PD, Lost Residual and Low Sodium

[Marilee]

I posted earlier that my hubby went through some drama this past summer and we've been reeling and dealing with the after-effects for several months. He fell, started having symptoms that could be concussion (headache, confusion, nausea, vomiting, weakness, muscle pains) but then never really got better.
His renal team deduced that probably he needed more PD and that probably his residual renal function had dropped off abruptly. So we went to 5 cycles, boosted the glucose amount and added a day-dwell. But his symptoms persisted. He even started getting dehydrated so they backed off the glucose concentration but kept the number of cycles.

But still the symptoms persisted.

He had CT scans and MRIs and his brain looks fine, so finally folks began to notice that his sodium had dropped after the change to his dialysis and just never recovered. This month at clinic the doc suggested we boost his salt intake (which felt so bizarre after so many years of limiting it).

Here's a link to a graph of his sodium numbers - we bumped the dialysis in August:

https://1drv.ms/u/s!AldgdpLz_2euhNlCX9s5DOeLTfXRzA

I couldn't understand why hubby's sodium levels dropped abruptly last summer and never got better. There's been no change to his diet (although his appetite went down a little), he's not drinking a lot of water... I've been combing the Internet about "hyponatremia" and got even more confused because when it happens to 'normal' people it's because of things like drinking too much water, reactions to drugs - more fluid than salt basically -  but none of what I read correlated to our situation.

Then I found this very specific article/study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033326/) that observed that nearly 15% of the PD (peritoneal dialysis) patients had low sodium and that it correlated mostly to those whose 'residual renal function' was lost abruptly (bingo). They also noticed that the dialysis fluid was drawing out more sodium than originally thought. This study blows the doors open on past assumptions because they fully expected all those with low sodium to be waterlogged - to gain water weight - but they had all lost weight (as did my hubby). Their description fits him to a T: his residual function dropped off sharply this past summer.

Now, the very interesting thing to me is the list of symptoms as given by the Mayo Clinic (the Check!s are mine) for Hyponatremia (low sodium levels):
Hyponatremia signs and symptoms may include:
Nausea and vomiting (Check!)
Headache (Check!)
Confusion (Check!)
Loss of energy, drowsiness and fatigue (Check!)
Restlessness and irritability (Check!)
Muscle weakness, spasms or cramps (Check!)​
Now I realize these symptoms are common among many problems, but they fit so well and all his other tests came back normal... I'm thinking he's one of those 15% people that the study identified.
It doesn't really change what we gotta do: Boost his salt intake by about 10% (I made him some beef jerky for snackin' today). But, I don't know, it just feels good to have perhaps a handle on what the heck has been happening.
Just had to share!

[cassandra]

That's terrible Marilee. Is there no PD fluid with a higher sodium concentrate?
I hope the jerkies have a possitive effect on hubby.


When my sodium is low I have a Cup-a-Soup (which is full of salt)
I have no residual renal function at all, so my sodium does go up fast.


TBH I find it worrying how the learned ones didn't notice the drop earlier.


Good luck, strength and love, Cas

[Marilee]

Hi Cassandra!

As far as I know, all the PD dialysis bags have the same solution of sodium. I also found this document https://www.kidneyatlas.org/book5/adk5-02.ccc.QXD.pdf that says:

"The sodium concentration in the ultrafiltrate during peritoneal dialysis is usually less than that of extracellular fluid, so there is a tendency toward water loss and development of hypernatremia. Commercially available peritoneal dialysates have a sodium concentration of 132 mEq/L to compensate for this tendency toward dehydration. The effect is more pronounced with increasing frequency of exchanges and with increasing dialysate glucose concentrations. Use of the more hypertonic solutions and frequent cycling can result in significant dehydration and hypernatremia."

So, the PD dialysate is designed to compensate for the sodium loss, but the more cycles, the more likely it can happen anyway.

As for not noticing the drop sooner, yeah, I'm a bit aggravated too... we were worried that he was getting Alzheimer's like his mom did... thinking that it was time to get all his affairs in order... he's now so weak that he needs physical therapy and a roller/walker to get around... it's been a tough time that could have been a much shorter tough time. That's really why I posted this: To spare others that may experience something similar.

The good news today: He's feeling some better already - I think just knowing what's really wrong and that it's not a stroke, not a tumor, not Alzheimer's and that one extra shake of salt here and there will help him makes a world of difference in his outlook. Plus, he loves homemade beef jerky


Soup is a great idea for boosting salt, thanks so much for that reminder!

[kickingandscreaming]

Happy to hear about the light at the end of the tunnel.

[Marilee]

Oh, thank-you, kickingandscreaming!