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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18541
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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FOR DR. LOVE ONLY, thank you I had oral surgery 6 days ago,

Customer Question

FOR DR. LOVE ONLY, thank you
I had oral surgery 6 days ago, a week, they pulled 6 teeth, I am stilling healing, have a top denture and still not feeling well. I do sub gammunex every other day, which need water to be absorbed well. I also do ozone shots, once a week, an alteranitive therapy each week, and it is to full infections and boost immunity, however after eeach shot I have a die off reaction, got puffy, dizzy, very out of it, and often get a bit low sodium. I had my shot yesterday and starting feel horrible, I work knowing I was diehard with very low BP and high pulse and then got shot, and then it just got super bad, very dizzy, high BP, irregular heartbeat....went to ER where they DX me with severe low sodium at 121, and admitted me, I just got out. They did IV's of sodium water for 16 hours, and now it is 135. They were saying that I was likely drinking too much water, but I have not been drinking any FREE water just mixed gatorade, but they said it does not have enough salt and when I drink like more than 8-10 glasses of any water a day, it is flushing sodium out. They were every concerned, and said they thought irregular heart beat was form low sodium, but also brought up that BIaxcin can cause it, but then today all day it was normal, so they think the low sodium caused it. They said I could die and it is super serious, but offered no concrete reason this would happen two times in three months. I just wanted your thoughts about other possible causes for such a big drop in sodium? I know after having oral sugery I had not eaten well this week and thought I was not drinking enough, but they said that would make sodium high.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.

The fact that you have not been eating well can contribute to the imbalance between sodium and water. I think that we discussed previously that a low blood sodium level is more of a problem of too much water for the amount of sodium, rather than inadequate sodium, per se.

In normal situations, the greatest amount of sodium intake is through the ingestion of solid food, and in that situation, drinking Gatorade is usually sufficient, because the fluid does not need to be the primary source of sodium. However, if you are not getting the normal amount of solid food intake and therefore much less sodium intake, the amount of sodium in Gatorade is not sufficient to maintain a proper balance.

In this situation, it would be important to try to increase oral intake of solid foods to re-establish the normal amount of sodium intake and restore the balance between sodium and water. It may be necessary to eat softer foods to accommodate the recent oral surgery, but the goal is to achieve the normal daily amount of food intake.

Customer: replied 1 year ago.

The nurse mentioned SIADH to me, does this sound like that, or should ask to be tested for that or can they tell?

Also does it seem too fast to bring a sodium of 121 at 10 pm, to 135 at 2 the next day?

Expert:  Dr. D. Love replied 1 year ago.

SIADH is one of the common causes of a low serum sodium. They would usually have looked for underlying causes when you had the first episode, but if there has not yet been any evaluation, it would be appropriate to do so. There is no single test for SIADH. The diagnosis is made by comparing blood sodium and osmolarity levels and urine sodium and osmolarity levels during times of stable body volumes and normal oral sodium intake. Since you have not been eating well because of the oral surgery, it actually would have made the evaluation more difficult during this encounter, but they may have already done this evaluation during the first episode.

Our usual goal over the first day of treatment would be to increase the sodium level by about 10-12, so an increase in the level of 14 by the next morning is slightly faster than would usually be the goal. If someone is having serious complications of a low sodium, such as heart arrhythmias, the doctor may decide to correct the sodium levels more quickly.

Customer: replied 1 year ago.

Yes I was having an arrhymia, it stopped, but they were surprised it went up from 121 to 135 in 17 hours. I am ok now, since noting happened. The nurse and doctor said with the SIADH usually they worry about that when restricting fluid intake and the sodium IV do not bring the sodium up,then they start to think about SIADH, that in SIADH those things will not fix the sodium levels?

Expert:  Dr. D. Love replied 1 year ago.

The diagnosis cannot be made by that characteristic. It would require the evaluation noted above, but practically speaking, if there is no obvious cause of the low sodium level, such as congestive heart failure or liver disease, then SIADH is the most common cause of chronic or recurrent problems with a low sodium level.

Customer: replied 1 year ago.

Ok, so when they said SIADH is not what they think when they can easily correct the sodium and had me talk to dietician about intake and food, you think they are wrong , that they should look at SIADH?

Expert:  Dr. D. Love replied 1 year ago.

I do not make or exclude the diagnosis based on the rapidity by which the sodium can be corrected.

Customer: replied 1 year ago.

Ok, so you think it could be SIADH, I saw two very good doctors there who did not mention it and they did many tests, so it's your opinion I should asked to be tested for it and what is the treatment for it?

