"Sodium dumping"

HeatherBLocklear

Hey all,

Can anyone tell me what sodium dumping refers to? I'm having my final AC tomorrow, and am terrified of the kidney freeze I've had the last three times. Someone suggested it might be due to what she called "sodium dumping," but I've been unable to get any information on the phenomenon. Any help would be much appreciated.

Hugs to all,

Annie Cold Sweat

otter

Annie, someone else will need to explain "sodium dumping."  I've had quite a bit of physiology coursework, but I've never heard the term before.  (I hadn't heard of "kidney freeze" either, though.)

I googled "sodium dumping", and half the hits were about toxic waste sites where sodium had been dumped.  I decided those probably weren't relevant.

The other hits dealt with kidney function, so they were relevant but I couldn't make sense of them.  It sounds like "sodium dumping" is a phrase used for the net loss of sodium through the kidney tubules.  That doesn't explain anything.  The web sites that I found weren't useful because they were mostly medical students' notes posted on the internet:  sketchy, thin, missing most of the context.  Not helpful.

I am so sorry you're been having this recurring problem, Annie.  Tomorrow is your last AC.  Maybe this one will be the one where nothing really bad happens.  I don't understand why your docs haven't figured this out for you.

Hugs...

otter 

AnnNYC

Annie,

I can't speak from experience, and I couldn't find much googling "sodium dumping."

"Excessive sodium secretion" turned up a lot of information. 

It seems "excessive sodium secretion" has a lot of causes, including simply "chemotherapy." 

Another cause is "syndrome of inappropriate secretion of antidiuretic hormone" or SIADH. For some reason -- perhaps because of low blood volume, perhaps because of overfilling with IV fluids that are too low in electrolytes, or a number of other causes -- the body releases more antidiuretic hormone (ADH, also called vasopressin) than it should.  This hormone tells the kidneys NOT to make urine -- could be called "kidney freeze", I think.

I think Otter has a much firmer grasp of the feedback cycle involved here -- and how it might be going awry.  The condition "SIADH" is all about a distorted feedback cycle, ending up with not being able to urinate and not having enough sodium in your bloodstream.

But have you spoken to your oncologist about this?  I would think a doctor should be reviewing with you the fact that this has happened with every AC treatment, and either should have a suggestion about how to prevent it, or arrange to keep you right there afterward for monitoring and for whatever follow-up treatment got you urinating when you had to go to the ER the other times.

From http://www.emedicine.com/emerg/byname/syndrome-of-inappropriate-antidiuretic-hormone-secretion.htm :

"The serum sodium concentration is normally regulated by the balance of water intake, renal excretion of sodium, and ADH-mediated water conservation by the distal renal tubule. These processes are mediated by stimulation of thirst, secretion of ADH, feedback mechanisms of the renin-angiotensin-aldosterone system, and variation of renal handling of filtered sodium. Disorders in any one of these components of sodium balance can result in hyponatremia [low sodium in the blood (serum)].

"ADH is secreted by the posterior pituitary gland. Its effect in the kidney is mediated via the vasopressin V2 receptor on the basolateral surface of the principal cells of the collecting duct, cyclic AMP, protein kinase A, and a molecular dynein motor. The key action of ADH in the kidney is the insertion of water channels into the principal cells of the collecting duct, thus increasing the permeability of water. These channels include aquaporin-2, which is located at the apical membrane, and aquaporin-3, which is located at the basolateral membrane. These channels allow free water to be reabsorbed from the collecting duct within the hypertonic renal medulla. In SIADH, the inappropriately elevated level of vasopressin enhances the reabsorption of water, thereby leading to production of concentrated urine, inability to excrete water, and consequently hyponatremia."

I'm way out of my league here, and the info I've quoted may not be relevant -- but I really think the oncologist prescribing the AC should be available to review with you what has happened with your kidneys at each of the previous 3 treatments, and also review your recent lab tests showing low serum sodium and potassium.

AnnNYC

P.S.  I see Otter posted -- all I found for "sodium dumping" was about toxic waste sites, too.

Otter, do you have any thoughts on what I posted?

Annie, among the possible causes for hyponatremia (according to this site) is too much intake (either by IV or by mouth) of fluid/water that does NOT have enough sodium.  Therefore, among the treatments listed for hyponatremia are IV of normal saline solution (or salt pills, for people with a chronic condition).  I don't think it could hurt if you drink Gatorade or Pedialyte rather than plain water tomorrow.  However, I have no idea whether it would be enough to help. 

Is DH or someone taking you to chemo?  I really hope a doctor can discuss the sodium/urination questions before your treatment.

AlaskaDeb

I had the "I can't PEEEE" problem with one of my A/C chemo treatments.  Since we had to run my drugs really slow, I knew there was a problem even before the chemo was finished.  My doc had blood drawn and checked for potassium, calcium and some other things.  For whatever reason, my body was spilling both those things and electrolytes like mad.  They stopped my chemo, gave me a bag of some kind of fluid with all the things I was loosing too much of, and within 2 hours I was peeing like the proverbial race horse and we finished my chemo.

