzhang9133]

Thank you so much, for the great explaination. I have diabetes insipidus using Dessmopressin for many years and sometimes fell into Hyponatremia. No doctor could explain the connection between the complex control loop. This video was a real enlightening!!!

[@Medcram]

Wow. Excellent.

[@jac1161]

they explain very little - I learned this as a nurse and a patient. Hot mess.

[@HanzShaoPing]

That's more complicated than I would have thought just to increase someone's sodium levels.

[@Medcram]

It seems the medicine is always more complicated. Likely because the body is complicated. Sigh.

[@garylancaster2031]

Excellent presentation….Even I understood this process! Thanks Doc👍

[@corinnenovotny9900]

I was hospitalized due to low sodium. It made no sense to me, or my family, as I’ve always craved salt, and as a result have always consumed a lot of salt!! While I still consume a lot of salt on my food, as well as eating salty snacks, I now add electrolytes to my water.

[@jima3345]

Smart!😊 I've been there too.

[@jac1161]

Careful with the 'snacks' as processed foods don't a healthy salt. On the plus side, you likely have great iodine levels which are not discussed but so important.

[@carl13579]

@@jac1161 Depends where she is. In the UK, for example, salt is not iodized.

[@theageofgoddess]

Something in the water or in our bodies chemistry must be changing. I never heard of having low sodium & it being an issue, only recently I’ve seen it in people on psych meds.

[@mavisemberson8737]

@@carl13579 Salt was always iodised when I was there. Cerebos table salt or any similar brand was recommended for everyone post WWII They said it prevented goitre I think. !

[@sapelesteve]

That was an excellent synopsis of ODS Doc! Yet another Med Cram video that I have to send off to my cousin (M.D.) for viewing. Thanks and I hope that all is well with you & your family!

[@Medcram]

Excellent!

[@rolandovivar6864]

Great stuff! Electrolytes are essential & should be part of a complete blood test. Interesting to see nausea with low sodium & also dehydration. Had low calcium levels recently.

[@briangriffiths114]

Well explained whilst also reminding me of how difficult it must be to be a doctor making such complex balancing decisions. Enjoyed the video, thank you!

[@rhyothemisprinceps1617]

I had symptoms of hyponatremia when I did my colonoscopy prep (nausea, vomiting, headache - I also felt really cold, tho I don't see that listed as a symptom). I reported it to my gastro, and he completely ignored it. I'm glad I managed to recover without any help, so I guess it wasn't that bad.

[@joyfisher8008]

No background in medical fiekd but you explain things so well i can get about 85% of this. BTW I remember "D5W" from an old TV show "Emergency"; seemed to be the 1st thing the doc ordered everytime

[@DonnaF-c1h]

I've read a lot of comments here about adding electrolytes, most focusing on powders or things like Pedialyte that also contain sugar. I just want to point out that coconut water (use organic, unsweetened) is an excellent, natural source of electrolytes. I've added it to my routine and have noticed a positive difference. I buy it by the case at Costco, their brand. It's great!

[@jcastro91235]

Thankyou

[@Melodie007]

You have a great channel. You are a wonderful teacher. I listened to you back when and I am the only one I know who didn’t get . . . V

[@vegan1dmd]

Ditto!

[@jcastro91235]

Thankyou so much I’m understanding what happened to my aunt she also has kidney problems

[@southerncomfortuk]

Fascinating video. It would be great if guidance was available on how much fluid / sodium intake is best. NHS advises 8 glasses a day which is fine in cooler weather but how much is too much when the temperature is high.

[@FriendlyPharmacy5]

This was a great case study. I recently had a family member who experienced hyponatremia due to carbamazepine that was being used for trigeminal neuralgia. Thank you for sharing, great explanation.

[@jcastro91235]

I hope the Doctor and nurses do this with my aunt today she has been there for 2 days

[@Medcram]

I’m so glad that you’re now informed about what’s going on with your aunt. Ask questions get answers.

