Dangerous low sodium level due to high BGs

[PattiEvans]

Just wanted to give a warning regarding the above. On Monday last I had a steroid injection in my knee for osteo Arthritis. As a consequence my BGs were running in the 20s all week, despite 70%+ temporary basals and umpteen corrections. At the same time I had been taking a high dose of Losartan for BP for onwards of a year. Due to the Losartan my kidney function (eGFR) had dropped from 70 to 54. Plus I was having low Sodium levels every time I had a blood test. I'd been asking to come off the Losartan but the GP stressed how important it was to control BP as a T1. Instead they added Bisoprolol and Doxasozin.

On Thursday last I was in the shower when I had a strange sensation that someone was in the shower with me. It turned out it was my own arm and I didn't recognise it. I could use it, but it had no feeling and felt completely alien. That wore off, I dressed and went downstairs and was able to talk normally to a friend who had dropped in. After lunch I started to feel confused and my speech became completely garbled. Hubby rang an ambulance and I was admitted to hospital. I thought I was having a stroke. I recall little of the rest of that day. The following day the Dr came to discharge me, but I started speaking to him in a garbled way again, so I was kept in. I finally got discharged into the care of the "virtual ward" on Christmas day afternoon. The nurses will be visiting me on a phone call every day as I monitor my vital signs with the equipment I have been loaned (BP, bloods, temperature, and oxygen levels). They will physically visit every other day to take blood samples for sodium levels for the next 14 days or until sodium levels are restored.

On reading my discharge notes I see I suffered not from a stroke but from Hyponatremia which can cause the brain to swell and cause confusion. I mention here that it is a very dangerous condition and my sodium levels are still not quite where they should be.

Since we as diabetics are prone to high BP and in certain circumstances high BGs I thought it was worth warning.

 

[eggyg]

Just wanted to give a warning regarding the above. On Monday last I had a steroid injection in my knee for osteo Arthritis. As a consequence my BGs were running in the 20s all week, despite 70%+ temporary basals and umpteen corrections. At the same time I had been taking a high dose of Losartan for BP for onwards of a year. Due to the Losartan my kidney function (eGFR) had dropped from 70 to 54. Plus I was having low Sodium levels every time I had a blood test. I'd been asking to come off the Losartan but the GP stressed how important it was to control BP as a T1. Instead they added Bisoprolol and Doxasozin.

On Thursday last I was in the shower when I had a strange sensation that someone was in the shower with me. It turned out it was my own arm and I didn't recognise it. I could use it, but it had no feeling and felt completely alien. That wore off, I dressed and went downstairs and was able to talk normally to a friend who had dropped in. After lunch I started to feel confused and my speech became completely garbled. Hubby rang an ambulance and I was admitted to hospital. I thought I was having a stroke. I recall little of the rest of that day. The following day the Dr came to discharge me, but I started speaking to him in a garbled way again, so I was kept in. I finally got discharged into the care of the "virtual ward" on Christmas day afternoon. The nurses will be visiting me on a phone call every day as I monitor my vital signs with the equipment I have been loaned (BP, bloods, temperature, and oxygen levels). They will physically visit every other day to take blood samples for sodium levels for the next 14 days or until sodium levels are restored.

On reading my discharge notes I see I suffered not from a stroke but from Hyponatremia which can cause the brain to swell and cause confusion. I mention here that it is a very dangerous condition and my sodium levels are still not quite where they should be.

Since we as diabetics are prone to high BP and in certain circumstances high BGs I thought it was worth warning.

So glad you’re home Patti. I had a nana nap this afternoon and you were in my dream. I popped in to see you, it was just a short drive! You were on your way out to meet friends in the pub! I think that’s a good omen that you will be back to your A game very soon. Xx

 

[Carlos]

So all in all good news in a sense, as long as the low sodium level is fixed. Have they sorted out your BP meds?

 

[AndBreathe]

@Pattidevans - I found myself on the trashed electrolytes merry-go-round, due to a low dose ace inhibitor.

Initially, my electrolytes were not checked as they should have been, but when they were, I had a call from one of the GPs at the surgery (not the one who prescribed it), telling me to stop immediately. Take no more, and retest in 2 weeks.

It was restarted to go through the loop again. Eventually I point blank refused to take any more ace inhibitors, no matter how great he thought they were. I actually felt well in myself, but it doesn't take sodium to be much out of whack to be in trouble.

I now take the lowest dose of beta blocker and that seems to have me on an even keel.

I'm so glad they're keeping tabs on you now. I hope you are back to your old self soon.

 

[trophywench]

I continually had low sodium when taking Losartan for my BP, Patti. Eventually the NHS decided I needed to stop taking them and swat to something else so after 'kissing several frogs' with a couple of them causing water retention in my feet and legs, severe enough so I couldn't get shoes on my feet - and I'm not allowed to take 'a water pill' because of the low sodium, and eventually settled on 40mg Doxasozin, that then needed increasing - 60, then 80. Then that wasn't enough so Moxonidine was added - and usually been OK - BUT.

