This week has been a long one, and it’s not over yet.
The woman who brought me into this world has been sick for several months, struggling with weakness, roller coaster hypertension, and now the lengthy illness has started to erode her spirit.
There have been multiple trips to the emergency room, some by ambulance, or a family member taking her to the dreaded place of sick people.
Recently Dr’s have been practicing medicine on her to attempt to lower the high blood pressure.
So here are some of the meds that have been tried some of which she is still on, with continuing constant high spikes of hypertension throughout the day.
Norvasc
Bistolic
Cozaar 100mg
Coreg 12.5mg
clonidine 0.2mg
Tekturna
Now I am not knocking the Dr’s, she has been to several, and the thing that strikes me is the Dr’s don’t seem to talk to each other enough, you basically have to be really sick before they really start looking at the root cause and stop just throwing meds at you.
So one week ago she had a heart catheterization after her primary care physician noticed something abnormal on an EKG. This is the proceedure where they insert a tiny tube in an artery typlically in your leg, and I assume they use some type of dye to examine the blood flow. So in a nutshell they found nothing to note, they said for an 80+ year young woman there where no significant blockages to speak of.
So relief right? No the issue of roller coaster hypertension, and extreme weakness persists.
So now on to a specialist, a Dr. called a Nephrologist basically a hypertension and kidney specialist.
By this time Mom is somewhat desparate, and can only focus on how bad she feels.
So the Dr. notices the blood work she had from the week before when she had the heart cath, and says “you are anemic, have you noticed any blood in your poop”, No Mom replies, “Dark stools?” again NO.
I hope she even knows this?
Also he says her sodium is low, so it sounds like both of these, anemia, and low sodium could cause weakness.
The Dr. ask’s Mom if she would agree to a colonoscopy, she replies with No I had one of those a few years ago and they did find anything.
So the doc proceeds to perscribe some new addition meds, (how many different pills can one take in a day anyway?) and orders an extensive blood test.
So this is on Friday, the weekend passes, I am sure like a bad dream for Mom cause the weakness and blood pressure are still out of control.
Needless to say I get a call at work on Monday, and Mom says she is calling 911, so back for another stay in the hospital, she gets admitted for low sodium. I understand this condition can be very dangerous?
Anyway a few days have passed and they have also found blood in her stool, so she is prepping for a colonoscopy at the hospital as I write this.
So tonight I say a prayer for Mom and get ready for what may be a long weekend.
Life… it is what it is sometimes.
I can only hope if there is someone out there with these same symptoms maybe this post might save you some time?
Get the doc to check your sodium, and take a stool sample to check for blood…
Update: 10/13/2008
Ok so they put Mom through a battery of tests, a colonoscopy, a CAT scan, and an MRA basically, covering her entire body. The good news is results came back negative, so they found nothing.
So I assume that this weakness is directly related to anemia, and low blood volume and low sodium aka Hyponatremia. So it comes down to reducing fluid intake and taking an iron supplement.
Now don’t get me wrong Hyponatremia is a very serious condition and can be treated.
If you read the explaination for Hyponatremia, you will understand the reason behind all the tests.
So there is a moral behind this story, eat right, everything in moderation, exercise, and especially when you get older and are a women take an iron supplement, but get the blood work from your Dr. and make sure that he is in the loop.
My research
Good information here on low sodium – the medical term is Hyponatremia
Update: 10/19/2008
Ok so this is current list of meds that Mom is on, and the times she takes them during the day.
AM
Hydralazine ( 50 mg ) but I am weary of this med based on her current side effects ?
Lexapro perscribed to my Mom for depression, I guess in her case geriatric depression, (also not sure of mg) but it does not matter, I just read a statement on the front page of the Lexapro website, and there is s specific statement stating that geriatic patients with symptomatic hyponatremia should not be taking Lexapro. I am starting to wonder if the doctor even read the drug interactions and caution statements, in this case regarding geriatic patients with hyponatremia.
Now her Dr is a Nephrologist, I.E. a hypertension specialist. I am starting to think the Pharmaceutical reps are just giving the doctor the breifing on these drugs verbally, and they are handing them out. Now I am starting to get pissed, needless to say I will be calling my Mom’s Dr. in the morning.
Interesting article here on geriatric depression, we are not Jewish but it sounds like they may have some useful information on treatment.
Noon
Hydralazine ( 50 mg ) again weary of this med based on her current side effects .
I would like to see her switched to an ACE inhibitor like the this “post” explains, maybe specifically Vasotec for example, I take the drug Vasotec for hypertension and tolerate it well.
PM
Hydralazine ( 50 mg ) again weary of this med based on her current side effects .