[@laurenoutland4035]

This is so interesting....when I was a neuro ICU nurse many years ago we had a patient admitted to the ward with altered mental status which we found out was due to his nutritionist daughter cutting salt out of his diet. His sodium was 115.

[@Just_forfun9140]

I thought all you need is a glass of water with salt in it, to raise sodium level. I could have never guessed this much complication. Who knew drinking too much water could cause this problem.

[@buckbenelli8]

After 43 years, now I understand. But I’ll keep watching and learning after I retire. Health care by corporations is horrible, they try to save pennies by hiring highly paid administrators. Then they blame us for everything.

[@jac1161]

healthcare is the most corrupt business of them all -- I became quite sick from them as a patient, and a nurse.

[@rezzer7918]

Ah the intricacies of feedback and feed forward physiologic regulation; what a piece of work is man ...

[@mariaj4]

This is why dehydration salts a must during dysentery etc

[@jima3345]

An alarm bell for me is if I'm craving potato chips (salt), that's when I hit the electrolytes.

[@Just_forfun9140]

I would like to know who is the architect of this body, for that matter even a Cell. I thought Eye is a very complicated organ, the Biochemistry of it, now I see how complicated with Na level balance in neurons. It never ceases to amaze me. What is most amazing to me is, we function fine, how is it possible with so much complexity happening all the time everywhere in the body.

[@ThomasAT86]

It's fascinating and probably true for a lot of fields that the "experts" or let's say "professionals", know WAY more about a topic than you'll usually ever get to know, as opposed to some scammers and quacks who know very little and yet still claim to know more than the professionals. When I did my strength coach and nutrition coach certification I learned a lot of stuff that I'll usually never get to tell a client, but that knowledge is crucial for the coach to be able to make proper decisions, digest and filter new information and explain things in an easier but still at least mostly accurate way. I'm sometimes picturing a sketch of a head and what comes out through the mouth is like a small opening and on the back of it is an exponentially wide funnel with all the information necessary.

[@nutmuffin1]

Excellent information

[@bjornbaron5940]

Love your drawings, makes following very easy.

[@sheila7814]

If you eat a healthy diet ( non processed foods), your sodium might be lower (at least mine was). I found I needed to start salting some of my food.

[@alanchappell414]

Yep me too and since ive started consuming salt again ie at least three teaspoonfuls aday. I feel great my body feels lubricated and no more brain fog.

[@GrandFyre]

Brilliant video.

[@k14michael]

Also Celtic sea salt is better for you than regular table salt. That has other minerals in it.

[@jakeaurod]

I always learn something useful in these videos, that help me understand something that's happened or could happen so I feel like I understand what's going on with my health or those around me. Unfortunately, post-covid fatigue and brainfog made my mom choose someone else to be her medical PoA when she went in for a procedure that should be simple and low-risk and next thing I know she has a hole in her heart, a balloon in her aorta, her liver and kidneys are failing, she's being flown to a second hospital, then a third hospital out of state, and by the time I get there I'm expected to make an informed decision on when to pull the plug. I still have no idea what happened. We haven't even gotten the death certificate or her ashes back yet.

[@Medcram]

Sorry to hear this….

[@mohamedtaha1762]

Fantastic. Thanks

[@rnw4468]

Great to have you breaking down the mechanism. Would love to have your work/interpretation on salt wasting syndrome in icu pt with brain damage. Thank you 🙏🏻

[@Medcram]

Yes! Now that’s a complicated one. And therefore a good suggestion.

[@yasmine4754]

Dr Seheult, could you please make a video about Gabapentin toxicity.

[@hollylorn131]

How much salt should we add to our diet daily along with how many ounces of water daily should we take in? You explained everything very well so that the average person could understand these medical topics, thank you!

[@nian60]

Thank you for the video. Very interesting.

[@deborahd.7281]

I was looking at the ingredients for Pedialyte and sports drinks and they have about 25g or maybe more of sugar per liter, that seems to be an awful of sugar if taken at once, could that lead to reactive hypoglycemia in sensitive people?

[@tuvoca825]

Sugar is sugar... if they would get it otherwise, maybe. And in dissolved form... faster absorption and it hits harder than in food.

