Chronic hyponatremia

Part 4:

Remember that serum sodium test I sat for on 3/17... well, it didn't come through until 3/24! The result... 125! 125 again... the number that landed me in the hospital on 3/10. Had my doctor seen this result on 3/18, I'm certain she would have sent me back to the hospital. However, that week, I had in mind that, even though I felt very weak, at least my sodium is likely okay. I also got a massage on 3/17 and engaged in deep breathing and meditation as best I could. (I still could not focus that well, as, unbeknownst to me, I was dealing with low sodium...)

So, my miracle of 2025 is that I somehow came up from 3/17-3/21 through anxiety reduction techniques and increasing both my sodium and fluid levels (like a POTS patient). I took in around 75 oz of fluid per day along with about 3500 mg of sodium (not just sodium chloride). I also took one pack of LMNT in 32 oz of water along with my 3x 1000 mg NaCL each day during that time.)

Since that worked, I took in about 110 oz of fluid per day along with 4000-5000 mg of sodium per day with bi-weekly sodium tests for the next three weeks. I actually reached 133 on 3/24, 134 on 3/25, and 137 on 4/15. (I did go back down to 133 after reaching 135.) By mid-April, my anxiety surrounding testing had become significant, so I stopped testing. I also realized I was retaining a significant amount of fluid and realized that it wasn't sustainable. So I cut my sodium down to around 3000mg per day. Just after that, I lost eight pounds of water weight in two days.

Even though I missed the assurance testing provided, I decided it would be best to just live my life and only test if I felt "off." I reasoned that I knew what it felt like to be low in sodium, so I could just move forward untethered from this self-imposed burden.

Listening to my body went well until I went through colonoscopy prep in early June. For the prep, I upped my sodium as well as my fluid intake again, thinking that this would "shield" me from any issues. I was SO wrong! With all the extra fluid specified by the prep instructions, I likely waterlogged my system, as I woke up with my heart pounding at 140 and then went into panic. Ugh!

Having learned a lot during the prior three months and having developed an aversion ot testing and to the ER (Ha, ha.), I thought I could "feel" my way out of the acute crisis and be just fine. Well, I made two key mistakes: I continued taking in too much fluid and would take in too much sodium at once (i.e., chicken soup). Both of these waterlogged my system, with the former providing my body with too much fluid to process at once and the latter led to a retention of fluid to protect my cells from an overload of sodium; both were dehydrating.

Part 5:

Six days later, with my heart pounding at night, I ended up going to the ER. I was at 129 but majorly dehydrated. My Mg was on the lower end at 1.8, but my potassium was on the higher end at 4.8. After Ringer's solution, I felt so much better. I was instructed to take in normal amounts of fluid and sodium, but, to me, that meant a lot of both. I continued to feel a bit waterlogged but slightly better each day. I had in mind that taking in chicken soup each day would help to raise my sodium levels, but, instead, it was causing me to retain fluid and feel more thirsty. Thankfully, a week after the ER, through research, I realized that I needed to stop taking in the sodium and give my kidneys a chance to process all that fluid.

I began practicing diaphragmatic breathing two days after I left the ER in mid-June, and this really helped my system to relax. I also started practicing vagus nerve exercises, and this also helped considerably.

Fast forward to two months later... I had been to Europe and had been going by how I felt each day with no testing. I would eat fish pie and take in 1000 mg of supplemental sodium per day. I did not test.

Part 6 (Final):

On 8/8/25, I saw the chief of endocrinology at a Top 10 nationally-ranked hospital. I was thrilled that he was the chief and had 42 years of experience. He took copious notes as I told my story. My PCP had requested an urgent appointment after I had dipped back down to 125, as she feared I may have an adrenal issue.

Sodium that day: 130. Ugh! The same old reading. However, what came next really surprised me...

Based on the numbers, he, like the hospitalist and my PCP, implicated SIADH. His notes read that my levels were consistent with SIADH and almost surely exacerbated by anxiety. I was surprised that it was SIADH, for I had come up to 130 by taking in more fluid and more sodium after going back down to 125 post-hospitalization, and with SIADH, someone would be expected to go down, not up. My renin/aldosterone readings were fine, as was cortisol. My DHEA was super low, but he said that it was an anomaly that is consistent with previous findings and did not indicate adrenal insufficiency. (Now, personally, I would love to be able to take supplementatation to raise my DHEA levels to normal, but more on that below.)

