Can I raise my low sodium levels by adding salt to my drinking water, considering I already have a regular sodium diet and liberally salt my food?

Adding Salt to Water for Low Sodium Levels

Simply adding salt to drinking water is generally ineffective and potentially counterproductive for raising low sodium levels in most clinical situations, because plain water (even with added salt) can paradoxically worsen sodium depletion by increasing fluid losses in certain conditions.

Understanding the Physiology

The effectiveness of adding salt to water depends critically on why your sodium is low and your underlying gastrointestinal anatomy:

• In normal individuals with intact intestines: Sodium from food and beverages is almost completely absorbed by the intestine, and circulating sodium is filtered by the kidneys with approximately 99% reabsorbed by renal tubules 1, 2
• The problem with plain water: Hypotonic fluids (water, tea, coffee) can actually stimulate fluid secretion or increase sodium and fluid influx into the intestinal lumen, potentially worsening losses rather than helping 3

The Critical Distinction: Concentration Matters

For sodium absorption to be optimized, you need the right concentration of sodium WITH glucose, not just salt in water:

• Maximal sodium absorption occurs with 120 mmol/L (2,760 mg/L) of sodium chloride combined with 30 mmol/L (540 mg) of glucose 3
• This is the principle behind oral rehydration solutions (ORS), which are specifically formulated to optimize sodium and water absorption 3
• Simply adding table salt to water without glucose creates a suboptimal solution that may not be effectively absorbed 3

When Salt in Water Might Help vs. Harm

Situations Where It Could Help (with caveats):

Patients with short bowel syndrome or high ostomy output:

• Should use salt liberally on food and snacks, with some tolerating sodium chloride capsules up to 7 g/24 hours 3
• However, even these patients should restrict plain oral fluids and instead use properly formulated isotonic high-sodium oral rehydration solutions 3

Patients with stomal losses <1,200 mL daily:

• Can usually maintain sodium balance by adding extra salt to food 3

Situations Where It Will Likely Harm:

Patients with high-output jejunostomy or net-secretion:

• Should limit oral intake of hypotonic fluids (including water with inadequate salt concentration) as this can increase output and worsen sodium losses 3
• Plain water or inadequately concentrated salt water can stimulate fluid secretion due to epithelial leakiness 3

What You Should Do Instead

Step 1: Identify the Cause of Low Sodium

• Excessive losses (vomiting, diarrhea, high ostomy output, excessive sweating) 1
• Inadequate intake (rare in developed countries) 2
• Renal or cardiac dysfunction causing retention issues 1
• Medication effects 3

Step 2: Choose the Right Intervention

If you have normal gastrointestinal anatomy:

• Continue liberally salting your food as you're already doing 3
• Normal salt intake ranges from 5-15 grams daily, most of which is excreted by the kidneys 1
• Ensure adequate overall fluid intake, but don't rely on salt-in-water alone 2

If you have gastrointestinal losses or borderline dehydration:

• Use a properly formulated oral rehydration solution with sodium concentration of 90-120 mmol/L (approximately 2,070-2,760 mg/L) plus glucose 3
• Commercial ORS formulas are available and superior to homemade salt water 3
• Sip these solutions in small quantities throughout the day (cold with flavoring may improve palatability) 3

If you have specific medical conditions:

• Patients with heart failure, cirrhosis, or kidney disease may need restricted sodium intake, not increased 1
• Consult your physician before increasing sodium intake if you have cardiovascular, hepatic, or renal disease 1

Common Pitfalls to Avoid

• Don't assume more water intake helps: Excessive hypotonic fluid intake can worsen sodium depletion by dilution and increased losses 3
• Don't use plain salt water without glucose: The sodium won't be optimally absorbed without the glucose co-transporter mechanism 3
• Don't ignore underlying causes: Low sodium often reflects a medical condition requiring specific treatment, not just dietary adjustment 1
• Watch for signs of sodium excess: Edema, weakness, disorientation, and signs resembling congestive heart failure can occur with excessive sodium administration, especially in patients with impaired renal or cardiac function 1

Bottom Line Algorithm

1. If you have normal intestinal anatomy and no cardiac/renal disease: Continue liberally salting food (which you're already doing), ensure adequate but not excessive fluid intake, and investigate why your sodium is low 3, 1, 2

2. If you have gastrointestinal losses: Use commercial oral rehydration solution (not homemade salt water) with 90-120 mmol/L sodium plus glucose 3

3. If you have cardiac, renal, or liver disease: Consult your physician before increasing sodium, as you may need restriction rather than supplementation 1

4. Never rely on plain water with added salt alone: This is physiologically suboptimal and may worsen the problem 3