Latterly I've had a number of 'funny turns' so they went down the route of finding out if I'd had a stroke, an epileptic fit, or anything else wrong with my brain. (I don't recommend an MRI scan of the brain unless you have no option) but anyway, nowt wrong with me brain apparently, so despite other beliefs of my darling husband - it has been irrevocably proven that I have one.

This time they decided to get me seen by Neurology - so I went, pleasant middle aged man, asked me and Pete lots of questions, then asks if he can take my BP again (cos I'd just had it done, with height & weight 5 minutes before starting the consultation) only this time could I lie on my back on the couch please, so my BP was 129/60 or summat equally ok, now could I stand up again please? Nearly a minute before he could detect a pulse and BP ridiculously low, then took several minutes to come back up to anything sensible - so he thought it might be simple postural hypotension and added that the BP meds I'm on are some of the worst culprits for causing that very thing. So he referred me to cardiology to wear an ECG monitor for 48 hrs which I did a couple of weekends ago and now sitting waiting to hear what if anything, is what.

Pleased it wasn't a stroke!

 

[SB2015]

Sorry to hear your news @Pattidevans and glad that you are home now, and being closely monitored. Juggling the cocktail of tablets is interesting with various side effects. I hope that they can find an effective so.union for you soon.

 

[PattiEvans]

So all in all good news in a sense, as long as the low sodium level is fixed. Have they sorted out your BP meds?

Yes, they have me on Bisoprolol (beta blocker) and Doxazosin (alpha blocker) and they seem to be controlling BP far better than the Losartan (ACE inhibitor) ever did. Thank you Carlos.

 

[PattiEvans]

@Pattidevans - I found myself on the trashed electrolytes merry-go-round, due to a low dose ace inhibitor.

Initially, my electrolytes were not checked as they should have been, but when they were, I had a call from one of the GPs at the surgery (not the one who prescribed it), telling me to stop immediately. Take no more, and retest in 2 weeks.

It was restarted to go through the loop again. Eventually I point blank refused to take any more ace inhibitors, no matter how great he thought they were. I actually felt well in myself, but it doesn't take sodium to be much out of whack to be in trouble.

I now take the lowest dose of beta blocker and that seems to have me on an even keel.

I'm so glad they're keeping tabs on you now. I hope you are back to your old self soon.

I think that had I not had the steroid injection that pushed BGs up into the 20s then it probably wouldn't have tripped me over into Hyponatremia. National Kidney Foundation says:

Other causes of hyponatremia that may not be directly related to kidney diseases include:

• Extreme hyperglycemia (very high blood sugar): extra fluid can build up in the blood to counteract the high level of sugar

So in some ways it may have been a good thing that it did and it's not at all likely that the GP will insist on me resuming Losartan and I'd certainly refuse. Though actually my GP is very nice and I think she will be mortified to find out what has happened.

 

[AndBreathe]

I think that had I not had the steroid injection that pushed BGs up into the 20s then it probably wouldn't have tripped me over into Hyponatremia. National Kidney Foundation says:

Other causes of hyponatremia that may not be directly related to kidney diseases include:

• Extreme hyperglycemia (very high blood sugar): extra fluid can build up in the blood to counteract the high level of sugar

So in some ways it may have been a good thing that it did and it's not at all likely that the GP will insist on me resuming Losartan and I'd certainly refuse. Though actually my GP is very nice and I think she will be mortified to find out what has happened.

I wasn't doubting your findings, just suggesting that an ace-inhibitor might have been a contributory factor along the way.

My sodium has always run low, so in my case it didn't take much of a shift to get into tricky territory. I was rather horrified to find how little there is between OK sodium and dangerously low.

The great news is it can recover in a matter of days, although I'm guessing that's more likely without any other contributory factors.

Those steroid injections can be like lighting a blue touch paper on all sorts of bits of us.

Hope you're back to your perky self soon.

 

[Leadinglights]

My OH is on an 8 week course of oral steroids for his Crohn's flare up and has put on loads of weight and he asked the consultant at his review appointment about how to best lose that weight and they joking said if he finds a good way then she would love to know.
He has been put on a different medication instead of the Pentasa which he has taken for years to something which can potentially cause nasty side effects so needs weekly blood tests for 4 weeks then 2 weekly then monthly and if they don't cause any problems then he will be on them forever.
The consequences of taking some meds can be not good and I suppose it is what is least bad.

 

[PattiEvans]

Hi @trophywench

Sounds like you have been having similar problems. I had a phone call this morning from a Stroke nurse who said the Consultant had said I had a TIA. I dispute this as I've had one before and the symptoms I had on this occasion were not the same and in fact they were just as described for Hyponatremia. TIA was not on my discharge papers. Description given by the Kidney association is

More serious symptoms can happen in severe cases when the level of sodium in your blood is extremely low. These include:

• Altered mental status (severe confusion)
• Hallucinations
• Decreased consciousness

And I was having hallucinations - I thought my arm belonged to someone else - as well as confusion. Unlike a TIA which feels quite different.

