From the Guidelines
Diarrhea can significantly lower sodium levels in the body through excessive fluid and electrolyte loss, leading to hyponatremia, especially in severe or prolonged cases. When diarrhea occurs, the intestines don't absorb water and electrolytes properly, causing large amounts of sodium to be expelled in watery stools. This rapid loss can lead to sodium depletion, and the body's normal sodium balance is disrupted. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, oral rehydration solutions (ORS) are recommended as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause.
The American Academy of Pediatrics recommends that oral solutions used for rehydration should contain 75-90 mEq/L of sodium 1. However, for the prevention of dehydration or maintenance of hydration status, solutions containing 40-60 mEq/L of sodium are recommended 1. To prevent dangerous sodium depletion during diarrhea, oral rehydration solutions like Pedialyte or homemade solutions should be consumed regularly. These solutions help replace both water and essential electrolytes.
Some key points to consider in managing diarrhea-related sodium loss include:
- Using low-osmolarity ORS, which can be given to all age groups with any cause of diarrhea, as it is safe in the presence of hypernatremia as well as hyponatremia (except when edema is present) 1
- Administering ORS according to the degree of dehydration, with specific recommendations for infants, children, and adults 1
- Replacing ongoing losses in stools with ORS until diarrhea and vomiting are resolved 1
- Considering intravenous rehydration in cases of severe dehydration, shock, or altered mental status, and failure of ORS therapy 1
In severe cases with signs of dehydration, such as dizziness, extreme thirst, and decreased urination, medical attention may be needed for IV fluid replacement. The underlying mechanism involves disruption of the sodium-potassium pump in intestinal cells, preventing proper absorption and leading to excessive sodium loss in stool.
From the Research
Effect of Diarrhea on Sodium Levels
- Diarrhea can lead to an imbalance of sodium levels in the body, resulting in either hypernatremia (high sodium levels) or hyponatremia (low sodium levels) 2, 3.
- The severity and type of diarrhea, as well as the patient's nutritional status and age, can influence the extent of sodium imbalance 3.
- In cases of acute diarrhea, oral rehydration solutions with sodium concentrations ranging from 50 to 90 mmol/L have been shown to be effective in correcting sodium imbalances and rehydrating patients 2, 3, 4.
Oral Rehydration Solutions and Sodium Levels
- Studies have compared the efficacy of oral rehydration solutions with different sodium concentrations, including 60 mmol/L and 90 mmol/L, in treating acute diarrhea 4.
- The results suggest that solutions with lower sodium concentrations (e.g., 60 mmol/L) may be as effective as those with higher concentrations (e.g., 90 mmol/L) in correcting sodium imbalances and rehydrating patients 4.
- Additionally, a low-sodium hypotonic oral rehydration solution (28 mmol/L) has been shown to be safe and effective in treating young children with acute gastroenteritis, without causing hyponatremia 5.
Sodium Diarrhea and Treatment
- Congenital sodium diarrhea is a rare condition characterized by high sodium levels in the stool, which can lead to hyponatremia and metabolic acidosis 6.
- Treatment of congenital sodium diarrhea involves oral rehydration with supplements of water and electrolytes lost in the fecal fluid, as well as medications to increase intestinal absorption of sodium 6.