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Pauline
Pauline, Doctor (MD)
Category: Health
Satisfied Customers: 8631
Experience:  Medical Doctor & Registered Pharmacist. Worked as Community pharmacist for 17 years.
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I drank up to 170 ounces of water on Wednesday and only ate

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I drank up to 170 ounces of water on Wednesday and only ate 250 mg of sodium. On Thursday (today) I only drank 66 ounces of water and ate between 500 and 2000 mg of sodium. Since my blood sodium level is much higher today than yesterday, could that lead to brain cell shrinkage? If I pay attention I notice that I have some jerking movements. This could be a sign of brain cell shrinkage. What should I do? Should I drink more water? I am afraid to drink 5 ounces every half hour (which would lower the blood sodium level), because I possibly didn't eat enough sodium to drink so much (if you don't eat enough sodium you cannot drink too much, as you could develop hyponatremia).
Submitted: 2 years ago.
Category: Health
Expert:  Pauline replied 2 years ago.

Pauline :

Have you had any blood tests to determine actual sodium and electrolyte levels?

Pauline :

Do you take any medication?

Customer:

No I didn't have any bloodtests. But I'm assuming that my sodium level on Wednesday was probably low. I didn't have symptoms of acute hyponatremia, so the sodium level was probably around 135 or so. Today, Thursday, the sodium level is probably 145 or so. I have been drinking 5 oz every hour (although I was dehydrated in the beginning of the day, I later became rehydrated), which leaves just a tiny bit thirsty. So the change in sodium level was probably 10 between yesterday and today. Could this lead to brain cell shrinkage? No, I don't take any medications.

Pauline :

How do you know your sodium intake so specifically?

Customer:

I only ate food without salt on Wednesday and half a bagel, which is 250 mg of sodium, probably. I'm not sure about my sodium intake on Thursday - it could be anywhere between even 300 milligrams and 2000 mg. I have Meniere's disease, so I need to watch my sodium intake.

Pauline :

In terms of looking at sodium and electrolyte balance from a medical point of view then we use mmol as a measure. The body has a stabilising influence called homeostasis that helps the body adjust for intake and losses using the kidneys. Without blood tests then we cannot say that you are in a state of hyponatraemia however very tight control of intake over a period of time could cause problems.

Pauline :

What is the color and volume of your urine?

Customer:

I produce a normal amount of urine and the urine was dark earlier today when I was dehydrated, but quickly became clear again. Most of the time I have clear urine. I'm worried about the quick shift in sodium levels between Wednesday and Thursday. Could a shift as big as 10 over a period of a day (I think the measurement is mEq - the normal range is 135 to 145) cause the brain cells, which might still be adjusted to Wednesdays lower level of blood sodium, to lose water because of the higher level of sodium in the blood?

Pauline :

You cannot use your daily intake as a sole measure of whether you are hyponatraemic or not. The body will work to keep sodium if your intake is low and so losses will also change. (we lose sodium naturally through sweat, urine etc). So without blood test then you cannot say that your plasma level has indeed dropped.

Pauline :

We often see changes in people in hospital who are dependent on IV fluids with added sodium, and the main concern is when their plasma sodium is very low and then we correct it too quickly.

Customer:

I'm not concerned about hyponatremia at this point - I'm more concerned about a hypernatremic effect, because the blood sodium is much higher today than it was yesterday.

Pauline :

But you do not know that it is too high....

Pauline :

If you had excess sodium then the body would usually excrete it. The ideal sodium intake in grams is about 1.3grams sodium chloride.

Customer:

My sodium level today is probably 145 because I'm just a tiny bit thirsty. A doctor told me to avoid big swings in sodium levels, that is why I am concerned. I am concerned about the brain cells losing fluid because the blood has a higher concentration of sodium than they do.

Pauline :

Big swings in any intake: sodium, water, calories are all to be avoided as they put pressure on the body's metabolic processes. Eating a normal healthy diet with 8 glasses water a day is the best way to ensure that you get all the nutritional and electrolytes components that your body needs. Excess restriction causes a problem. You need a blood test to determine exactly what your currently levels are, and if you have been having jerking movements then you need to test for potassium, magnesium and calcium too.

Customer:

Could the jerking movements be a sign of shrinkage of the brain cells?

Pauline :

I would not use the phrase 'shrinkage of the brain cells'...but low sodium levels can cause muscles spasms, cramps and seizures.

Customer:

I don't think I have a low sodium level, as I am mildy thirsty. My sodium level is probably near the upper limit for the normal range.

Pauline :

However hypernatraemia can also cause jerks too.

Pauline :

I think you are trying to extrapolate with insufficient information. The body has a mechanism to adjust hormone levels to maintain a steady sodium level.

Customer:

So maybe I have the symptom of hypernatremia because my brain cells have shrunk? Would the brain cells still be at the sodium level that I had yesterday? In that case there would be a movement of water out of the brain cells into the blood, and the brain cells would shrink.

Pauline :

I think it unlikely that you have hypernatraemia given your recent intake. Do you have a medical background?

Customer:

I'm a biologist. I don't think I have hypernatremia, but I could still have brain cell shrinkage due to the big difference in sodium levels in the blood between Wednesday and Thursday.

Pauline :

The renin-angiotensin system would have adjusted for the sodium intake. In hospitals we use other factors such as heart rate and blood pressure to assess fluid status. In practice, the body does not always act as an invitro situation...so in theory the intake would cause fluid shifts, but the body accomodates to adjust in order to prevent the fluid shifts so you cannot consider sodium intake in isolation.

Pauline :

I'm going have to get off to the ward soon, in order to get a clear answer of your sodium levels then you need a blood test. However looking at blood pressure/heart rate would determine if you were under or over perfused.

Customer:

So could the brain have adjusted to the rapid shift in sodium levels in the blood?

Pauline :

Yes,

Pauline :

the hormone levels adjust for intake in order to prevent rapid changes. But if persistent sodium restriction were to happen then we would see a hyponatraemic state.

Customer:

So if I had a change from 170 ounces of water and 250 mg of sodium to 66 ounces of water and maybe 1500 or 2000 mg of sodium, the body would make sure there was not a very rapid change in sodium level in the blood?

Pauline :

That would be the aim. It all depends on the body's ability to compensate.

Pauline :

I'm sorry but I must go now. I'll check back later.

Pauline :

Regards

Customer:

Thank you very much. Take care.

Pauline, Doctor (MD)
Category: Health
Satisfied Customers: 8631
Experience: Medical Doctor & Registered Pharmacist. Worked as Community pharmacist for 17 years.
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