Dealing with Hypertension and Hyponatremia at the Same Time

My husband, Bill, is a member of the United States Army. As a soldier, he must take a physical fitness test every six months. The test includes a timed run, sit ups, and push ups. Bill is in good shape and works out regularly. Despite being physically fit, Bill failed his latest physical fitness test because he experienced sudden dizziness and blurred vision during the timed run. The sudden dizziness almost caused Bill to faint, so he started walking and missed the time limit by just twenty seconds.

A lot of people would just blow off the dizziness and blurred vision and plan to retake the physical fitness test as soon as possible, but Bill knew his sudden condition during the run was unusual and concerning, so he paid a visit to his doctor. Bill's doctor, an internist, ordered blood tests and a electrocardiogram (EKG). Bill's EKG was slightly abnormal and his bloodwork showed that he had a very low sodium level, a condition known as hyponatremia. Bill also has high blood pressure (hypertension), for which he takes prescription medication.

Too much salt is a bad thing... but so is too little salt

Everybody needs sodium to help regulate fluid levels and around cells. Most people get plenty of sodium naturally by eating a regular diet. Some people get too much sodium because they salt their food, eat too much processed food, or use too much salt in recipes. Too much salt can exacerbate hypertension in people who are sensitive to sodium. High blood pressure, particularly if it's untreated, can lead to stroke, heart attack, kidney disease, and brain damage, among other things.

When the body doesn't get enough sodium, the body's water levels rise and cells begin to swell, which can lead to a number of problems that range from mild to life threatening. This swelling affects cells all over the body, including in the brain. Swollen brain cells are confined by the skull, which can lead to brain damage or even death. Sodium also plays an important role in maintaining proper blood pressure.

Symptoms of hyponatremia

According to the Mayo Clinic, symptoms of hyponatremia include: nausea and vomiting, headache, confusion, lethargy, fatigue, muscle weakness and cramps, irritability, and appetite loss. The condition can eventually lead to seizures, coma, and even death.

Why doctors advise salt restriction to people who have hypertension

Many people who have high blood pressure get plenty of salt and have normal to high sodium levels in their blood. Most people won't miss extra salt in their diets, so it's safe for them to eat less of it. Too much sodium has been proven to exacerbate high blood pressure in those who are sodium sensitive. For those reasons, most people would be advised to eat less salt. It's a simple piece of advice that works for most people and good public health policy.

In Bill's case, eating less salt is not a healthy choice. Even though Bill has hypertension, his sodium levels are consistently below average. His father, who also suffers from high blood pressure, also has hyponatremia and has been hospitalized for the condition a few times. So instead of restricting his salt intake, Bill has been told to salt his food... something that most people with high blood pressure almost never hear!

What causes hyponatremia?

Hyponatremia has a number of different causes ranging from the simple to the complex. Some people get hyponatremia because they drink too much water too quickly. In fact, back in January 2007, 28 year old Jennifer Strange of Sacramento, California died of water intoxication when she participated in a radio contest called "Hold Your Wee for a Wii". The object of the contest, run by KDND 107.9, was to see how long participants could drink bottles of water without urinating or vomiting. The winner would get a Nintendo Wii system. Initially, participants were given eight ounce bottles of water to drink in 15 minute intervals. Strange came in second place and unfortunately drank so much water that she developed hyponatremia and died.

Hyponatremia can occur as a result of taking medications. People who have hypertension often take diuretics, which causes increased urination and sodium loss. Bill was taking medication that caused him to urinate frequently, which may have had something to do with his low sodium levels. The recreational street drug, Ecstasy, can also cause hyponatremia, particularly when it's taken during an episode of heavy drinking.

Some people get hyponatremia because they have hormonal deficiencies such as those caused by Addison's disease or hypothyroidism. It can also occur in people who have kidney damage or are suffering from congestive heart failure.

What Bill is doing about his hyponatremia

Like anyone else who suffers from low blood sodium, Bill is taking steps to find out what's caused him to have hyponatremia. His doctor has changed his blood pressure medication and he will soon visit an endocrinologist to find out if his hormone levels are abnormal. He may also visit a nephrologist to find out if the problem stems from kidney trouble. For now, he's taking his medication, salting his food, and preparing to retake his physical fitness test.

If you see yourself in Bill's symptoms of hyponatremia, you should visit your health care provider to find out what your sodium levels are. If it turns out your blood needs more salt, your health care provider can work with you to determine the underlying cause of the condition and the best way to correct it.

Sources:

The Mayo Clinic

"Woman dies after water-drinking contest" The Associated Press. MSNBC.com. Janurary 13, 2007. Retrieved from http://www.msnbc.msn.com/id/16614865/