Hyponatremia and Massage

Hyponatremia (Low Blood Sodium)

Tyra Blanchard

Pathology

02/10/2015

The reason I chose the subject of hyponatremia is because of how close it to home, my mother-in-law suffered from this condition and I had a front row seat in experiencing the effects it can have on a person.

I found it extremely fascinating that people can deplete their systems of necessary sodium just by drinking too much water, taking prescription medications and participating in endurance sports.  I have found the following information to explain the condition of Hyponatremia, the causes and the treatments as well as observations of the elevated cases of Hyponatremia in the elderly.

Hyponatremia can occur in many ways, one being drinking too much water, this causes the body's water levels to become diluted causing the cells to swell. The swelling of the cells can cause mild to life threatening conditions (Mayo Clinic 2014). Other conditions that may cause hyponatremia are:

• certain medications
• diuretics
• antidepressants
• pain medications
• and a recreational drug called ecstasy.  

These medications can cause you to urinate and perspire more causing a drop in your sodium level.  As a result people that have heart, kidney, and liver problems can have a higher risk of fluids accumulating in their bodies which dilutes the sodium levels. The more common conditions that can cause hyponatremia is a person drinking too much water, excessive vomiting, diarrhea, dehydration and hormonal imbalance (adrenal gland insufficiency) (Mayo 2014).  

A normal sodium level is between 135 and 145 mill equivalents per liter of sodium, hyponatremia occurs when the sodium level in your blood falls below 135 mEq/L. (Mayo 2014).

Sodium plays an important key role in your body, it is needed in order to maintain blood pressure.  Sodium is also needed to nourish muscles, nerves and other tissues of the body.  When a person depletes their bodies of sodium it causes the fluids outside the cells to drop and water moves into the cells to balance fluid levels.  A significant organ effected by this reaction is the brain, when effected it causes the person to be confused, have headaches, nausea, loss of appetite, irritability and many more conditions that can be as extreme as possible death (A.D.A.M. encyclopedia, Inc. 2013).

The prevalence of hyponatremia is 15-20% in elderly patients that reside in nursing homes.  Mild asymptomatic hyponatremia may influence gait and attention in the elderly resulting in a higher incidence of falls (Nzerue 2003). Mortality rates as high as 18-30% are reported for hyponatremia patients.  High mortality rates reflect the severity of underlying conditions and are not influenced by treatment of hyponatremia  (Hochman et al 1989).

During examination, a health care provider will perform a complete physical examination to help determine the cause if the patients symptoms.  To help determine the condition blood and urine tests will most likely be done.  There are 3 tests, both blood and urine that can help diagnose hyponatremia. 

1. The first is a comprehensive metabolic panel, including blood sodium, this test is conducted while the patient has fasted for 8 hours .  This test determines how your kidneys and liver are working as well as blood sugars, cholesterol, and calcium levels.  It also checks for your sodium, potassium, and chloride levels also known as electrolytes.  
2. The second test is called an osmolality blood test, this checks for your body's water balance.  An osmolality urine test is performed to check the body's water balance and urine concentration.  
3. The final test performed is a urine sodium test that determines how much fluid your  body has and to see if your kidneys are able to maintain and remove sodium from the urine.  It can also determine if there is a kidney disease (A.D.A.M 2013).

In conclusion I find it fascinating that in everyday life many take for granted how well the body functions even though it is put it through so many extremes.  The neurological effects of sodium depletion can be from minor symptoms such as dizziness, confusion or feeling faint to extreme effects such as seizures, swelling  of the brain, to brain damage and eventual death. 
Our bodies need sodium to perform a number of biological transactions.   It is important to keep a healthy balance of sodium in our bodies, too little or too much can cause us to not function properly.  In fact most Americans get too much sodium, most often people have other conditions that cause 1% of the population to have hyponatremia  (Angela Ogunjimi, 2011). 
Our bodies are in a constant battle to stay in homeostasis, with a low sodium level our bodies are not able to balance the fluids in order to stay in this state.  In order to maintain a healthy balance of sodium, we need to be conscious of what we put in our bodies as nourishment.  There are many people that drink a lot of water thinking that they are doing a good thing for their bodies when in fact, drinking too much water leads the body into a "waterlogged" state that can cause digestive problems, such as chronic diarrhea as the food intake is basically being washed away causing these patients to have to go to the bathroom soon after eating  (Your Acupuncture Specialist 9/7/11).

In Chinese medicine, this is called dampness, the condition in which your body is unable to metabolize water effectively.  In these instances the dampness is brought on by drinking too much water In Chinese medicine, dampness is almost always a digestive problem, in which your spleen is being taxed with too much water causing it to not function efficiently. 
Dampness can lead to many symptoms to include; diarrhea, bladder infections, yeast, poor energy, joint pain, headaches, and a feeling of heaviness.   In Chinese medicine the fat roll around your middle is considered to be a "damp" issue.   Dampness is a drag, it's moist and heavy,  like wet sand.  There are many ways that you can become too damp; eating and drinking too much, eating the wrong foods (greasy foods, rich foods, sweets (Your Acupuncture Specialist, 9/7/11). 

Massage can be a very beneficial for hyponatremia as it helps to reduce edema by increasing venous and lymphatic  flow.  Some strategies to reduce edema may be contraindicated in conditions such as CHF, but precautions can be taken to still be beneficial without harm. You must establish what type of edema you are dealing with.  To establish this you can do a test on the skin, if the skin doesn't rebound and becomes pitted (indentation remains after pressure is applied) NO MASSAGE! (http://www.learn-massage-therapy-online.com/contact.html).

References

Ogunjani, A (2011) The effects of low sodium levels. . Retrieved May 31. 2014

http://www.lifestrong.com

Skorecki K, Ausiello D. Disorders of sodium and water homeostasis. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 118. Retrieved May 31, 2014   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001431/

Mayo clinic staff (2014) diseases and conditions, Hyponatremia. Retrieved May 31,2014

http://www.mayoclinic.org/about-this-site/welcome

Acupuncture in the Park (Your Acupuncture Specialist, 9/07/2011)

http://www.learn-massage-therapy-online.com/contact.html