Salt and potassium question. Should I pursue a specialist to find out why this is happening?

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marydys Asked April 2021

Salt and potassium question. Should I pursue a specialist to find out why this is happening?

So this is a medical question but maybe someone here has had this issue. My dad's body craves salt. Even with a heart condition, the doctor has said he can have all he wants and in fact prescribed over the counter salt pills twice a day (from REI). This is because his BP gets very low and he gets more confused and loses his balance. His body spills salt for some reason. We have found (sort of accidentally) that steroids help. He was on prednisone for something else and he suddenly began acting 10 years younger. Now he's on less powerful steroids.

He's 93 and has lots of issues but I'm wondering if I should pursue a specialist to figure out WHY this is happening (lately his potassium is also scary low). I asked the rehab doctor if there were tests to figure out why and she said maybe but she didn't recommend it at this point (frankly she just wants him to go on hospice).

It will be difficult to find such a specialist much less get him to one... and I don't even know what kind of specialist to look for. So I was wondering if anyone knows if there is a "cause" for this that can be fixed to help him (rather than just steroids to help fix the symptom).

I don't think its Addisons disease because the potassium being low is now also a problem. But I really don't know and don't know if a DX even matters if there is nothing to be done.

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score 0 · Answer 1

The condition might be an unwanted side effect of medication he is taking. Along with an endocrinologist you might consider an evaluation by a kidney specialist.
Personally I have to work at keeping a proper electrolyte balance. The prednisone as a side effect retains water and that might be one reason he felt better as well as for a short time everyone feels better on prednisone.
At 93 he is going to have problems; but a good patient
specialist might make every thing more comfortable for
him.

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score 1 · Answer 2

Mary, I will tell you a funny story. So, mom got admitted to the hospital with the aforementioed high bp. They admitted her to neuro, sure that it was a stroke. Then they discovered the sodium/potassium imbalance.

Because these were neurologists, they really had no idea how to treat. One person came in with 5 bottles of water and told my mother to drink them all. The next doc came in and told her she needed to have less salt in her diet and took away the water.

I finally asked for a consult from Internal Medicine because it was clear the neuros had no clue...

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score 0 · Answer 3

You're dad may suffer from hyponatremia, too little sodium in the blood which could cause sudden mental status change. Sodium is an electrolyte, not a hormone. Listen to the doctor.

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score 2 · Answer 4

Marydys, you don't necessarily have to wait until rehab is through.   If he's mobile enough, and it's safe, take him to an endocrinologist before he leaves rehab.

There are advantages to this, including the fact that if the endo prescribes any vitamins or something else, he'll be in a facility where nurses can monitor reactions.

But I wouldn't rely on a rehab doctor who didn't seem to be aware of the potential benefit from an endocrinologist.    If you're in good standing with the nurses, talk to the DON; she/he and the nurses would be able to monitor on a more regular basis than the rehab doctor. In my experience those doctors aren't on site as regularly as are the nurses.

You could also ask if the endo would be willing to be consulted while your father is still in rehab.   I did that a few times, and it was well worth it.

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score 1 · Answer 5

Actually what I'm learning is that if you have this hormonal imbalance and drink water thinking it's dehydration, you then lose too much salt and become confused etc. I am pretty sure that's what is wrong. He isn't dehydrated at the present time (he was on an IV) but he still loses salt and his BP goes down and he gets confused. So what I've learned now is that all the pushing I did to get him to drink water for his BP was probably the wrong thing to do. Maybe an electrolyte drink would have helped but his issue has something to do with hormone in the adrenal glands OR it's something to do in his brain called salt wasting syndrome. Either is possible with my dad and who knows, it could be both? I'm just wondering if it's worth getting a dx and if there is a better treatment if we knew the dx... so I will ask my endrocrinolgist what she thinks. At this point dad is so old and so frail that I'm not sure we can treat anything but symptoms...

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score 0 · Answer 6

Salt stimulates thirst. The symptoms you describe are a sign of dehydration or electolyte imbalance. Ask the dr about that.

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score 1 · Answer 7

Aha! Endocrinologist it is! As soon as he's out of rehab and I'm able to take him somewhere, I'll take him to my own endrocrinologist and ask her how to figure out if this is the right med for him. It seems it's a hormonal thing based on what Barb said above and the fact that steroids work so well for him. I'd just like a diagnosis because the lack of a diagnosis is probably why the hospital took him off these meds and let him get so bad in the first place. If they knew he wasn't producing a hormone and I could have given them a dx, I bet he'd have recovered more quickly. Instead I had to fight like hell to get them to talk to his cardiologist and get him back on the steroid he had been taking for a year.

I just didn't know what type of specialist to ask nor whether getting a dx would give us more tools (better meds) to give him.

Thanks!

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score 1 · Answer 8

I was going to say diuretics too. Low Potassium will cause them to be a little out there. My Dad went into depression.

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score 1 · Answer 9

I'd go with BarbB's suggestions, especially that of consulting an endocrinologist.

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score 1 · Answer 10

Mary, I used to know I was about to get my period when I would find myself wolfing down a bag of salty chips.

My mom's sodium and potassium got out of whack once; her bp went up to 220 over 180. They never figured out what caused it but we were told that a nephrologist or endocrinologist was the sort of doc who follows this sort of thing.

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score 2 · Answer 11

I can tell you what my mother's cardiologist told me.

My mom also craved salt; and she had never before had that craving. In fact, from the time I was very young, we followed a low salt diet, because my dad had hypertension and his doctor told him to avoid salt. But when the CHF got really bad with my mom, she really, really started to crave salt.

I asked her doctor why that was. He said, since the CHF makes her heart beat so weakly, the body's "instinct" is that the heart is beating weakly because you're going into shock from a loss of blood. To make more blood, the body needs water; salt helps the body retain water. Hence, the salt craving. But because salt makes a body retain water, if you have CHF, then ingesting too much salt makes fluid retention even more tenacious.

If your dad is taking any sort of diuretics, that can explain his very low potassium. The doctor can prescribe a supplement. Every time my mom was admitted into the hospital for IV Lasix, one of the medications they gave her was a potassium pill, since diuretics will strip a body of potassium.

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He doesn't have CHF nor is he on diuretics.. he doesn't retain water or have edema. But I know salt makes him feel better and intuitively he chose to start salting everything. But it is interesting that our bodies know what we need, isn't it?

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score 1 · Answer 12

Here is an interesting read:

https://www.yourhormones.info/hormones/aldosterone/

The answer is "it's complicated" but it is the kidneys and adrenals that mediate this stufff.

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Salt and potassium question. Should I pursue a specialist to find out why this is happening?

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