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Dr. Thomas, 3 weeks ago I had a seeming episode of heat exhaustion and showed low potassium, low sodium, and mild Anemia on blood work. Only a basic panel was checked. These symptoms stabilized after about a week of taking electrolyte replacement drinks and electrolyte supplements.This past week I have had about 8 episodes of watery diarrhea and have been since experiencing severe episodes of dehydration, to the point where I appear very pale, cold, and have collapsed unconscious. I have painful muscle cramps and muscle twitching all over. I have had to keep replacing electrolytes and drinking water or these dehydration episodes continue to worsen until I can't stand upright without passing out unconscious. The diarrhea seems to have stopped as last 2 days movements were no longer liquid. Other symptoms seem to depend on severity of dehydration - extreme weakness, dizziness, fluctuations between low and high blood pressure, alternate between weak and slow pulse (<50) and weak but fast pulse, shortness of breath, nausea, excessive thirst and urination, chest tightness, cold/pale skin and collapsed veins when most dehydrated. Initially my doctor thought I had depleted electrolytes from the heat exhaustion and electrolyte replacement seemed to do the trick then. However after the more recent diarrhea these dehydration episodes have become severe unless I am frequently replacing fluids and taking all 4 major electrolytes.
I have been drinking electrolyte replacement drinks and eating foods high in potassium and magnesium, moderately high in sodium, and taking magnesium glycinate and calcium. The magnesium has seemed to have had dramatic effect when taken with potassium, but is has not lasted more than a few hours unless I continue taking small amounts. I remember when I had reported these same symptoms before you had said potassium deficiency will not correct until magnesium deficiency is corrected. That has seemed the case here as potassium alone only seems to worsen my symptoms.
What do you think is going on?What do you recommend for treatment?
How serious might this be, and if it were to worsen at what point should I seek emergency care?
I had a stool sample checked for blood after the heat exhaustion out of concern there was further internal bleeding but it was negative. I don't know what test my Dr did for that.
My watery stools recently have looked like brown colored water. During that time I was going several times a day (9 total times I think) with it watery every time. The last three days it has returned to once a day and it is more solid, still kind of gooey but solid and brown colored.
I suppose it is possible there has been more bleeding but my Anemia now was only a 2 point drop in hemoglobin between May and September. During that time I felt much more stable than I do now. Hct, RDW, RBC were also mildly low 3 weeks ago.
I had felt far more stable before the heat exhaustion, exercising every day, etc. For a week after that I felt huge improvement from electrolyte replacement and magnesium, calcium supplements. Currently I have again felt strong improvement from these but it does not last, and if I don't continue supplementing the dehydration continues to get worse until it is so severe I black out unconscious and show all the symptoms I listed before.
After the heat exhaustion, when I was much more stable, after I had already been rehydrating and replacing electrolytes, sodium was 132, potassium 3.4.
I do not have current values as I can't get them checked during these episodes of dehydration because the symptoms are way too intense to be going to get blood drawn.
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I am fairly certain the diarrhea was caused by food poisoning. I am less concerned about that now since it has seemed to have stopped over the last 2 days. But I am very concerned about recovering from the effects of the severe watery diarrhea for several days.
How long does it take for potassium and sodium to replenish if they are severely depleted from diarrhea or other causes? What kind of doses are needed? Does it take a long time to recover from like it does with magnesium deficiency?
What is the best way to go about it?
I have a few follow up questions for this thread.
It does seem that high sodium intake has been the trigger for these recent severe episodes of electrolyte symptoms. High sodium diet for several months seems to have slowly worsened these symptoms over time. Then they became worse after an episode of heat exhaustion, and then severe after the watery diarrhea. I have only had blood checked after the heat exhaustion a month ago when potassium was low along with several other things. I don't know how low potassium is now, or how low magnesium is. However as you said in the past the blood levels don't reflect the intracellular levels.
Lately whenever I have consumed larger amounts of sodium and then lose much water, either through sweat or urine I feel worsening slow and weak heart beat, dizziness, and shortness of breath, tingling, muscle spasms, twitching, painful muscle cramps, excessive thirst and urination. If I don't start drinking water and taking electrolytes they continue to worsen until I can't even stand up without blacking out.
Do these sound more like the effects of high blood sodium, or high sodium causing or aggravating low potassium? Or more to do with low magnesium or calcium?