@AndBreathe no, sorry, I didn't think you were disputing me. I was just saying that if the two situations had not coincided then I don't think it would have come to a head the way it did, I'd have just struggled along with low sodium. I am convinced it was due to the Losartan, no doubts whatsoever. I have been saying that to the GP for long enough. It's blooming shocking the way they keep us on these tablets that are damaging. (same @Leadinglights )

Today so far I've had 4 phone calls from the "virtual ward" nurses, checked vital signs 3 times for them. 1 phone call from the stroke nurse and a visit from the district nurse to take blood. In between I've managed to shower and clean teeth (with an interruption with mouth full of toothpaste) and finally get something to eat! Due another vital signs test at 3pm and another phone call at 3:30 then I just may be able to relax and watch "House of Dragons" DVD that I got for Xmas!

 

[rebrascora]

So pleased to hear you are home Patti and managing to potter about a bit looking after yourself and in some respects good to hear that it wasn't a stoke although obviously what did happen is equally scary. Relieved to read that the follow up care at home is well coordinated, even if most of it is just by telephone which actually seems like a really good option to free up beds with patients who are competent to monitor themselves at home and I am sure that your recovery at home where you will be happier and can eat better food, will be speedier than being stuck in hospital but with the comfort of knowing that you are still being monitored.
Hoping you are back to your old "full of life" self soon. X

 

[AndBreathe]

Hi @trophywench

Sounds like you have been having similar problems. I had a phone call this morning from a Stroke nurse who said the Consultant had said I had a TIA. I dispute this as I've had one before and the symptoms I had on this occasion were not the same and in fact they were just as described for Hyponatremia. TIA was not on my discharge papers. Description given by the Kidney association is


And I was having hallucinations - I thought my arm belonged to someone else - as well as confusion. Unlike a TIA which feels quite different.

@AndBreathe no, sorry, I didn't think you were disputing me. I was just saying that if the two situations had not coincided then I don't think it would have come to a head the way it did, I'd have just struggled along with low sodium. I am convinced it was due to the Losartan, no doubts whatsoever. I have been saying that to the GP for long enough. It's blooming shocking the way they keep us on these tablets that are damaging. (same @Leadinglights )

Today so far I've had 4 phone calls from the "virtual ward" nurses, checked vital signs 3 times for them. 1 phone call from the stroke nurse and a visit from the district nurse to take blood. In between I've managed to shower and clean teeth (with an interruption with mouth full of toothpaste) and finally get something to eat! Due another vital signs test at 3pm and another phone call at 3:30 then I just may be able to relax and watch "House of Dragons" DVD that I got for Xmas!

GP wanted me to go around the ace-inhibitor loop again, stating I might handle the first one better this time. Never in my lifetime was that going to happen. How was that EVER going to be a good idea?

There seem to be a gazillion options to manage slightly elevated BP, so why insist one something that is patently harming me?

I've considered changing GP, but this bunch have a CQC rating of Good, and at least now I know to trust absolutely nothing I am told on face value.

I'll say it until I am blue in the face. It has never been more important for us to self advocate and do our own homework an anything that comes our way. I really feel for those who believe, with certainty that the doctor knows best.

 

[SB2015]

I hope that things are settling for you @Pattidevans
You have prompted me to make sure that I get a proper review of my meds which is ‘a bit overdue’
Take care

 

[everydayupsanddowns]

I hope that things are settling for you @Pattidevans
You have prompted me to make sure that I get a proper review of my meds which is ‘a bit overdue’
Take care

Me too! A very timely reminder to keep on top of things @Pattidevans

So pleased it wasn’t a stroke, and that you now have meds that suit you better.

Must have been a properly scary time. Get well soon.

 

[PattiEvans]

Yes, @SB2015 do get a proper review - though I don't know how much good it will do. I had a review and I brought up the Losartan, but it was ignored! I have now had them on the phone arranging a phone appointment with the GP to put me on Statins. Not in a million years. At the very least I would want a full lipid review and not just a total chol number because it always proves I have very low trigs and high HDL. I am fed up of being bullied over statins.

There seem to be a gazillion options to manage slightly elevated BP, so why insist one something that is patently harming me?

Exactly @AndBreathe what I am on now (Doxasozin and Bisoprolol) is controlling BP much better than the Losartan ever did!

 

[Bloden]

Good grief! @Pattidevans. 😱 So glad to hear you’re home. What a horrible experience. Take care...and stay away from doctors for a while!

 

[PattiEvans]

Thank you @Bloden.

So this morning I was expecting my routine call from the Virtual Ward people and I answered the phone to discover it was the GP's receptionist wanting to make me an appointment with the GP "to review your medication because your sodium is a bit low". I almost laughed out loud. I said, that's a bit late since the hospital has already reviewed and changed my medications. So we decided to stick with the appointment they made for 19th January when she's ringing to suggest statins for me. Though I said "I've already been made very ill by ingesting prescribed chemicals and I don't feel like ingesting other chemicals (i.e. statins) that have nasty side effects!"