I would like to see her switched to an ACE inhibitor like the this “post” explains, maybe specifically Vasotec for example, I take the drug Vasotec for hypertension and tolerate it well.
Verapamil (360 mg) for hypertension, this is a large dose for an old lady of 81, but it does seem to be keeping her blood pressure down, I also take this medication an d have been for several years now with limted side affects.
There is a high incidence of constipation associated with Verapamil’s use, but increasing your fiber intake to 25 to 35 grams of fiber per day will keep you in check.
I think it is a good drug.
Lastly she was perscribed tekturna (300 mg), in reading the website I just hope it is not tekturna HCT based on the fact that it has a diuretic added to it, and IMO “In my Opinion” would be a mistake for a Hyponatremic patient.
Mom is also taking xanax / alprazolam (.25 mg) twice a day, or as needed, I.E. if she does not need it twice a day she does not take it. Lately though her axiety has been very high, and this drug does a good job at treating axiety disorders.
So currently Mom is so weak she can’t hardly get around, just since she has gotten out of the hospital a week ago and has been taking these meds for one full week, and now she is weaker than ever. I will be calling the Dr. in the morning and requesting that she is taken off of the Lexapro ASAP due to the warnings about Hyponatremia in geriatric patients, which she is currently battling, this is critical mistake IMO “In My Opionion”
Also based on this Doctors comments it sounds like hydralazine may should be replaced soon with an ACE inhibitor, something like Vasotec ?
It really sucks to see my Mom in this state, if there are any doctors out there reading this feel free to comment, all I want is to see her stablized, and based on my research so far I think some of her current symptoms are based on the side effects of two of these medicines, specifically Lexapro and Hydralazine, and which may be agrivating the hyponatremia.
1. She has had roller coaster hypertension, I think the verapamil has done the most for her so far because as soon as she started taking it her BP stablized.
2. She does have anemia, and is taking iron for that, as bleeding has been ruled out because she had a coloscopy last week and the only thing they found was mild Diverticulosis / Diverticulitis
3.She also had a full body CAT scan / MRI I think to rule out any tumors / cancer which sometimes if a cause of Hyponatremia.
4. She is recovering from hyponatremia, on Thursday 10/16/2008 her sodium level was 129 which is about 7 points low of the low end of the scale outlined here. The Lexapro to me is a medical mistake considering her current conditon.
Argh…
Update: 10/26/2008
Mom quit taking the Lexapro with the ok from the Dr. after I raised concerns with him about the direct warning on the front page of thier website.
The mystery continues though, on 10/22/2008 Mom called 911 because if extreme weakness, and now she is back in the hospital. This is her third stay in the past two months. She was admited once again for
hyponatremia, low sodium level in the blood. Over the last week since her last hospital stay she had gotten progressivley weaker each day. One good develpement was that Mom’s blood pressure was now being controlled at levels ranging from 150 over 80, to 130 over 70, and sometimes a bit lower, but overall what would be considered controlled without huge spikes in blood pressure for long periods of time like she has been experiencing for so long.
The first day when she was admitted into the hospital her blood sodium level was 117 to 119 which is very low. At that time they placed here on lasix, what they call a loop diuretic. Now my first reaction was what are they trying to do kill her?, but after I read more about how a loop diuretic works it seems increase renal free water excretion, thus allowing the sodium level to raise?
On Friday 10/24/2008 I had a disucssion with the doctor about Mom’s hyponatremia, and I asked him, “based on the tests that have been performed up to this point do they have any clue what may be causing this low sodium issue“. The Dr. went on to tell me that based on the lack of findings up to this point, and Mom’s age of (81), that the condition appeared to be something called SIADH, sometimes common in geriatic women, basically a hormonal condition that makes you absorb too much water, and the result is hyponatremia. I then inquired what causes this SIADH (Syndrome of inappropriate antidiuretic hormone), and he says that it can be caused by a number of reasons, maybe a small undetectable stroke that may not even be able to be found by normal means, which he said is most likely they case here.
In addition to lasix, fluid restriction limited to 800ccs a day, they have also added a drug called demeclocycline, a drug in the family of tetracycline antibiotics used also to treat hyponatremia due to SAIDH.
They also have started her on a pottasium, because you can loose pottasium during the lasix treatment, and that is whole other condition, lets not borrow trouble, because low pottasium is fraught with it’s own problems.
In a conversation he had with my sister, she voiced some concerns whether some of Mom’s recent hyponatremic condition could have been brought on by the mix of blood pressure medicine that she has just recently been changed to, with a special focus on hydralazine, as the drug has some contridictions that reference hyponatremia. And xanax / alprazolam, not a huge concern, but still worth consideration because certain mood altering drugs can be associated with hyponatremia because they mess with the receptors in the brain that control serotonin. His reply was yes, the drugs that she is currently taking to control her hypertension, and anxiety are under scrutiny and consideration as well, and one of them could be a partial cause.