I am very concerned that I have again caused magnesium deficiency, and that is what is causing my again very high sensitivity to sodium and potassium. 2 months ago I could eat 5-10 grams of sodium in a day and hardly feel a difference. Right now more than 1 gram over an hour and my blood pressure shoots up from 130/80 to 180/100, pulse gets very slow and weak, I feel very dizzy and short of breath, muscles twitching, painful muscle cramps, dry mouth and increased thirst, and increased urination.
Magnesium glycinate has again had a strong temporary effect reversing these symptoms many times now. And increasing potassium rich foods also seems to help reverse these symptoms especially when taken with the magnesium. However as soon I as eat more than about 1 gram of sodium even spread over a few hours, the symptoms start worsening again quickly.
How long supplementing with magnesium does it take for sodium retention/sensitivity to improve?
Are there other mineral/vitamin deficiencies that can cause or worsen sodium sensitivity/retention? I have read b vitamins, especially B6 affect magnesium metabolism but I am not sure how?
If magnesium deficiency is present how much longer does it take for potassium levels to normalize, particularly replenishing intracellular levels?
Does it affect the amount of magnesium absorbed if I take it with an equal amount of calcium? I have found I feel even worse without balancing the magnesium with calcium.
I have a few more questions regarding magnesium deficiency and electrolyte imbalance.
I have continued to supplement with magnesium glycinate and the short term improvement in all my symptoms is usually very strong and obvious. Conversely when I do not take enough magnesium I feel greatly intensified symptoms when taking/eating substantial amounts of calcium, potassium, or sodium. I remember you saying and my reading many times that electrolyte imbalance will never resolve without adequate magnesium.
I am curious of other dependencies. I am aware that for potassium to absorb into the cells there needs to be sufficient magnesium, and that magnesium is essential for proper calcium absorption, metabolism, and storage in the bones.
Does magnesium absorption depend on any minerals or vitamins for absorption into the body?
Once absorbed into the blood does magnesium depend on any mineral or vitamins in order to be properly absorbed into the cells (like potassium requires magnesium to enter the cells)?
I have read that magnesium is stored mostly in the bones. Is magnesium dependent on any minerals or vitamins in order to be properly stored into the bones?
How much magnesium do I need to supplement with in order to make sure the magnesium reserves are being replenished and the supplements are not just treating my symptoms only acutely?
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I have many electrolyte imbalance/deficiency symptoms as I described above, but I am trying to figure out what is causing the neurological symptoms as that might be a big clue in figuring out which electrolytes are most out of balance.
I have been feeling severe muscle cramps, spasming, and twitches all over my body and my eyes for weeks and they have been getting worse, despite eating lower sodium, high potassium diet. I know the heart is a muscle also and it seems to be strongly effected when these symptoms are the worst, feeling chest tightness, big shifts in blood pressure and pulse, and breathing difficulty. They also seem to worsen when I get too dehydrated which is often because of excessive urination. The excessive urination seems strongly to be caused by the electrolyte imbalance as some days it is much less an issue when I try different combinations of electrolytes.
Which electrolyte(s) are most responsible for the muscle cramping, spasms, and muscle and eyes twitching?
I know calcium, magnesium, sodium, and potassium all play critical roles in muscle function but it has been very difficult to figure out which is causing the worst of the cramps and spasms. I can't figure out for certain but it does seem that when I take much higher magnesium, although my blood pressure, pulse, and shortness of breath improve a lot the cramps seem to actually worsen. Calcium seems to improve the cramps sometimes but seems to worsen other symptoms. I can't really tell how much the potassium affects the cramps because since it is in food it absorbs much slower.
I don't know how much detail you need to refresh your memory. Do you not have access to the previous posts on this thread? I asked you questions recently about magnesium deficiency. I will just re-write to make sure.
This is not a problem for a neurologist. It is clearly due to electrolyte imbalance and other nutrient related issues as these are longstanding issues with me. I have had blood tests done many times over the last year and recently. I have shown at different times low readings of potassium, sodium, calcium, and magnesium (low normal, although I have had pronounced symptoms indicating magnesium deficiency and very pronounced improvement from supplementation).
Over the past 2 months I have had heat exhaustion twice, a week of watery diarrhea from food poisoning which has since stopped. Prior to that for several months I had been exercising and sweating heavily, consuming a high sodium diet low carbohydrate diet to lose weight. I have ever since had severe symptoms of electrolyte deficiencies and frequent continued episodes of dehydration because of excessive urination, which varies widely from normal frequency to as often 40 times per day, seeming to depend heavily on electrolyte intake.
