ArcaMax

DEAR DR. ROACH: I'm a 71-year-old female. I weigh about 96 pounds, and I'm 4 feet, 9 inches tall. My blood pressure has always been good. When I was 25 years old, I donated a kidney. I was told by doctors and nurses to drink lots of fluid to take care of my one remaining kidney. After watching what happened to my brother and the many patients in dialysis, I made sure to drink at least 16 cups of fluid a day, including coffee, tea and water.

As far back as I can remember, my sodium levels have been between 126-129 mEq/mL. I have no symptoms, and my kidney function is good. I live alone, walk 3 miles a day, exercise every day for 1 hour, and take care of my house, yard and four dogs without help.

Over two years ago, I was diagnosed with hyponatremia. My kidney doctor told me to try drinking less fluid, which I did, but there was no change in my blood work. I tried taking 3 salt tablets a day, but it gave me a terrible stomachache. So, I started taking 1 salt tablet a day, but there still wasn't a change in my blood work.

My new kidney doctor said to take 2 salt tablets a day and eat 60 grams of protein a day. (I'm vegetarian.) I tried doing this for four days, but my stomach became bloated and upset. I started getting headaches, and I also started sweating. I had to stop the tablets because I didn't want to eat or drink anything while feeling this awful. Now my doctor wants me to take medical-grade urea powder.

I've had low sodium as far back as I can remember without problems. Now that they're trying to make me "normal," I feel awful. I'm afraid to do anything else that will mess with my system. What are your thoughts or suggestions? I'm feeling really frustrated. -- Anon.

ANSWER: You have SIADH, the syndrome of inappropriate antidiuretic hormone secretion, which has made your sodium level low. (Normal is between 135-145 mEq/mL, and "hyponatremia" just means low blood sodium.) SIADH means that your kidneys can't get rid of enough free water.

Even though you don't have symptoms, your doctors would like your sodium level to be above 130 mEq/mL. This is because at lower levels, people can have subtle neurological problems that can be hard to recognize, and they are more susceptible to falls.

Your doctors have tried all three of the major first-line therapies: reducing your water intake, increasing salt, and increasing urea. (Dietary protein is a good way to increase urea, but many vegetarians do not consume a lot of protein obviously.) From what you are saying, it sounds like the salt tablets are the worst at making you feel bad. You might ask your new doctor about smaller amounts of supplemental protein, along with less water intake.

At some point, however, your doctors are going to have to consider whether it's worth making you feel unwell for a small benefit. Your sodium level is not dangerously low, and you are close to the usual goal of 130 mEq/mL. While I don't recommend drinking as much water as you were to anyone who has SIADH, I might try to give you as much sodium as you can tolerate without feeling unwell. Then I would have you reduce your fluid intake (not to an extreme level), give you a little extra vegetarian protein, and let you live your life without feeling awful or frustrated.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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