Mr. A, sixty years of age, went to the toilet early in the morning and fainted. His daughter heard the sudden thud and saw him on the floor.

She and his wife tried to revive him but he remained semi-comatose . He is non Diabetic and his blood pressure before this happened was normal. The daughter called me up and I advised her to call an ambulance and get him admitted to hospital.

He was taken to the hospital and after starting saline , he improved. When his tests came in, his sodium levels were very low. Around — 108 milliequivalents per liter (mEq/L). Normal serum sodium levels are— 135 to 145 milliequivalents per liter (mEq/L). The levels gradually came to normal over a period of one week and he was discharged.

Mr. A is otherwise a very fit person who exercises regularly. A week before the episode, he had done some heavy electrolyte solution . He drank a lot of water as was his habit when he trekked. Two things happened. He lost sodium and salts due to sweating, and his blood got diluted by the excessive water he drank. Over a period of one week, he attributed his weakness to the strenuous trekking he had undertaken, but when his sodium levels went too low, he collapsed.

Sodium is a very important salt for the body. It helps maintain normal blood pressure, supports the work of nerves and muscles, and regulates the body’s fluid balance.

Hyponatremia or low sodium occurs when the sodium in blood falls below 135 mEq/L. It can be due to drugs that cause loss of sodium from the body, too much loss of sodium in sweat, or due to diarrhea and vomiting, liver, heart, and kidney problems where fluid accumulates in the body, drinking too much water, and in the older age group where the regulatory mechanism especially of the kidneys is less. There are also rarer causes. When sodium levels drop suddenly and drastically , there can be rapid effects on the brain, and unconsciousness. But when it drops gradually, there may only be a little weakness.

Lessons learned from this case

• Exercise is good for you at any age. But remember, drink only enough water to replace fluids that you have lost.

• If you are doing heavy exercise, it is a good idea to carry a sports drink with salts.

• Older people should get their serum electrolytes checked when they go in for regular checkups.

• It is a good idea to understand from your doctor the effects of any medication you may be taking.

*These are real case stories, but the names of patients have been changed to hide their identity.

Dr. Geeta has over 41 years of experience as a practicing doctor in Internal Medicine. Dr. Geeta is a prolific writer and has been writing health books since the year 2002 and two of her books published are best sellers – Health after Forty and A-Z of Bone Muscle & Joint diseases. She has worked as an honorary Physician in several hospitals including Dr BL Kapoor memorial hospital Delhi and Poona Hospital and research center Pune. At present, she has her consultancy practice at Pune.

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