The most prominent symptoms have been wide fluctuations in blood pressure (as low as 90/50, as high as 180/110), wide fluctuations in resting pulse (40-110), varying shortness of breath from moderate to severe, varying excessive thirst and urination, painful muscle cramps, muscle spasms, muscle twitching, back and neck pain, eyes twitching. These symptoms have strongly correlated with hydration and electrolyte intake, sometimes improving, sometimes worsening greatly.
Right now I am asking which electrolyte(s) are most likely causing the severe muscle cramps, muscle tightness, muscle spasms, muscle twitching, back and neck pain, eye twitching because these seem like major clues to figuring out what I need most?
It must be either or some combination of magnesium, calcium, potassium, sodium, because when I do guess right the muscle symptoms improve markedly but only temporarily. Then when I guess wrong they worsen greatly.
I have continued with magnesium glycinate which often has shown strong improvement in many symptoms, but sometimes seems to worsen the muscle symptoms when in higher amounts, perhaps affecting calcium levels.
I also have longstanding symptoms that seem to indicate calcium deficiency such as painful joints, easy joint injuries, brittle nails and hair, tooth pain and yellowing and rotting and chipping teeth, despite consuming no sugar and daily brushing. I know magnesium and calcium take much longer to replenish than potassium and sodium and these seeming calcium deficiency symptoms have been going on much longer. I know magnesium deficiency can cause chronic hypocalcemia and poor absorption so perhaps that is a major factor here.
Another question would be how much calcium would I need to consume per day to treat a long standing calcium loss/deficiency, accounting for my large frame of 6'1" 235 pounds?
Which electrolyte(s) deficiencies are most likely to cause severe muscle cramps (and in muscles that have not been exercised recently), muscle twitching, eye twitching, back and neck pain?
I feel many other symptoms mostly heart rhythm related but these muscular symptoms seem like if I can figure out what is causing those I can figure out which electrolytes I need more of at what times according to symptoms.
I have not been getting enough calcium for a long time because of my lactose intolerance and I have many symptoms of that which improve markedly when supplementing. Months ago I had the same symptoms and they had improved dramatically from increasing calcium and balanced with magnesium but over time they returned after months of high sodium diet, huge fluid losses from exercise, and watery diarrhea.
Right now sometimes the calcium dramatically improves my symptoms, but sometimes if I take too much calcium I feel much worse different symptoms. It seems too much calcium aggravates the magnesium deficiency. And too much magnesium aggravates the calcium deficiency. The ratio seems different every day and when I guess the ratio correctly I feel very marked temporary improvement, when not I feel much worse, with increased nausea and urination, and other symptoms.
How can you recover from a calcium deficiency when you also have a magnesium deficiency and magnesium so strongly affects calcium absorption and metabolism?
How can I determine how much calcium I need assuming long standing deficiency and that I am very large and at risk for poor absorption and losses for many reasons? I have painful joints, easy injuries, brittle hair and nails, rotting and sore teeth.
These same symptoms have resolved over time many times before after figuring out proper supplementation and diet, this time however has been much more difficult to figure out. I can't figure out which are causing the which symptoms and how much I need of calcium, magnesium, sodium, potassium. If I take too much of any one it seems to aggravate the others and cause worse symptoms.
Which electrolyte(s) are most likely to cause severe muscle cramps (even in muscles that have not been exercised recently), spasms, muscle twitching, eye twitching?
How do you recover from calcium deficiency without the increased calcium intake aggravating magnesium deficiency or causing low magnesium symptoms? How do you recover from magnesium deficiency without the increased magnesium interfering with calcium absorption or causing low calcium symptoms?
I have tried 1:2, 1:1, 2:1 calcium to magnesium and at different times one ratio seems to work for a few days and then I start feeling worse until I take more of the other. It seems like I am going back and forth between increased calcium causing low magnesium symptoms, and increased magnesium causing low calcium symptoms.
Could taking the highly absorbable forms of calcium glycinate and magnesium glycinate be causing too much to be absorbed at a time? The effects are very strong and often times a dose that works one day seems to greatly increase urination another day which I know flushes out other electrolytes.
How much quicker might these highly absorbable supplements correct magnesium or calcium deficiency?
How much of a role could potassium be playing? I know you had said that low magnesium prevents potassium repletion, and with the excessive urination I might be losing a lot there.