Low levels of sodium in the elderly

While we often hear about the dangers of having too high an amount of salt within your diet and how increased sodium in your body can damage your health, for older people, the opposite can also be the case.

A common condition in older adults is hyponatremia which means that you have low sodium levels in the blood or too high a level of water in your blood. Sodium is an electrolyte that helps maintain fluid balance in the body and is needed for muscle contraction and nerve function.

Sodium levels are measured in the blood, and an example of the normal range of blood sodium is 135-145 mmol/L. Mild hyponatraemia occurs when the level is less than 135 mmol/L. Severe hyponatraemia is a level less than 120 mmol/L.

When sodium levels in the body become too low, it can cause a number of problems including:

• Dizziness
• Headaches
• Fatigue
• Muscle cramps or weakness
• Nausea and vomiting
• Confusion

If left untreated, hyponatremia can lead to seizures, coma, and even death. Therefore it's vital that should you be worried about yourself or a loved one, you seek medical advice as soon as possible. Low sodium levels often go hand in hand with dehydration, so it's important to understand how to prevent dehydration in the elderly.

What causes hyponatremia in older people?

There are a number of causes that can contribute to low sodium levels in the elderly such as certain medications like diuretics, heart failure, liver disease, kidney disease, and malnutrition. In some cases, the cause may be unknown. However, some common issues include;

• Dehydration from not drinking enough fluids
• Loss of fluids from excessive sweating, diarrhoea or vomiting
• Certain medications including diuretics, ACE inhibitors, and some antidepressants
• Heart failure
• Liver disease

Signs of hyponatraemia

It's important to understand that the symptoms can vary and depend on two factors, namely the level of sodium in the blood and how quickly those levels have fallen.

Hyponatraemia can be divided into two categories:

Acute: where there is a sudden fall in blood sodium levels

Chronic: where a large fall in levels occurs over days to weeks.

In the case of chronic hyponatraemia, few overt symptoms may be seen as the body, and the brain, may adapt over time to the lower sodium levels. However, it is still a very dangerous condition.

Acute hyponatraemia is very dangerous indeed and can cause swelling of the brain. Some symptoms of all types of hyponatraemia include:

• Dry mouth
• Sunken eyes
• Low blood pressure
• Increased pressure in veins, seen in the neck
• Swelling of the tummy or legs.

Symptoms of low sodium levels

Several factors can contribute to low sodium levels in the body. If you have congestive heart failure or kidney disease, your body may be unable to rid itself of excess fluid. This can lead to a build-up of fluid in your body, which can cause sodium levels to drop. In addition, certain medications, such as diuretics, can also cause sodium levels to drop.

The symptoms of hyponatremia can be mild, such as headache and nausea, or more severe, such as confusion and seizures. Elderly adults are more likely to develop hyponatremia because they may have underlying health conditions that contribute to the condition, such as congestive heart failure or kidney disease. In addition, older adults may be taking medications that can cause low sodium levels, such as diuretics.

Low blood sodium is common in older adults, especially those who are either in hospital or living in long term care.

How what you eat affects salt in the body

If you have hyponatremia, it's important to watch your sodium intake. Too much salt can cause your body to retain water, which can worsen your condition. On the other hand, not enough salt can also cause problems. Your body needs a certain amount of sodium to function properly.

Effects of low levels of sodium on the elderly

Elderly adults are more likely to experience symptoms from low sodium levels because their bodies are not as efficient at maintaining fluid balance.

Mild hyponatremia can be dangerous as it leads to a loss of balance which leaves an older person at risk of a fall. Longer term it can also weaken the bones meaning that if an older person does have a fall, they are more likely to suffer a break or fracture. Mild hyponatremia can also cause memory issues and difficulty in being able to concentrate.

Sudden hyponatremia can lead to life-threatening complications and can cause the brain to swell, leading to fits and even a coma which can be fatal.

Treatments for low sodium levels

If you think you or someone you know may have hyponatremia, it is important to seek medical attention right away. Treatment for low sodium levels will vary depending on the underlying cause. In some cases, simply adding more sodium to your diet may be all that is needed. In other cases, more aggressive treatment may be necessary, such as being put on an intravenous drip.

The speed at which sodium levels are replaced is vital. Where someone has been suffering from low blood sodium for some time, too rapid a replacement can lead to convulsions. Therefore it's of vital importance that you visit a medical professional if you are worried about low sodium levels.

How is hyponatremia diagnosed?

Generally speaking, hyponatraemia is shown through taking a blood test. However, while this will identify low sodium levels in the blood, it won't show the underlying cause. Therefore more investigations may be needed.

If low blood sodium is identified your doctor will assess you for levels of fluid in your body to understand whether you need more urgent treatment in hospital.

Some tests to do this may include:

• Further blood tests to check kidney function
• Urine sample to test for low sodium levels
• Imaging - if the cause is thought to be something such as heart of kidney issues, a chest x-ray may be required.
• ECG to check heart function
• Renal ultrasound if kidney disease is suspected.

What can you do to prevent low sodium levels

There are a few things you can do to help prevent low sodium levels. First, it is important to monitor your fluid intake. If you are taking diuretics or other medications that can cause sodium levels to drop, be sure to drink plenty of fluids. It is also important to eat a balanced diet that includes foods high in sodium, such as table salt, pickles, and olives. You may want to take electrolyte replacement solutions if you are on certain medications or have suffered fluid loss from an illness.

Finally, if you are elderly or have a condition that puts you at risk for low sodium levels, or are taking medication that may be diuretic, be sure to talk to your doctor about how to best prevent the condition.

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