I have learned since then that SIADH is not caused by anxiety, but the effects can be intensified. It began to make sense... when I when to the hospital last March, I was a nervous wreck, and this not only caused me to drink more water nervoulsy, but it also via the release of too much ADH (Vasopressin) retain fluid (which keeps sodium from reaching the blood).

Through research, I think I now know why I was so remarkably anxious early last March: I had resumed an SSRI after a 6-month cessation AND was taking 25 mg of DHEA each day (per another doctor's suggestion). Apparently, there is an interaction between the two that can lead to poor digestion, difficulty sleeping, and worsened anxiety. Check, check, and check! I stopped DHEA on 3/3/25 and suspect that it took a couple of weeks for my levels to go back to normal, which for me, is very low. With the combination of these two medications (well, medication and hormone), I began to spiral with my anxiety... like I never have before or since. Due to all that anxiety, my normally mild SIADH ramped up! Drinking more water as an anxious tick... made things even worse. Ugh!

So, after the August visit and answers that put my mind at ease, I did what the doctor suggested: took in less fluid (to about 64 oz. per day) and took in less sodium. He suggestion more restriction and less supplemental sodium due to my high blood pressure readings in the clinic. You see, I have "White Coat Syndrome," and my readings are usually at 140/90 in a clinical setting, no matter how hard to try to relax. This seemed to be working well, as I felt well most days, exercised a lot, and ate a diet with about 2000-2500mg of sodium and took in the 64 oz. per day or so.

Fast forward to yesterday... I went in for a double ear infection to request an antibiotic. My doctor said, "Hey, why don't we test your sodium to see how you are doing with your new system." Being averse to testing, at first I objected, but then I changed course and agreed to the test.

The first thing I see this morning in my phone notifications was a message from my provider. It read, everything looked great in your BMP, but your sodium was low again. However, as this is consistent with past readings, you shouldn't worry. Despite the long distance I have come with my anxiety since last June, I worried. It was a gut punch! "How? I felt fine in the office yesterday!" Once again, I'm following doctors orders regarding SIADH, and I'm still low?

I didn't know how low and had to work to get my nerve up after doing some errands and hanging out with my child. When I looked, I wasn't so upset... 132. "Hey, at least it's not 130. That's improvement over my chronic level, at least!" Also, as I understand it, SIADH can be triggered or worsened by infections, so perhaps my level right now is lower right than whatever my new normal has been since August. I am going to check it again once my infection is gone and I am feeling like myself fully again. For now, given that my blood pressure readings outside of a clinical setting have been around 125/85, I think it will be fine to increase my supplemental sodium back up to 1000mg for a spell, as it had been down to 500mg for a couple of months based on how I felt, which is strong. 🙂

I am determined to get back to at least 135 consistently, for when I was at 135 and 137 with major intakes of sodium and fluid last April, I felt great! Now, if I can just fine tune my sodium intake amount on 64 oz of fluid each day. I'll get there!

Thanks for reading. I do hope that my novella will, again, help someone feel less alone, and, even better, help guide someone's steps in both recognizing the signs of moderate/severe hyponatremia and avoiding the mistakes I made.

Blessings to all,

Jon

P.S. -- I'm open to any questions anyone should like to ask.

@sueinmn I have been on Hydrochlorothyizide for over a year. My bloodwork just came back and my sodium level was 127. I see a doctor next week. I’m hoping this is all a medication change and I’ll be back to normal. In the meantime is there anything I can do to bring sodium level up?

@debbie22 Your doctor is the one who can monitor your natrium levels properly and give you the correct remedies. My father took salt tablets initially, but resorted to salting his water which a half tsp of salt to a large glass. He took that twice a day if I recall. So, you can up your salt intake, provided it doesn't cause unwanted side-effects like high blood pressure. This is where your own doctor or endocrinologist comes in.