[@yossarianmnichols9641]

Very interesting, I wonder how often this occurs in the population and can it occur under circumstances not related to an illness such as outdoor exercise in very hot weather. I have read of people dying of heat stroke with water in their water bottle.

[@shakeyj4523]

If the water is hot enough, you can die of heat stroke while submersed in water. Water alone does not prevent heat stroke.

[@megeek727]

I can not imagine this happening in the U.S. There is so much salt in our diet. Folks who are rehydrating after extreme dehydration like marathon runners may be the few that need be concerned.

[@shakeyj4523]

@@megeek727 Not all of us eat highly processed foods. If you don't it's actually fairly easy to be low on salt.

[@aprilmichael5410]

Great dr🎉

[@shrabonihasan147]

Nicer presentation

[@Rene-uz3eb]

Maybe a point should be made about ace inhibitors causing hyponatremia, because they prevent more sodium reabsorption, which is then compensated with vasopressin which only absorbs water without sodium. 13:51 it seems these patients are mainly hyponatremic, not hypovolemic. So by giving them fluid you make them fluid overloaded, which would seem to be the main reason why the body is dumping tons of water so fast.

[@Medcram]

Actually they are both hypovolemic and hyponatremic. The mechanism is explained.

[@Rene-uz3eb]

⁠it seems easier to diagnose hyponatremia than hypovolemia. I'm not saying it's impossible that the body would suddenly try to start concentrating sodium now that it has more fluid, and get back into a hypovolemic state for benefit of correcting sodium balance. Since the body prioritizes maintaining volume over sodium concentration though, if these patients were truly hyponatremic hypovolemic (GI losses, diuretics, dying of thirst), then fluid resuscitation would bring them back to normal without rapid urine production and sodium increase. Vs a patient who just drank too much water. Thanks for the video though and the danger of increasing sodium too fast

[@Rene-uz3eb]

I think an even bigger problem is IV fluid induced pulmonary edema (especially with IV vasopressin, during hyponutremia) which has high mortality. Wouldn't a better solution in acute hyponatremia be to administer isotonic fluid to correct hypovolemia, and then have a very slow drip saline IV according to raising sodium concentrations per time unit?

[@jakobw135]

Is it not BETTER to consume a complete MINERAL COMPLEX, like Celtic salt or Himalayan salt, rather than just plain sodium chloride?

[@Medcram]

I think so.

[@catb4918]

It's difficult for most ppl to understand that hydration is not about drinking water, it's the electrolytes. There are a lot of 0 cal 0 carb 0 sugar flavored & unflavored electrolyte mixes that if you consume one or 2 packets mixed in water a day you will feel so much better. I hike ALOT & carry salt, electrolytes all the time. You have no idea how many ppl I have saved on hikes because they're cramping or just feel horrible. Always they say 'my Dr tells me not to eat salt...'. I tell them them you are doing an altitude marathon. You need salt! & get a new Dr! 😂

[@lynpolkabla4088]

Thanks! Am post massive stroke (almost all cognition & aphasia recall & fluency) and don't trust most docs to keep current with research. My huge intellectual reserve means I can ask for help when I notice symptoms. Good info to know if/when I get dehydrated: dilute electrolyte better choice for me as sodium usually tests low side normal. Ya got some of us who're biochem 'groupies' or should I say nerds LOL! Thanks again for this one esp.

[@currentconditions962]

Wow! This is really great information. I am always worried about my sugar levels because I don’t want to develop diabetes, but now I also have to check my salt intake. How does someone keep a well balanced salt diet? Is that’s why sometimes the body craves salt once in a while?

[@Medcram]

This has little to do with dietary sodium intake. It has more to do with acute illnesses, that cause loss of sodium with the replenishment of just water.

