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Published on March 16, 2021

Could your memory confusion be low sodium levels?

Sodium Confusion

For most patients, the first things they look at when their bloodwork comes back are the cholesterol levels and, perhaps, the glucose reading. If they even think about their sodium level, it’s usually to make sure it’s not too high, which could mean a need to cut back on overly salted food.

But a sodium level that is too low?

“That’s not something people usually think about,” said Michael Messina, MD a family medicine physician at Bramblebush Primary Care in Falmouth.

But, in fact, managing your sodium level so that it doesn’t drop below the acceptable range is equally important as not letting your level get too high. Sodium helps maintain normal blood pressure, supports nerves and muscles and regulates the body’s fluid balance.

A normal blood sodium level is between 135 and 145 milliequivalents per liter. When the sodium in your blood falls below 135, a condition known as hyponatremia occurs, which can lead to numerous complications, ranging from loss of energy, confusion, muscle weakness and nausea to more serious issues such as seizures, coma and even death.

A rapid, acute drop can lead to temporary brain cell dysfunction, including memory loss, Dr. Messina said. “If it happens over a day or two, you can usually reverse it pretty quickly and get the patient feeling normal.”

How does one know when their sodium level is out of balance?

“Typically, the symptoms are fatigue, a little confusion and a general feeling of weakness,” he said. “You have no get-up-and-go, and your muscles don’t feel like they’re working well.”

Other signs are nausea, vomiting, headaches, restlessness, irritability, muscle cramps and spasms.

Causes of Low Sodium

The most common causes for low blood sodium are diuretic medications used to treat high blood pressure, antidepressants and pain medications that can interfere with the normal hormonal and kidney functions.

“If you have high blood pressure, you need to check your kidney function annually, because high blood pressure can wear on kidneys,” Dr. Messina said. “You should also check your electrolytes, because diuretic medications such as hydrochlorothiazide and its cousins can decrease sodium.”

Sodium levels can also drop when drinking too much water, he added, which can overwhelm the kidneys’ ability to excrete water.

“If you’re running a race in extreme heat, you must drink not only water but something with electrolytes,” he said. “Every year at the Boston Marathon, runners end up in the hospital with low sodium levels because they sweated out too much sodium and drank only water instead of alternating it with [an energy drink].”

Dehydration, heart, kidney and liver problems, and hormonal changes brought on by Addison’s disease, which affects your body’s ability to maintain the proper balance of sodium, potassium and water, can also cause low sodium.

A sudden and significant drop in sodium level could also be due to Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH), which causes the body to retain water instead of excreting it normally in the urine. Physical stress after a surgery or trauma can cause SIADH.

“Your brain is not telling your kidneys to concentrate urine properly, and your kidneys are flushing out too much sodium,” Dr. Messina says.

Blood sodium level is best managed by treating any associated conditions, such as adrenal gland insufficiency, by taking precautions during high-intensity activities, by drinking sports beverages during demanding workouts and by drinking water in moderation during such times. For those with chronic hyponatremia, patients are often given regular doses of salt tablets.

Although it can be a complex procedure to diagnosis the underlying causes for a drop in sodium levels that lead to hyponatremia, Dr. Messina advises patients with mild symptoms to speak with their primary care physician, and stresses that those with more worrisome signs, such as a loss of memory regarding recent events or confusion over what day it is, should seek immediate attention at an emergency department.

Ultimately, it is important to educate yourself about the risks of any medications and to be aware of the signs that could indicate low blood sodium, he said.

“If somebody has acute low sodium that comes out of nowhere, look for an underlying cause, go to your doctor and talk about your symptoms. They’ll know your medical history, what medications you’re on and how to guide treatment to fit what is happening.”