A 60-year-old man Maneesh (name changed), was rushed to the emergency room in an unconscious state. Astonishingly, he had been perfectly fine the previous night. Given his history of blood pressure medication, doctors were prompted to consider an alternative diagnosis, eagerly awaiting the results of a specific blood test.
The subsequent report confirmed the doctor’s suspicions, revealing an alarming drop in Mr. Maneesh’s blood sodium levels. His sodium concentration had plummeted to 105 (normal range is 135-145). This marked a severe case of hyponatremia, a condition characterised by a dangerously low sodium concentration in the blood, said Dr. Sudhir Kumar, a neurologist at Apollo Hospitals Jubilee Hills who attended to the patient.
“Upon investigating the potential causes of this condition with the patient’s son, we learned that he had significantly reduced his salt intake. Influenced by advice from friends who warned against salt consumption due to its impact on blood pressure, Mr. Maneesh’s family physician had also advised the same,” said Dr. Sudhir.
The main factors contributing to the dangerous drop in sodium levels were identified as insufficient salt intake and the loss of salt through urine, stemming from the use of blood pressure medication, specifically hydrochlorothiazide.
According to a recent report from the Indian Council of Medical Research (ICMR), the daily salt intake in India averages eight grams, with disparities observed among men (8.9 grams/day) and women (7.1 grams/day). These values surpass the World Health Organisation’s (WHO) recommendation of a daily salt intake of up to five grams. The study also revealed higher salt consumption among men, residents in rural areas, and individuals who were overweight or obese.
Mr. Maneesh’s treatment involved a 3% saline infusion, which resulted in a gradual recovery over the following 48 hours. He was successfully removed from the ventilator, and by the fourth day, he had returned to his normal state and was discharged to his home. Dr. Sudhir advised Mr. Maneesh to maintain a regular salt intake in his diet and made adjustments to his blood pressure medications. “Most people with high BP need to consume normal salt as part of their diet,” he added.
“The intake of five grams salt per day need not necessarily be from a single source as we consume salt in many forms. The water we drink also contains sodium. Another thing to be focussed on is the fortification of salt in India. This is done to tackle deficiency of iron and iodine among all age groups. Double fortified salt (DFS) is a form of table salt manufactured with added iron and iodine. The iron and iodine can be consumed from some other source,” said Dr Kiran Madala, Scientific Committee member to IMA Telangana.