Also I am reading about it and it says that SIADH

tends to occur in people with heart failure or people with a diseased hypothalamus (the part of the brain that works directly with the pituitary gland to produce hormones). In other cases, a certain cancer (elsewhere in the body) may produce the antidiuretic hormone, especially certain lung cancer.....

Can it occur in people that don't have these type of issues?

Also this occurs when I get these shots of ozone which create a major doe off of bacteria, so I am stopping the shots, and it happens after each shot to some degree. This seems to point to the shots driving the low sodium, I always get puffy, dizzy, go in to urgent care and have mild low sodium this time high....they did not know why expect that if I am having a large die off of bacteria, I need more water to flush the toxins outs?

Expert:  Dr. D. Love replied 1 year ago.

You should have an evaluation for the cause of the low sodium, not just an evaluation for SIADH.

The first line treatment for SIADH is free water restriction, which is done for many different causes of low sodium levels. If that is not effective, then the next step would be the use of a specific type of diuretic while trying to increase oral sodium intake.

SIADH can occur in people without these other conditions.

Ozone is not well studied, but to the extent that side effects have been reported, there is no evidence to indicate that it can contribute to the low sodium.

Customer: replied 1 year ago.

Also, sorry lastly, last time they raised the sodium and my doctor kept checking it for like 3 weeks and it stayed at 138, would a person with SIADH maintain sodium levels like that?

and are you thinking since it happened twice, even thought I know the 1st time I drank way too much water, and this time I had oral surgery and couldn't eat protein or much at all, and did not keep up my drinking, you still think SIADH could be likely?

Expert:  Dr. D. Love replied 1 year ago.

Yes, if you were restricting your free water intake.

SIADH is certainly a primary concern, but a proper evaluation is indicated.

Customer: replied 1 year ago.

So a person with SIAHD could maintain their sodium on there own for a long time? Also sorry what do you mean if I were restricting my free water, I had been drinking about 10-12 glasses of water or more each day, because I need a lot due to the sub q gammunex, and they said most people who were my weight at 110 and drank like 100 ounces a day would likely get low sodium, but this would not be from SIADH?

Why if SIADH seemed to fit this would two very good doctors say no, it is because you drank too much and did not eat enough salt?

and could sweating at time make this worse, I been been sweating at night, off and on and it seems to happens after several sweating nights.

Expert:  Dr. D. Love replied 1 year ago.

If they are restricting free water, yes.

You said in your original question that you were not drinking any free water. That is what is meant by restricting your free water.

If these two doctors did an evaluation and decided that it was because of another reason, that is fine. I have only said that SIADH is a primary concern and there needs to be a proper evaluation for the cause of the low sodium level.

Any condition that can cause dehydration can contribute to a low sodium level.

Customer: replied 1 year ago.

They said I was drinking too much free water, like 100 ounces a day, and I should be drinking 55, based on 1/2 body weight. Is that not right? They said when you drink a lot of free water like more than double your ounces in body weight you can wash out sodium?

Expert:  Dr. D. Love replied 1 year ago.

Yes, drinking excessive water can create an imbalance between sodium and water.

Customer: replied 1 year ago.

Ok but that would not be SIADH?

Sorry I am not grasping this well. So even though I have the same reaction after each ozone treatment, always puffy, low don't think it is for the shot, I have gotten them for 10 years and the doctor says people experience a die off effect and it takes more water to wash the die off toxins out. For some reason this happens a lot after the shots, I get that maybe you don't know why, but I know it does, because I have lived it.

So, is SIADH common and is it odd that the doctors did not seems concerned with it?

Also when I search Mayo clinic I get this: and I don't have any of these, are you saying I could have one and not one, or have none and still get SIADH? It seems these are the common triggers?

Causes of SIADH

Cancer, especially lung cancer, is the most common cause of SIADH. SIADH is often one of the first symptoms of lung cancer.

SIADH can also be caused by tumors of the head or neck. Other triggers for SIADH include:

  • diseased or damaged hypothalamus
  • encephalitis (inflammation of the brain)
  • Guillain-Barré syndrome (GBS) (immune system disorder)
  • heart failure
  • lung disease
  • meningitis (inflammation of the membranes covering the brain and spinal cord)
  • trauma to the head
Expert:  Dr. D. Love replied 1 year ago.

No that would not be SIADH.

Since the ozone is not well studied, no one can say whether this could be a side effect. Whenever you decide to use a treatment that is not well studied, then you are accepting that no one knows all the possible side effects.

