From the Guidelines
Yes, vomiting can cause low sodium levels (hyponatremia) in the body. When you vomit repeatedly, you lose not only stomach contents but also electrolytes, including sodium. Additionally, vomiting causes the loss of hydrochloric acid from the stomach, which can lead to metabolic alkalosis and further sodium depletion as the kidneys try to compensate. The body may also release antidiuretic hormone (ADH) in response to volume depletion from vomiting, causing water retention that dilutes the remaining sodium. Severe or prolonged vomiting is particularly concerning for sodium depletion. If you're experiencing persistent vomiting, it's essential to seek medical attention, especially if you develop symptoms like confusion, headache, muscle weakness, or seizures, which can indicate dangerously low sodium levels.
Causes of Hyponatremia in Vomiting
- Loss of sodium and hydrochloric acid from the stomach
- Metabolic alkalosis leading to further sodium depletion
- Release of antidiuretic hormone (ADH) causing water retention and dilution of sodium
- Volume depletion from vomiting leading to hypovolemic hyponatremia
Treatment of Hyponatremia
- Addressing the underlying cause of vomiting
- Carefully replacing fluids and electrolytes
- Sometimes requiring intravenous solutions in severe cases
- According to the 2018 EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1, treatment of hypovolemic hyponatremia consists of administration of sodium together with identification of the causative factor.
Important Considerations
- Severe or prolonged vomiting is particularly concerning for sodium depletion
- Symptoms like confusion, headache, muscle weakness, or seizures can indicate dangerously low sodium levels
- Treatment should be started in the hospital with close clinical monitoring and assessment of serum sodium levels, to avoid increases of serum sodium of more than 8–10 mmol/L/day, as recommended by the 2010 EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis 1.
Note: The most recent and highest quality study relevant to the question is the 2018 EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1, which provides guidance on the management of hyponatremia. However, other studies, such as the 2017 IDSA guidelines for the diagnosis and management of infectious diarrhea 1 and the 2010 EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis 1, also provide relevant information on the topic.
From the Research
Causes of Hyponatremia
- Hyponatremia can be caused by various factors, including certain medications, excessive alcohol consumption, very low-salt diets, and excessive free water intake during exercise 2
- It can also be classified into four categories: pseudohyponatremia, hypovolemic, hypervolemic, and euvolemic hyponatremia, based on overall patient fluid status 3
- Hypovolemic hyponatremia can be caused by fluid loss due to diarrhea, vomiting, or other gastrointestinal fluid losses 4
Relationship between Vomiting and Hyponatremia
- Vomiting can lead to hypovolemic hyponatremia, which is characterized by a low sodium concentration and decreased fluid volume 3, 4
- The treatment for hypovolemic hyponatremia includes infusion of isotonic fluid to replenish lost fluids and electrolytes 4
- It is essential to identify the underlying cause of hyponatremia and treat it accordingly to prevent further complications 2, 5
Symptoms and Treatment of Hyponatremia
- Symptoms of hyponatremia can range from mild and nonspecific, such as weakness or nausea, to severe and life-threatening, such as seizures or coma 2, 5
- Treatment of hyponatremia depends on the severity and underlying cause, and may include fluid restriction, hypertonic saline, or vaptans 2, 3, 5
- Severely symptomatic hyponatremia requires urgent treatment with bolus hypertonic saline to reverse hyponatremic encephalopathy 5