[@ThingsWeMayNotKnow]

I get 140 and have symptoms. Twitching, heart issue, migraines

[@sylviawelsh9518]

Been advised to limit salt and givin LASIK to eliminate fluid but also messes with my electrolytes, any recommendations.🤔

[@oaktowngrrrl]

Do be careful! Dr. changed my diuretic to Chlorthalidone 25MG. After approx. 5 days, noticed that I was not urinating much. Sixth or seventh day, it was like a dam broke! So I thought the "worst" was over, and continued to take the medicine. However, my body kept saying that "something was wrong", so I quit taking any diuretic after taking it for 5-6 weeks. About 2-3 weeks later, came down with Vertigo. Horrid! It then affected my eye (as eyes will roll around), and I was to learn that I had early AMD. Three months later, the Vertigo is still with me (considered a vestibular problem by Drs.), and the eye has problems not experienced before the meds+vertigo 6 months ago. Good luck in finding the right balance!

[@desa9414]

This is wisdom, knowing how to despense complex information in lay man's term so the average Joe can understand it.

[@jennifertwede7142]

Boy do I have SO many questions for you! I got Cushing’s disease, and they found my posterior pituitary had liquified. My second pit surgery for the ACTH adenoma was in LA, and after removing 90% of my pituitary, on the drive home I was drinking a gallon every 10 minutes and peeing just as often, DDAVP, didn’t really help, and low sodium was one of their immediate concerns. Fast forward about 15 years, and I end up contracting Guillan-barre, which I know is an autoimmune disease that demylenates the nerves (as it took me a year or two to walk). Are there any studies linking having had severely low sodium and nerve issues like GBS and fibromyalgia? Thank you so much for the wonderful way you teach! I was pre- med, and LOVE this stuff!

[@Medcram]

I have not heard of a connection between low sodium and GBS. Just wondering if DDAVP didn’t work, what did they use?

[@jennifertwede7142]

@@Medcram I went unconscious in no where, California. My husband called my surgeon freaking out because I wouldn’t wake up. He said to shove salty chips into my mouth. My husband also bought fresh fruit, so perhaps the combo of salt and sugar helped? I ended up needing both adrenals removed (not due to the salt issue), and have been soaking up any and all knowledge I can find with my natural proclivities towards the study of medicine over the last three decades to try and figure out my completely horrific medical history. So this topic got me thinking. Thank you so much for responding!

[@pearlneidlinger391]

Thank you this is interesting to me. My left kidney died it's still in my body and I've been concerned that I don't eat enough skat. I don't eat processed foods so I'll be asking about this blood test. Also have you ever heard of the mouth salivating profusely and it tastes like salt coming out of the saliva. It usually lasts five minutes or so and its very odd. Im embarrassed to ask but this video piqued my curiosity about this salty run off.This has happened to me over my lifetime quite a few times. I've asked my doctor what it could be and he didn't understand what it is. Im very curious about it, it hasn't happened in over a year but its very strange. Any information would be appreciated.

[@Medcram]

I have not heard that before. Interesting

[@honorburza9110]

Could it be coming from your sinuses? Only because after I do a nasal irrigation with salt water, I suddenly get salty water in my mouth for a couple of hours later as it seems to flow from sinus cavities I guess. Although this doesn’t feel like excessive salivating as you’re describing. My partner tells me he gets excessive salivating , or almost bubbling saliva, if he’s about to be sick/vomit.

[@pearlneidlinger391]

@@honorburza9110 No its really like my mouth is over watering but its strong salt, and awful when it happens. But I'm so curious about what it's doing to my body. I don't use salt and I dont eat processed foods, I don't use nasal sprays uts so weird. I do feel exhausted and slightly nauseous after. I really am wondering has this happened to anyone else?

[@nian60]

I wonder if the increase in hyponatremia is partly due to more people doing intermittent fasting and OMAD*. I started intermittent fasting a few months ago, and I got headaches that were cured by taking salt with the water. When you only drink tap water (or poor quality bottled water) for a long time, it can give you salt and electrolyte deficiencies. Some fasts last for several days. So it's important to eat some salt and electrolytes then. *OMAD = one meal a day.