So on this note of possible drug contridictions, they have titrated (lowered the dose to 25 mg), of hydralazine three times a day.
In reading all the causes for SIADH, my hopes are that it is just idiopathic, which means it just happens for sometimes reasons unknown.
Today is Sunday October 26th 2008, and Moms sodium level is up to 127 which is very good, she is still very weak, but at least she is up and walking with prompting from others.
I inquired with the doctor at what point is low sodium dangerous, and he said anything 115 or below they get very concerned.
I really would like to see her stay another few days just to ensure her sodium levels do not fall, and ensure the levels continue to increase. What we don’t want is to see another imminent trip back to hospital.
I just hope the mystery is narrowing.
If this goes on much longer, we will need a Dr. House
Update: 11/09/2008
Here is the timetable, Mom comes home from the hospital on 10/27/2008 with a sodium level of 129.
She is home all week and has a Dr’s appointment on 10/30 at 4PM to have a blood test to check her sodium level. Well my Mom and sister gety jacked around and have to wait forever at the Dr., needless to say the front office screws up and allows another patient ahead of Mom, and in the mean time the lab closes.
So she has to return the next Morning only to delay the blood test.
The weekend passes, Mom gets weaker, and Monday 11/3 Mom calls 911 again because she can’t take the weakness any longer. She is admitted with a sodium level of 123, the test on Friday 10/31 showed her blood sodium level at 129. After a week a treatment with demeclocycline and Furosemide (lasix), it seems the sodium level of 129 stayed level and has not risen? But now on 11/3 the level is at 123, so it dropped 6 points over the weekend. Mom constantly complains of going from sweating, to being chilled and freezing. I imagine the sweating part could be making her loose sodium. He blood pressure remains stable.
During her stay this go round the Dr’s remove her from the lasix, continue the demeclocycline treatment.
The Dr’s also order the following tests, a thyroid scan, endoscopy, and a gallblader sonogram .
The endoscopy test yeilds that Mom has a stomach ulcer close to where the esophagus meets the top of the stomach, and also they observe that eh lining of the stomach is irritated, I.E. Gastroenteritis.
During the procedure they took biopsy of cells in the stomach and the ulcer to check for any cancerous cells.
Immediate treatment will begin to treat the ulcer and the gastroenteritis and the ulcer.
They are using Sucralfate 1 (gm) tablet 4 times a day to treat the ulcer, and lactulose 10 2 table spoons once a day for constipation.
A few nights while in the hospital Mom is given salt tablets at night to try to raise her sodium level.
Later in the week I had a converation with the Dr. and he advised that it is balancing act trying to treat hypertension and Hyponatremia, basically he says sometimes depending on the geriatric patients hypertension severity caution should be used in trying to lower the blood pressure to what is deemed as totally normal levels. He says typically hypertension levels of 10 to 20 percent higher than the norm of 120/80 is sometimes the norm in older patients. So a BP of 140 / 90 to 150 / 100 may not always warrant treating it with too many meds.
On this vein of thinking they have removed the tekturna (300 mg), from her treatment.
The ulcer could be a root cause and contributing factor to the Hyponatremia
So Mom gets out of the hospital on 11/7 and we will see how things go.
Time will tell, the medical saga continues.
Update: 3/20/09
I found a great book that covers a multitude of medical subjects, it has helped me understand more about this condition. The book is called CURRENT Medical Diagnosis and Treatment 2009 (LANGE CURRENT Series), I spent hours reading it at the book store but just could not bring myself to purchase it, I think it was close to $80.00 there. I am sure I could find used copies of it for a much better price, I checked it out over on Amazon, this is what I found.
CURRENT Medical Diagnosis and Treatment 2009 (LANGE CURRENT Series)
Posted under Family, health, relationships
This post was written by Andrew on October 9, 2008
Hi Andrew. I hope things have improved for your mother. My mother-in-law is now going through a similar ordeal. She suffers from extreme weakness due to low sodium, and has been in and out of the hospital many times in the last month from this baffling condition.
My mother, 79, is going through the same thing. Her sodium level was 117 when admitted to the hospital yesterday. Thank you for your info and we will see how things go as we continue our research. I can’t help but believe it is drug related, however. So many older people, including my mother, are taking numerous drugs with so many side effects. I think the domino effect of physicians giving a person a drug for one ailment and then continuing to prescribe subsequent drugs to counteract the bad side effects from the previous drug is horrific. I believe the issue of physicians helping to make the pharmacies wealthy at the expense of someone’s health needs to be examined closer in the legal and communities.
