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Medical Forum / General / General / July 2005Hyponatremia mistreatment
My girlfriend suffered from Hyponatremia about half hour after a mountain biking race. Even though I told the medics that I suspected she was probably overhydrated and probably suffering from Hyponatremia, unfortunately they treated her for dehydration in hospital, and put her on a normal IV drip. This was even though her arms were bloated, which I had pointed out was a sign it may be overhydration, my request for them to check her bloood plasma Sodium levels, and the fact she drank 7 litres of water during 5 hour race (very hot weather conditions). She was treated like this in hospital for 4 hours, until I managed to get through to the right hospital and talk to a doctor and point out their mistake. During these 4 hours she became gradually worse and lapsed out of consiousness several times. Once they treated her properly and gave her salt she started to recover. My question is, can this have caused any short or long term damage? 4 days later she still does not feel 100%, and sometimes feels lightheaded. Tests have shown her Sodium level to now be normal again, and liver & kidneys are ok. Your help is appreciated, as we are not 100% trusting of the medical advice now, Regards, EF. > My girlfriend suffered from Hyponatremia about half hour after a > mountain biking race. Even though I told the medics that I suspected [quoted text clipped - 24 lines] > Regards, > EF. I guess that that rules out any contribution by any of the several health care professionals that frequent this newsgroup. Perhaps one of the chiropracters will be able to help you out. Sorry about your girlfriend. I'm glad she's recovering and I hope she continues to do well. HMc >I guess that that rules out any contribution by any of the several health >care professionals that frequent this newsgroup. Perhaps one of the >chiropracters will be able to help you out. Hi Howard, Sorry, I do not understand what you mean by that. I'm basically looking for a second opinion, because the medical professionals in this case dont seem to know much about Hyponatremia, think it is not a major problem, and in fact thought the initial treatment for dehydration was quite satisfactory. Also hoping to see another doctor for a second opinion, but this takes time, and thought I might be able to get some advice via the newsgroups. We'd like to know if there is any short or long term damage, because she still does not feel 100%, and we'd like to know if there is something more we should be looking out for. Regards, EF > >I guess that that rules out any contribution by any of the several health >>care professionals that frequent this newsgroup. Perhaps one of the [quoted text clipped - 17 lines] > Regards, > EF Long term damage is unlikely. Severe hyponatremia can indeed occur with water intoxication, and if it's severe enough, it can promote seizures, although it doesn't sound like she got to that point. I can understand your frustration. Clinically, dehyration in her setting would probably seem more likely, but a simple set of electrolyte measurement would show a low sodium concentration. It shouldn't have been a difficult diagnosis, especially given the history you gave HMc > My girlfriend suffered from Hyponatremia about half hour after a > mountain biking race. Even though I told the medics that I suspected [quoted text clipped - 22 lines] > Your help is appreciated, as we are not 100% trusting of the medical > advice now, Hyponatremia can result from dehydration and muscle trauma, both possible after extreme physical exertion, or from taking in too much free water, which has been reported in athletes drinking a lot of water during an event, as well as lots of other things. The plasma sodium itself does not tell you which of these it is. Did they check a urine sodium? A low urine sodium would be consistent with dehydration/muscle trauma, wheras a high urine sodium could be from taking in too much free water. Giving her normal saline would treat both of these things, which is probably what was in her first IV. It is true that normal saline is a little hypotonic, so hypertonic "hot salts" are sometimes used, but that would only be necessary in more extreme cases. Treating severe hyponatremia can be tricky, since you don't want to correct the sodium level too fast. > > My girlfriend suffered from Hyponatremia about half hour after a > > mountain biking race. Even though I told the medics that I suspected [quoted text clipped - 35 lines] > in more extreme cases. Treating severe hyponatremia can be tricky, since > you don't want to correct the sodium level too fast. COMMENT: Agree with the above. The key point is there's no such thing as a "normal IV". There are all kinds of different solutions. If they were treating her for dehydration (loss of simple water more than salt) they probably gave her normal saline (since correction of HIGH sodiums too fast really IS dangerous). So, as med-girl notes, she probably got fairly appropriate therapy for low sodium water intoxication also. Normal saline treats everything, so long as your kidneys are working :). Water intoxication is common in distance running, and it seems more common in women and people who take NSAIDS, which foul up ability to excrete water. Low sodium can cause brain swelling if it happens very fast, and this is what probably happened in your case. Too-rapid correction of low sodiums seems not to be the risk that going the other way, is. It's true that you don't want to correct any electrolyte too fast, but the worst brain damage risk is too-rapid correction of HIGH sodium, not low. Brain cells can stand rapid shinkage from treatment better than rapid swelling (which is what happens if you correct high sodium too fast). My guess is she'll be fine. Probably there wasn't really a medical error, inasmuch as the docs surely knew that if she wasn't volume-depleted but instead water intoxicated (as you guessed), saline would still be (close to) the treatment of choice. If your kidneys work, your body can always deal with volume overloads better than it can electrolyte disturbances. SBH |
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