[@jumpnsmashbadminton3948]

Just now got back mother from hospital for low sodium, they increased slowly only,

[@jcastro91235]

Hi how long was your mom at the hospital

[@jcastro91235]

Hope she is better

[@sanbetski]

7:03 this is INaccurate. multiple studies suggest it is safe to administer 3%NaCl in peripheral vein to treat severe symptomatic hyponatremia

[@Medcram]

Sure if delay will cause harm but then use risk benefit.

[@bobthrasher8226]

What about the K? How did that get restored? What about using a balanced electrolyte IV?

[@Medcram]

Yes, the potassium was replaced successfully. We really didn’t need to use balance fluids in this case because it only took a small amount of fluid to restore the volume that was enough to shut down ADH secretion.

[@jaggeranand6408]

Perfect thank you Dr

[@ItsSakuraKeiIRL]

Very interesting. 😮

[@littlevoice_11]

Are you seeing an increase in this? I wonder if it is anything to do with the trend in carrying giant water bottles and constantly drinking from their bottle?

[@Medcram]

Not really an increase, but a constant drip. No pun intended.

[@freddiereadie30]

What can you do at home as first aid if you cannot go to a hospital so soon?

[@fingerdreck2328]

So i had a patient with hyponatremia of 120 mmol/l without any synptoms. Consequently we could diagnose SIADH, the origin was ovarian carcinoma. After this we tried to create an overview about the diagnostic algorithm of hyponatremia becauae it is so complicated. What are the most important first steps in hyponatremia?

[@Medcram]

We go over this in our video on our website, but basically it’s the first determine whether or not the patient is hypotonic, hypotonic, or isotonic. Most of the time the patient is hypotonic. Then the next step is to determine whether the patient is hypovolemic, hypervolemic, or isovolemic. SIADH is isovolemic and this patient was hypovolemic.

[@DavisonVideo]

Ur nice, Roger. ☺️

[@Fredgast6]

Then what about water fasting? During a water fast (only drinking water and taking salt every now and then for a few days) sodium levels fluctuate all over the place. People mention that they first get dizzy, then take salt, and then feel better, but what im learning here is this might cause a little bit of damage every cycle which is very worrying.

[@casiandsouza7031]

I rely on my tongue to judge the salinity of food/fluid intake.

[@tafarihowe3277]

I come here to watch videos so I can the smartest respiratory therapist at my job lol

[@jac1161]

How about "so I can help save and optimize lives under my care, by God's grace and my thirst for wisdom to apply it to others".. ?.."lol"

[@tafarihowe3277]

@@jac1161 the joke went right over your head. As a side note lol usually means it’s a light hearted joke. Find someone else to play with. Thanks

[@nian60]

@@jac1161 Maybe the OP is not a religious fundamentalist?

[@srm6366]

The functional medicine dr im seeing said my ADH was really low n its from CIRS from mold toxicity can you do a video on CIRS. Im dealing with electrolyte i imbalances i been to hospital multiple times n i pee like crazy. Doing a little better taking electrolyte but still not tight.

[@Momofukudoodoowindu]

Is it ok to drink a serving of electrolytes after a 30-45 minute stint in the sauna?

[@Medcram]

Generally yes.

[@Momofukudoodoowindu]

@@Medcram Doctor, may I make a video topic request? I have attempted to find YT doctors to discuss this topic to no avail. I take spironolactone for PCOS. Is it unproductive to drink electrolytes if the drug is a diuretic? I don't understand that drug factored in to the salt-and-water relationship. How do I properly hydrate on this drug? Thank you so much. 🙏🏼

[@iceangel587]

Myelin sheath Just like the plastic in a wire

[@Monica-gj2yx]

Well said!

[@fs3579]

Do you recommend any Cardiac EP well experienced in PFA ablation? In any location. Thank you!

[@sheila7814]

Does anastrazole cause a problem with sodium? Just curious. Every since I have started it, my sodium is borderline 135.

[@joemoya9743]

Good Example. But, it would also be an interesting discussion to use an example where someone becomes hyponatremic as a result of excessive consumption of water during an ultra-endurance sporting event (such as an Ironman). And/Or, where the cause may be the onset of the kidney's failure to function properly may be a contributory cause as a result of long term abuse of NSAIDS (...such as may be the case of an Ironman athlete or women who use NSAIDS for mensural cramps).

