From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Hyponatremia mistreatment
Date: 15 Jul 2005 17:23:35 -0700
Message-ID: <1121473415.813974.301510@o13g2000cwo.googlegroups.com>

medgirl wrote:
> <electronicfur@yahoo.co.uk> wrote in message
> news:1121426417.270687.266530@g49g2000cwa.googlegroups.com...
> > My girlfriend suffered from Hyponatremia about half hour after a
> > mountain biking race. Even though I told the medics that I suspected
> > she was probably overhydrated and probably suffering from Hyponatremia,
> > unfortunately they treated her for dehydration in hospital, and put her
> > on a normal IV drip. This was even though her arms were bloated, which
> > I had pointed out was a sign it may be overhydration, my request for
> > them to check her bloood plasma Sodium levels, and the fact she drank 7
> > litres of water during 5 hour race (very hot weather conditions).
> >
> > She was treated like this in hospital for 4 hours, until I managed to
> > get through to the right hospital and talk to a doctor and point out
> > their mistake. During these 4 hours she became gradually worse and
> > lapsed out of consiousness several times.
> >
> > Once they treated her properly and gave her salt she started to
> > recover.
> >
> > My question is, can this have caused any short or long term damage? 4
> > days later she still does not feel 100%, and sometimes feels
> > lightheaded.
> >
> > Tests have shown her Sodium level to now be normal again, and liver &
> > kidneys are ok.
> >
> > Your help is appreciated, as we are not 100% trusting of the medical
> > advice now,
>
> Hyponatremia can result from dehydration and muscle trauma, both possible
> after extreme physical exertion, or from taking in too much free water,
> which has been reported in athletes drinking a lot of water during an event,
> as well as lots of other things.  The plasma sodium itself does not tell you
> which of these it is.  Did they check a urine sodium?  A low urine sodium
> would be consistent with dehydration/muscle trauma, wheras a high urine
> sodium could be from taking in too much free water.  Giving her normal
> saline would treat both of these things, which is probably what was in her
> first IV.  It is true that normal saline is a little hypotonic, so
> hypertonic "hot salts" are sometimes used, but that would only be necessary
> in more extreme cases.  Treating severe hyponatremia can be tricky, since
> you don't want to correct the sodium level too fast.


COMMENT:

Agree with the above. The key point is there's no such thing as a
"normal IV". There are all kinds of different solutions. If they were
treating her for dehydration (loss of simple water more than salt) they
probably gave her normal saline (since correction of HIGH sodiums too
fast really IS dangerous). So, as med-girl notes, she probably got
fairly appropriate therapy for low sodium water intoxication also.
Normal saline treats everything, so long as your kidneys are working
:).

Water intoxication is common in distance running, and it seems more
common in women and people who take NSAIDS, which foul up ability to
excrete water.

Low sodium can cause brain swelling if it happens very fast, and this
is what probably happened in your case. Too-rapid correction of low
sodiums seems not to be the risk that going the other way, is. It's
true that you don't want to correct any electrolyte too fast, but the
worst brain damage risk is too-rapid correction of HIGH sodium, not
low. Brain cells can stand rapid shinkage from treatment better than
rapid swelling (which is what happens if you correct high sodium too
fast).

My guess is she'll be fine. Probably there wasn't really a medical
error, inasmuch as the docs surely knew that if she wasn't
volume-depleted but instead water intoxicated (as you guessed), saline
would still be (close to) the treatment of choice. If your kidneys
work, your body can always deal with volume overloads better than it
can electrolyte disturbances.

SBH