You need what I said above - a proper evaluation to determine the cause of the low sodium. There is no need to consider the causes of SIADH until there is the evaluation for the low sodium.

Customer: replied 1 year ago.

Sorry what do you mean evaluation for low sodium? Like what do they need to do, they went over lot with me. Are you saying you don't consider SIADH unless you can't find reason for low sodium?

Expert:  Dr. D. Love replied 1 year ago.

Your doctor would do the evaluation. SIADH is one of the common possible causes of a low sodium, so would be considered as part of the evaluation.

Customer: replied 1 year ago.

OK, I will ask about it, do you feel it is likely based on what I have told you, I have none of those triggers, have kept my sodium levels normal on my own, and had two separate times with serious low sodium that they feel were caused by circumstances, like too much water, and this time, the surgery and not even food and water.

Also, what is the treatment for SIADH, is it treatable?

Expert:  Dr. D. Love replied 1 year ago.

As I said above, if the doctors have already done an evaluation to determine the cause, then that is fine, and it does not need to be repeated.

I addressed the treatment for SIADH above.

Customer: replied 1 year ago.

So last thing, is I had SIADH, and did not drink a lot of free water, that cold treat a mild case?

Does it always progress?

And the doctors ran a bunch of tests, I am not sure they were looking for SIADH.

I had a high Estimat Glomular filtration ratio, what would that mean, my BUN and CREATINE both low normal.

Expert:  Dr. D. Love replied 1 year ago.

It does not matter until you get a proper evaluation and diagnosis, if it has not already been done. We also do not need to speak about the congestive heart failure that I mentioned above. The next step would be the proper evaluation, and then deal with the identified problem.

Customer: replied 1 year ago.

Sorry I did not see you mentioned heart failure. I am confused. I asked if SIADH always get worse, and what an elevated Estimat Globular Filtration rate could mean?

I just read that 130 for the globular rate would be good so sorry.

Would magnesium be low in SIADH?

Expert:  Dr. D. Love replied 1 year ago.

We do not need to discuss the prognosis of SIADH until it is diagnosed.

An elevated eGFR generally means nothing. Many labs will only report that it is >60 and not differentiate an upper limit.

Customer: replied 1 year ago.

Ok, well since you said I should be evaluated for SIADH, I just wondered if it always gets worse, if it is treatable, because I was not worried about it until you said to be evaluated since the hospital said not a concern.

Expert:  Dr. D. Love replied 1 year ago.

No. No. No.

You are not reading what I am saying. I said that if they did an evaluation and made another diagnosis, that is fine.

If you look above, I was not the person that brought up SIADH. You did, when you said a nurse said it to you, and I said it was a possible cause and that they would usually have looked for the underlying cause of the low sodium, but if it had not yet been done, it would be appropriate to do so.

Please read through the entire discussion.

Customer: replied 1 year ago.

Ok, I am going to asked to be evaluated. Based on what I said does this sound like SIADH?

Expert:  Dr. D. Love replied 1 year ago.

The diagnosis is not made based on what it sounds like. You need a proper evaluation, if it has not already been done.

Customer: replied 1 year ago.

Ok, I am sorry, when they say people with SIADH present a certain way and have certain conditions......whichI don't have, that would seem to argue that I don't have SIADH, or make it unlikely?

This conversation has gotten to confusing for me to follow. I am going to reask the question of another expert and see if I can get what I am trying to understand.

Expert:  Dr. D. Love replied 1 year ago.

You are asking me the same question using different words. You need a proper evaluation if it has not yet been done.

As I said above, it usually would have already been done.

Please provide a positive rating so that I am credited for assisting you.

Customer: replied 1 year ago.

I called my doctor last night, and he said the hospital would have looked for SIADH, and "I can guarantee you, and I never Guarantee that a person with SIADH would never have their sodium go from 121 to 135 in 15 hours from a water IV, it always takes much longer than that, it just would not happen". Do you agree with this?

Expert:  Dr. D. Love replied 1 year ago.

I agree that the doctors and hospitals usually look for the cause of a low sodium, as I said above, and his statement confirm what I told you usually happens. And if the evaluation showed that there is no SIADH, then that i far more reliable than using the speed of recovery, as I said above.

Since they did the evaluation and excluded SIADH by the evaluation, then you clearly do not have it.

Customer: replied 1 year ago.

Cant evaluated blood sugars lower sodium?

Expert:  Dr. D. Love replied 1 year ago.

An elevated blood sugar creates an omsotic load that affects sodium levels, but the doctor can perform a correction for the level of blood sugar to get a truer indication of the sodium level.