[@Medcram]

Yes. That is a different story. If it happens in less than 72 hours, it’s considered acute and the real danger there is the opposite. It’s brain swelling and you want to get the sodium up and the brain swelling down. In this case, it was six days which is much longer than 72 hours. And you want to correct things more slowly.

[@joemoya9743]

@Medcram Yep... different story. But, it is a story where many EMT's confuse hyponatremia with dehydration in the case of ulra endurance events. Thus, complicating the problem by applying dehydration treatments to a hyponatremic situation. And, where the symptoms are similar and the environment points the wrong direction for proper treatment. My rule of thumb is... if there is vomiting involved in what appears to be dehydration, it may be best to test for hyponatremia rather than assume dehydration, especially in the case of an ultra endurance event. Btw. very informative video.

[@teddyko7363]

Does this also happened with low potassium correction, Doc? I was once hospitalised because of hypokalemia and when the nurse gave the potassium correction, I can feel my head was like an expanding baloon. Sorry for my poor english.

[@thaominhtruong6038]

You neglect to mention SIADH in patients with history of brain or lung diseases, such as stroke and COPD, which are quite common.

[@Medcram]

SIADH happens but those patients are not hypovolemic. We discuss treatment for that in our series on medcram.com

[@honorburza9110]

Could the patient have prevented this if she’d been drinking rehydration salts instead of just water please?

[@Medcram]

It’s possible. She was also on a chronic diuretic which may have exacerbated the issue so it’s hard to tell.

[@jamesalles139]

As a 'normal' adult human I add 1/8 teaspoon of table salt to 10 ounces of water for my break-fast drink in the morning. It will taste slightly sweet, not salty. It is all about the osmolality!

[@scoobtoober2975]

Do you have any thought on someone who was bit by a brown recluse, got temporary paralysis, then Guillain-Barre syndrome then today doctors say he has chronic inflammatory demyelinating polyneuropathy (CIDP). He says when he consumes salt his ears start ringing. He gets ivig infusions every two weeks. Very obese and is resistant to diet changes. Lots of chronic pain and brain fog. And sleeps during the day. Awake at night. Just a curious study at this time. We've tried getting him out in the sun. But has a hard time walking, uses two canes. I'm bringing this up your discussing nerves and salt. Very interesting. I was obese and kidneys were all messed up, to some extent. Would urinate 6-8 times a day, very poor salt regulating, very clear bladder fluid. Fasting was a nightmare because i didn't add salt to water. Metabolic syndrome, the usual. It's pretty much turned around and i eat tons of salt. Recently lots of sun. This topic is fascinating. Keep researching and publishing, we love it.

[@billbob7982]

Symptoms sound like too much sugar in diet. No cookies, pie, cake, pudding, candy, sodas, packaged foods (wrapped, nor boxed), table sugar, fruits, corn, white potatoes, rice, nor canned vegetables. Symptoms (joint pain, brain fog, insomnia, day time drowsiness) will be GONE!

[@scoobtoober2975]

@@billbob7982 Thanks. i agree. Then again with this light/photo biomodulation. He is an introvert and lives on the nightshift lifestyle too. Zero sun. lots of carbs and processed carbs that is.

[@RobMcGinley81]

Does anybody know why 3% "Super Salt" shouldn't be given peripherally? Because that's how we do it in my ED

[@Medcram]

It’s not an adequate access for 3%. Usually that needs to go through central line because of the hypertonicity.

[@MatheusOliveira-er4gq]

I had this event 3 weeks ago, my sordium was 109 and I had convulsion. In my case it was a complication of Dengue fever and adrenal insuficiency, but I left the Intensive care 3 days later with a 127, I just fell pain in a leg nerve, everything else is ok, no brail lesion, do you think it could be myelin loss?