Hi Andrew, Hope your mother is improving. My sister has a similar condition and I am very interested in your mother’s progress. Please let me know if you have any more updates from your interesting and informative narrative. You are so dedicated and have so much information.
Hi Andrew,
My mother-n-law is going thru right now with the same problems. She has been the hospital 3 times in the last 6 weeks. her Dr. has decided that her bi-polar meds is causing most of her sodium levels to drop. They have taken her off Lexapro and Trileptal for her mood swings and has left her on Clonazepam which last longer up to 8 hours from being taken than her Lorazepam which is a fast acting med. We hope she is our of the hospital by next Monday with her sodium level up from 120 to 130 or above. Her doc said, that anything number under 120 is dangerous and it should be up by 130 or above. She is on a water restriction of 1000cc for right now. Today seems to be a good day for her right now. Hang in there and keep being informed about her health. It’s harder when we get older and it’s better we start taking care of our selves before we get where they are now.
Thanks for your infomation and sharing your story with us viewers.
Judith
My mother had some kind of seizure and is in the hospital with very very low sodium. She was fine except for complaining of a sore jaw or tooth. She was drinking a lot of ice water for that, apparently. She has been there several days and they are trying to elevate her sodium — but she remains combative (not weak) and only says “no” or “help” — and is very tranquilized. It really seems too serious to be just from a day of a lot of ice water – Mom has diabetes (well controlled) and high blood pressure (ditto) but nothing else and is in her mid-60s. All the tests show nothing but low sodium and she is not getting at all better, from what I can see… I don’t feel the docs are testing enough possibilities but…it’s very mysterious and I hate it!
After reading the article, I feel that I really need more info. Can you suggest some more resources please?
Hello Andrew,
My dad has been struggling with low sodium for about 3 months now. He was diagnosed while in the hospital after calling 911 early one morning after being found very weak, diaphoretic (sweaty & clammy) and near faint. Nothing was found so he was discharged 2 days later. They ran a series of tests mostly outpatient which included ct scans, colonoscopys, etc… checking for cancer after the nephrologist figured it was probably caused from cancer? Everything is negative so far. He continues with a sodium of 123-127 around that range. They just sent him sodium pills which he is afraid of taking due to his hypertension (under control for many years). He is also on fluid restriction. I can relate to all of the posts here. It is very mysterious. Please keep us updated.
My 80 year old mum has been home from hospital for two weeks now after a nearly eight week stay. She had very low sodium and also uti’s. It resulted in seizures, confusion and hallucinations. She is doing very well now but still has periods of confusion. Does anyone know how long it takes for this to go or if at all?
This is Hyponatremia, which I’m currently suffering from. It comes from sodium depletion. Sodium, of course, is an electrolyte. I was tested and don’t have diabetes, by the way. I just ran all the salt from my body drinking excessive amounts of water; besides, I don’t use salt at all in on my foods and haven’t for years, see where I’m going with this? Oh yes, my feet were cramping so bad, that I couldn’t walk downstairs. Had a lot of the other symptoms too; weakness, etc. I tried Pedialyte, (yes, that stuff for kids) and it works, too. It’s the only thing I’ve tried that has and believe me I’ve wasted lots of dollars trying get some relief, but nothing helped until I got the Pedialyte.
It’s helping me, but not everything works for everybody.
They also have started her on a pottasium, because you can loose pottasium during the lasix treatment, and that is whole other condition, lets not borrow trouble, because low pottasium is fraught with it’s own problems.
I hope your mother is doing well! Have you noticed any mental decline? I believe your mother has an elevated Voltage Gated Potassium Channel Antibody (VGKC-Ab) most often associated with an occult cancer developing somewhere in the body. It causes neuromyotonia (extreme muscle weakness), hyponatremia (low sodium), anemia, and many other symptoms can also be present. It can cause incontinence, delirium, double vision, memory loss, seizures, etc. etc. The Mayo Clinic can diagnose this rare illness with a blood test.
Here is the good news! It is completely treatable! Your mother can recover completely, or nearly completely depending on some factors. It is auto-immune in nature and is a paraneoplastic syndrome. The treatment is this: 5 pulses of 1 gram of solumedrol every day for five days. Then taper to two pulses of solumedrol a week for two weeks, then 1 pulse of solumedrol a week for 2 weeks. At the same time, she needs to take prednisone at 60 mg every day, and taper the prednisone at the same time as the solumedrol (actual dosage will vary depending on her weight, etc. Let your doctors guide you). You should notice a huge difference in her condition within 2 weeks of starting treatment. Get a good neurologist!
Thanks for posting this information. It will help a lot of people, especially those who are at risk in stroke/ heart attacks. What are the other advise that you can give to us to be more knowledgeable about it?