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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
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Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am following a low sodium diet and need to know how much

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I am following a low sodium diet and need to know how much water I am allowed to drink if I am on a low-sodium diet. I tend to get very thirsty. I read a scientific article where it says that the kidneys can excrete 4 liters of urine a day if you eat 300 mOsm/d of solutes. An excerpt from the article: "...if the intake of solutes decreases to 600 mOsm/d, 8 L can be excreted, and in the more extreme setting in which the intake decreases to only 300 mOsm/d, a mere 4 L of free water can be excreted." Could you please tell me how many milligrams of sodium is 600 mOsm/d, and 300 mOsm/d?
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello,

I am sorry that your question was unanswered for long.

Osmolarity is dependent on the volume of fluid in which the sodium is dissolved. Osmolarity is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). So just on this basis; your sodium intake cannot be calculated. Body has enormous adjustment and it will keep the amount of urine and blood sodium levels to the optimum levels according to your body needs if you are drinking normal amount of water. If you are thirsty, drink more water as body is demanding it.

In normal environmental conditions and with no disease process, body will keep your sodium levels in the normal range, automatically, as body has large reserve.

Please feel free for your follow up questions.

 

I would be happy to assist you further, if you need any more information.

 

Dr. Arun
Customer: replied 2 years ago.
I might have been hyponatremic because on Friday, Saturday and Sunday I drank between 78 and 134 ounces of water per day, while eating 600 or 800 mg of sodium per day. On Sunday and Monday there was a 12 hour period where I only drank 15 ounces of water. Could that have rapidly shifted my sodium level after having been hyponatremic? That could cause central pontine myelinolysis. Or is that only something that develops when an IV is used to correct hyponatremia? Please note that on Friday, Saturday and Sunday I did have periods of time where my urine was dark, so maybe I wasn't hyponatremic from drinking too much water, as I might not not have had an excess of water in my system. If I had an excess of water in my system from drinking too much while not eating enough salt, my body would consistently be trying to get rid of excess water and would not concentrate my urine at any point in time during those days. So on the whole perhaps I was not hyponatremic for a full 48 hours or more. Can I go back to eating more sodium or could that cause rapid shifts in the blood sodium level and central pontine myelinolysis? Your input is greatly appreciated.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello and welcome,

Yes, body would have decompensated very fast and shifted your sodium levels back to normal, when you drank 15 ounces of water. Central pontine myelinolysis is rare with the oral sodium restriction or oral excess water consumption. Body get rid of excess water and kidneys conserve the sodium by reabsorbing it, so hyponatremia in your case is quite not likely. If you start taking normal amount of sodium (about 2-3 gm per day); there is no problem anticipated.

It is privilege assisting you.

Dr. Arun
Customer: replied 2 years ago.
Could I have been hyponatremic if I drank 108 ounces of water in a day and ate 950 mg of sodium that day? Could I be hyponatremic if I drank 96 ounces of water and ate only 315 mg of sodium in a day? Can one be hyponatremic if one's urine is dark from time to time? What about hypovolemia due to a low sodium diet? Could I have dark urine after sleeping inspite of being hyponatremic, if I have hypovolemia?
Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello,

Just one or two day of low sodium or increased water does not cause hyponatremia. Urine color is not dependent on sodium concentration. I do not feel that you have hypovolemia.

Dr. Arun
Customer: replied 2 years ago.
However, if I have an excess of water in my system due to drinking too much water over too short a period of time, can I be certain once the urine color changes to a darker color that all the excess water has left the body?
Expert:  Dr. Arun Phophalia replied 2 years ago.
Yes. A darker color of urine point that body has get rid of excess water.
Customer: replied 2 years ago.
Does having clear urine mean that one cannot be hypernatremic? A doctor told me that I might also have been drinking too little. I have been drinking less than I usually do, but also eating less sodium. I drank 80 ounces of water over a 24 hour period and had dark urine sometimes, but also often clear urine. I was often thirsty. I only ate 300 mg of sodium.The day before that I drank 106 oz of water and ate 300 mg of sodium. I was sometimes thirsty. Could I have been hypernatremic for 2 days? If you are hypernatremic for 2 days and then go back to drinking more water, you can develop brain edema. I am planning on going back to eating 2000 mg of sodium and drinking 200 oz of water. Can I just do that? By the way, I accidentally drank a yogurt drink that had turned sour. Could I get diarrhea? I need to go back to eating more salt and drinking more water, so to have diarrhea now would be a problem.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello,

