Water restriction discomfort on spironalactone & bumetanide for hf

[CarerEdi]

Hi folks, 88yo mum is on 12,5 mg spiro & 1 mg bumetanide to keep fluid down from diastolic heart failure. She's on water restriction, sodium was 129 last week but is finding this very hard. She's waking up with a dull ache on both sides and very little wee in the morning. Has been told 1,500 ml water per day including tea. How are others managing?!

She even temporarily stopped spiro for 2 weeks before the 129 sodium result. Lowest ever sodium was 123 but that was when A&E gave her 3mg a day bumetanide before her first cardiology appt

[bluemoon572]

1500 cc a day fluid intake allowance appears reasonable. In cases of such severe hyponatremia, the mechanism causing it needs to be identified and treated. Are her diuretics causing an imbalance between urinary sodium excretion out of proportion to water excretion? Is this the best combination of diuretics for her? An endocrinologist could collaborate with her prescribing physician or cardiologist.

[CarerEdi in reply to bluemoon572]

That sounds sensible. We'll try to get a referral, we're just going through the cardiology nurse, her GP doesn't feel that she can manage the complexity of the case and says all referrals have to be done through the cardiac nurse. There's an appointment tomorrow so we'll have another chat with her and try to get to the bottom of it.

[Dollcollector]

I am the same age as your mum and have also got heart failure. I am also on the same amount of bumetanide and the spironolactone has been doubled to 25 mg. I never used to put salt on my food but now put a little. I have chronic kidney disease which goes with heart failure. I take mypills at 7.a.m after my breakfast and have to keep going for a wee for the next 6 hours. In the afternoon and evening l will get an ache in my tummy when l want a wee rather than the usual feeling. I was told l could have one and a half litres to 2 litres of liquid in 24 hours. I drink 2 pints of water , l suppose that is about 1 litre, 1 mug of tea, 1 herbal drink, and 1 ovaltine. Also 1 very small orange juice. I eat a lot of fruit and veg. And of course there is liquid in food. Tea is a diuretic, l would limit that. It looks as if the spironolactone and bumetanide aren't working as they should. Is she drinking enough water. It is important to keep hydrated. What does the g.p. say about it?

[Deejay62]

Hi I’m on 25 mg spironolactone and 2 twice a day 1mg Bumetanide for severe heart failure. My sodium has never been low. My latest blood test was 140. I also take Dapagliflozin, Entresto and Bisoprolol and other meds. My kidney function is 39. Most times I have to tell my self to pee but that’s mainly in the afternoon. In the mornings I go regularly.

[CarerEdi]

Thanks both, useful to know not everyone is gets low sodium on the spiro/butenamide combo.

[CarerEdi in reply to CarerEdi]

GP hasn't been helpful and puts no further action on all her tests even when they are out of range :-(. Cardiac nurse is generally good though xx

[Lezzers in reply to CarerEdi]

Hi Edi

A lot of GP's put 'no further action' on abnormal test results. I don't know why they do this but my husband's bloods have been abnormal for absolutely years and 2 different surgeries have done this.

Over the years we've come to realise that if further action is required (despite what they've written on the results!) you will hear from the Dr to either re-take bloods/discuss, depending on what was abnormal/levels etc. However, all the results need to be read as a whole so, although there may be some that are abnormal they're probably not an issue. I hope that makes sense?? If in doubt perhaps phone the GP and ask to go through them or maybe ask the nurse.

Good luck

[CarerEdi in reply to Lezzers]

Yes, that makes sense. A bit new to all this, and to be fair to the GP it isn't clear why her sodium keeps going low, so it is a complex case.

[Lezzers in reply to CarerEdi]

I did ask my husband's nurse if she could explain to me how they read the results & was told it's too complicated!! I'm afraid I don't know anything about sodium issues so can't help there. I hope they're able to find what's causing the issues for your mum before too long.

[Blackknight57]

1500 is a minimum. That’s 6 mugs of drink.

[CarerEdi]

Yes, especially in this weather...she's cut her beloved tea down to 1 and a half mugs a day, rest water including soup but is often getting too thirsty and needing to go up to 2,000.

[Happydayz17]

My 84 year old father had the same problem with the sodium. It's a real balancing act with the diuretics and fluid. He began to have difficulty urinating for months which was the fluid restriction making him dehydrated. Dad was on Spiro too but it didn't really work for him. He's been on Bumetanide and is now on Furesomide. The side effect for your mum could also be other medications. For example the blood pressure tablet Ramipril can also cause low sodium. When that was stopped, the sodium went up.