Low Sodium

[Phed]

Yesterday I had my usual blood test as I’m on methotrexate, today I had a phone call from the Doctors Surgery to say they have made me a Doctors Appointment for tomorrow as they needed to see me urgently as apparently it showed I have low sodium levels which was fine on my last blood test in September, is this something that methotrexate can cause as it’s the only new medication I have taken since I developed GCA 2018 and PMR in 2021, I started taking methotrexate in March 2022.

[SnazzyD]

what dose of Pred are you on and how do you feel generally?

[Phed in reply to SnazzyD]

Thank you for your reply. I’m on 5mg of Prednisolone due to cut down to 4mg on Sunday. I feel extremely tired I seem to have gone from having trouble sleeping a few weeks ago to sleeping a lot in the evening and still managing a good 7 hours sleep once I’ve gone to bed, more confused than normal (which I put down to get old😂) and swollen ankles despite not being on my feet much of the day mainly because I have no energy to do anything.

[PMRpro Ambassador in reply to Phed]

Don't reduce any further - go up a bit if anything. An adrenal crisis is NOT a good look! And tell the doc all that when you go.

[PMRpro Ambassador]

How low - did they say? Do you feel OK?

Methotrexate CAN cause low sodium but most MTX side effects like that are usually when it is used in chemotherapy for cancer. Rheumatology doses are much lower.

[Phed in reply to PMRpro]

Thank you for your reply, they didn’t say how low when they rang today so I will ask them when I go to see them tomorrow, she just kept saying we need to see you urgently, she did say today originally but I had just picked up a friend to go out for the day so she reluctantly said ok tomorrow then. I seem to be extremely tired, confused and swollen ankles despite not being on my feet all day. I’m on 20mg of Methotrexate and 5mg of Prednisolone.

[PMRpro Ambassador in reply to Phed]

Ah - the combo probably - low sodium is a sign of adrenal insufficiency too, as are the other symptoms, and that is not unlikely at the dose you are at. It might be a good idea to take an extra dose of pred now.

Those are signs you should always be on the look out for. If you get worse - call 999. Paramedics can give you an injection of hydrocortisone if you tell them you are a longterm pred patient now on a low dose. It is all very well using MTX - return of adrenal function is your limiting factor now.

[SnazzyD in reply to Phed]

like PMRPro I’m wondering about poor adrenal function which is why I asked about your dose. Low sodium is one symptom which isn’t good and someone needs to address this. Sometimes in the rush to get people down the Pred ladder with Methotrexate etc, the risk of adrenal crisis is forgotten. Your symptoms sound like you are teetering on the edge of a crisis which can be serious. If you start to feel any worse, nauseated, abdominal cramps or diarrhoea, call for urgent help. I don’t like the confusion either, especially if it is recent.

Have a read of this

medlineplus.gov/ency/articl...

[Phed in reply to PMRpro]

Sorry I should also of added lack of energy.

[Phed in reply to PMRpro]

I had my appointment with Doctors this afternoon, apparently my sodium blood result was 127, complete checked out blood pressure, heart, ect, and remarked how well I looked, she has changed my Omeprazole to Famotidine 40mg as she thinks as I went up to 20mg of Methotrexate in October just after a blood test and now it’s show’s low sodium at the blood test on Monday she thinks that could be contributing to low sodium levels now so I have to have another blood test on Monday.

[PMRpro Ambassador in reply to Phed]

That isn't too horrendous - my husband lived with a level like that for years!!! And he ate loads of salty food.

[Phed in reply to PMRpro]

I will admit I didn’t think it sounded to bad.

[PMRpro Ambassador in reply to Phed]

How you feel is more significant - and you weren't too bad were you

[Phed in reply to PMRpro]

Apart from feeling tired I feel fine which is the main thing.

[PMRpro Ambassador in reply to Phed]

Wouldn't it be nice not to feel tired!!!!

[Phed in reply to PMRpro]

Definitely

[nallufl24 in reply to Phed]

I had a low sodium of 127 when I was first diagnosed with GCA. No one knew why. I was hospitalized and they would not release me til it went up to 130. It was awful because I was on 60 mg prednisone and they kept giving food with a lot of salt. Plus they restricted my water intake. When I was released I had to keep eating a lot of salt and drank only 32 oz of water a day. It took several months but eventually the sodium stabilized. That was over a year ago. Have no idea why that happened

[Phed in reply to nallufl24]

Gosh I’m glad I wasn’t hospitalised, I developed GCA August 2019 and PMR March 2021, my blood tests have been fine since taking methotrexate in March 2022 I had to increased the dosage in August 2022 to 20mg the low sodium showed up on my blood test Monday which is what is making the doctor think it could be something to do with the increasing of methotrexate and omeprazole.

[Elephants2019]

I do not know if this will help, but I was diagnosed with SIADH(low sodium), and doctor has me limit what I drink to 48oz a day. She told me it could take up to a year for my metabolism normalize, and one of the side effects I had was water retention. I salt all my foods now,too.

[Phed in reply to Elephants2019]

Thank you for your reply. I spoke to my rheumatologist this morning (I thought I would seek their advice before going up for Doctors appointment this afternoon) they checked my blood results and my sodium level was 127 also my CPR has gone up slightly since my last blood test 2 months ago, I will admit I have swollen ankles now which is new for me, I don’t drink a lot during the probably about 5/6 cups of tea, coffee or water, I will admit I never use salt on my food so maybe that will be worth me doing now.

[Myfoe]

I have been on methotrexate injections about 8 weeks my sodium levels are low as well just outside “normal” I just attributed it to my “no appetite diet” interesting let us know how it goes please

[Phed in reply to Myfoe]

I had my check up at the doctors this afternoon , very thorough everything came out good and she even said how well I looked. I went up to 20mg of methotrexate in October and she thinks it could be to do with that and the omeprazole as it has only changed since increasing Methotrexate, they want to do another blood test Monday, I guess it’s a question of just trying to see if it is that.