Just 2 days of less sodium or increased water intake does not cause hyponatremia as body has a very high reserve of sodium. You can get back to normal levels of sodium and water immediately and that would not cause any problem. Body has enormous balancing mechanism according to it's need. A sour yogurt may not cause any problem as stomach and intestinal juices are very likely to kill the organisms. Even if you develop diarrhea, eating more salt and water should be helpful

Dr. Arun
Customer: replied 2 years ago.
I have had about a week to 12 days of less sodium in my diet ( 300 to 500 mg a day, one day where I had 900 mg) while I was drinking about 100 to 112 ounces of water a day (one day I drank 134 ounces). Could I be hyponatremic? My blood sodium level was normal when I was tested 7 days ago. My urine is sometimes dark, after I wake up. I was told that if my urine is dark I cannot be hyponatremic. Is that true? The rest of the time my urine was clear, but when I woke up it was dark.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Normal blood levels of sodium would point that you were not hyponatremia. Dark urine does not mean hyponatremia, which is true.
Customer: replied 2 years ago.
But could I have become hyponatremic after one week of drinking between 100 and 120 ounces of water a day and eating only 300 to 500 mg of sodium?
Expert:  Dr. Arun Phophalia replied 2 years ago.
Can be hyponatremia. But there is no rule as individual body responses are different.
Customer: replied 2 years ago.
But if my urine was sometimes dark and sometimes clear in those 7 days, then maybe I was not hyponatremic? My urine was always dark after I woke up after 8 hours of sleep. And it was sometimes dark during the day as well.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Darkness alone cannot be criteria for the sodium concentration in urine. Darkness is more likely criteria of concentrated urine which goes by your total water intake. But if you did not have any symptoms, it means you were not hyponatremia.
Customer: replied 2 years ago.
Can dark urine be a signal that the blood sodium level is not low? Could be blood sodium level have dropped from 140 to 120 in one week?
Expert:  Dr. Arun Phophalia replied 2 years ago.
It is very rare to drop so low without causing any symptoms. Dark urine alone is not the criteria. It has to be supported by the urine sodium and blood sodium.

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Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29703
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Customer: replied 2 years ago.
I do have some minor symptoms. Yesterday I had occasionally some flickering in my vision, but that happened after a 12 hour period where I only drank 25 ounces of water. The flickering went away after I drank water more often. Also, I have sometimes a little bit of a jerking movement in my hands. But I had some jerking movements even before my blood sodium level was checked and it was found to be normal.
Expert:  Dr. Arun Phophalia replied 2 years ago.
Flickering of vision and jerking movements are not signs of hyponatremia, so you should not worry about it.
Customer: replied 2 years ago.
What if the body and brain adapts to the chronic hyponatremia, so that I have very few symptoms? Could the sodium level have dropped by 20 mEq/L within one week or is that not possible?
Expert:  Dr. Arun Phophalia replied 2 years ago.
Change of sodium level of 20 mEq just in one week by oral control of sodium and water is quite unlikely. Body brain adaptation of low levels of sodium is rare phenomenon.
Customer: replied 2 years ago.
Thank you for your advice. I might have further questions later on. Have a very pleasant day.
Expert:  Dr. Arun Phophalia replied 2 years ago.
You are welcome. Have a great day.
Customer: replied 2 years ago.
My bloodpressure had risen half an hour ago from its normal level of 120 over 70 to 133 over 86 (normal pulserate). Is that significant? Now my blood pressure is 129 over 81 (pulse 74). I have another question: is it possible to be dehydrated if one has clear or pale urine?
Expert:  Dr. Arun Phophalia replied 2 years ago.
Ho one is not dehydrated with clear urine.

Your blood pressure is in normal range.

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