[@doinacampean9132]

Did the old lady also have low bp because of the low sodium? Could she have prevented the ER trip by replenishing her fluids with electrolytes? Given the price of electrolytes in the pharmacy, could she have done it with orange juice and a bit of salt?

[@pipedreams57]

Very technical. But how does the average Joe construction worker who is doing heavy labor out in direct sunlight in 98 degree heat who is sweating profusely and developing a headache handle this scenario using only bottled water and those little salt packets from fast food restaurants without doing a lot of damage to oneself? I have seen this happen dozens of times on construction jobs where there were no heat abatement programs in force. Sometimes the man was taken to the ER and just like you said, they were given 2 bags of D5w Ringers lactate over a 1 or 2 hour period and discharged right back to the same work site on the same day. Sounds dangerous doesn't it?

[@Medcram]

If it’s happening, acutely within a 24 hour period then this is probably OK. It’s when this happens over a longer than three day period of time.

[@pipedreams57]

@@Medcram I have had it happen 3 times in the last 10 years in the deep south on 105 degree days and made a quick trip to the ER to get a blood draw to check electrolytes. Sodium would be very low and they would usually want to give 2 bags of fluid [with me standing there eating a salted banana and drinking bottled water. Being the crew chief, I have to decline and return to finish out the 15 or 16 hour day. I am 67, retired now, with high BP and take Inderal 40mg 3/dayfor hypertropic subaortic stenosis [diagnosed 1970]. We tried Lisinopril but the side effects were horrible/multiple. I'm thinking I need a better qualified MD, a diet & exercise plan and maybe a little higher dose of Inderal IF my current doctor doesn't run me off for non compliance or "WHINING" as his nurse said.My BP averages 165/93 with a pulse of 84. Thanks for your reply.

[@freddiereadie30]

Will gatorade help?

[@pipedreams57]

@@freddiereadie30 You can do better than those bottled drinks and do it for free. Just use kool aid or similar and salt.

[@billbob7982]

@@pipedreams57 Cut ALL sugar from your diet. NO candy, sodas, cake, pie, cookies, table sugar, fruit, white potato, corn, carrots…..

[@pearlneidlinger391]

I understand what your partner is saying but mine is different its watery (is that really a word). And ooh so salty. Maybe one day I'll find the answer its very strange. Nausea is slight but part of it and, when it stops I'm exhausted. Thank you for replying g I appreciate it. Pearl

[@AE-yt4lx]

I know someone who had cancer and it was undiagnosed and she was so low on sodium, she could have died, right away.

[@AdAstra870]

Is osmotic demyelination brain damage permanent?

[@Medcram]

There have been reports of some improvement overtime, but generally yes

[@martinklawinski2933]

The normal value is what? 135 pears or apples or kg/l?

[@Medcram]

Meq/L

[@barleyhops38]

Question: I don't drink water. I drink probably 2 PowerAdes a day (similar to Gatorade) Is that bad for too much electrolytes etc?

[@infinitelo_op]

Powerade is 96% water

[@barleyhops38]

@@infinitelo_op Understood it's water mostly. My question is perhaps too much electrolytes. Is it harmful to heart etc.

[@shakeyj4523]

Look up how much sodium and potassium you are supposed to have in a day. Calculate how much you are getting in your food and drinks. Do the same for sugar. If you already have too much sugar and salt in your diet, and then you add a sugary drink to that, yes, it is harmful to your entire body. You could look for a drink that does't have so much sugar. Or you could make sure the rest of your diet Plus the drink is not over daily recommendations. You can get the information from the American Heart Association Website.

[@jonmoceri]

It's bad because of all the sugar in it.

[@KMx108]

I put a Nuun electrolyte tablet in all but 8oz of the water I drink every day and it hasn't been a problem for me. I've done this for the past 3 years.

[@Ockv74]

❤❤❤

[@neail5466]

Unnecessary RO water is to blame here. UF and Charcoal filtration with UV is sufficient for most of the people.

[@bethra.flowers]

❤

[@sylviawelsh9518]

Most MDs don’t understand Diet or electrolyte imbalances just keep writing those scripts.🤨😵‍💫😡