 The doc said that is a cascade of problems that is usually started by being dehydrated before the chemo starts.  From then on I always drank 2 big things of Gatorade before each treatment and I never had the problem again.

Don't know if that helps, but I would talk to your doc and see what they can do to keep from having your poor kidneys freeze up....NOT fun.

Deb C 

otter

Ann and Deb C, I think you've hit on the answer.  I have to admit that I don't understand much of what's in the text Ann quoted, but this statement makes sense:

"In SIADH, the inappropriately elevated level of vasopressin enhances the reabsorption of water, thereby leading to production of concentrated urine, inability to excrete water, and consequently hyponatremia."

It sounds really paradoxical that the urine would be concentrated but low-sodium fluids would be retained in the body.  The feedback loops for sodium, potassium, and H2O maintenance are really complicated, though.  I even found them confusing when I was in school and somebody was grading my ability to make sense of them.

Deb C's remedy (infusion of a normal saline or electrolyte solution) is an easy fix.  I was given extra fluids (normal saline) during my first chemo infusion, but for the next 2 they cut way back and only gave me enough to keep my i.v. lines clear.  I had some peculiar SE's during the 3rd round that suggested maybe my kidneys were not behaving normally, so I reported that to my onco's nurse.

I had been drinking lots of extra fluids during the day before, day of, and week after, my chemo infusions, so I didn't think I was dehydrated.  However, for my last chemo infusion, they ran a whole bag of normal saline before they even started the chemo drugs.  The chemo nurse said that change had been ordered by my onco to see if it reduced the weird SE's I'd had.   I produced a lot more urine during and after that infusion, and I felt a lot better. 

It's amazing how much our fluid & electrolyte levels can affect how we feel.  Annie, I hope your onco got on top of the problem this time, and your post-infusion renal function is improved this time.  Please let us know.

otter

Shirlann

bump

AnnNYC

Annie -- how are you doing?????

AnnNYC

Hi Annie,

Hope you're home okay after last AC.

HeatherBLocklear

Hi all,

First, this will be brief since I'm still feeling pretty punk. However, I want to thank everyone who gave such sterling advice and great wisdom. I don't think my oncologist has really understood yet what was going on (in spite of my having printed out the article above and brought it to him -- he says this is a phenomenon one sees only in terminally ill cancer patients!). He keeps maintaining it's the Decadron (turns out they give me a minimal dose last time too, even though they'd sworn they wouldn't).

In any case, this time I took Deb's advice and brought along two huge bottles of Gatorade that I chugged during infusion. As soon as I got home and started bloating again, I took 50 mg of Lasix (prescribed for DH). Those two things together cleared up the problem within a few hours, and I was able to avoid the ER.

However, it is extremely frustrating to deal with physicans who simply WILL NOT BELIEVE their patients. I like my doctor and think he's pretty good overall, but this whole scenario has made me decide that if I need more chemo, either after surgery or in the future, I will seek out a different medical team.

Again, thanks to all for caring so much about someone who really doesn't pull her weight on these boards. I will step up to the plate and become a heck of a lot more active when I'm completely over the chemo and the surgery part. I'm just so darned exhausted right now, especially with the teaching on top of everything else. 

Love to all,

Annie

otter

Annie, good move to try the Gatorade/Lasix combo.  I'll bet that's exactly what your onco would have done, if he'd been paying attention.  (Well, maybe not the Gatorade--I'm sure he would have infused some high-octane, $$$ electrolyte solution instead.)

Do keep watch on the nausea again, though.  I've only had an electrolyte imbalance a couple of times, but I got a pounding headache and/or queasy stomach because of it.

But, don't feel guilty about not reading or posting very much.  I think we all understand the exhaustion--Sueper13 called it "being dog-ass tired."  I've been scarce here, since finishing chemo and starting on Arimidex.  I don't have all the SE's other women are getting from their AI drugs, so I don't have much to add to those discussions.  I still hang out on a few of the chemo threads, even though I feel like an interloper sometimes.  (My baldness is slowly being replaced by peach fuzz, but my eyelashes and eyebrows continue to disappear, so I guess I still qualify as chemo-challenged.) 

It's good to hear from you, and it's good to hear that you may have escaped the fluid/electrolyte difficulties you had with your first 3 tx's.

Hugs,

otter 

ICanDoThis

Annie - DON'T YOU DARE SAY YOU DON'T CARRY YOUR WEIGHT!

Your posts always mean a lot to me, as does your story and your recovery. 

Right now, your top priority is taking care of you.

{{{{{Hugs}}}}}}}

AlaskaDeb

Hey Annie -

I am so glad to hear you are doing well in spite of a not-so-bright medical team!  I'm just glad you took the bull by the horns and did what you needed to do to protect YOU!

Please don't feel like this board is some kind of math equation.  You contribute plenty. 

One of the things that is important here is that people ask good questions, which you always do.  Look at how many people read a thread.  A lot of those people read but don't post.  Who knows how many people have the same problem you did, searched for the answer and found it because the thread is already here. 

   I had a good friend say something very profound to me a few months ago.  Her husband has stage 4 cancer and she told me that is is hard to be supportive when you are having trouble staying above water yourself....So Rest, heal and take care of yourself.  There is plenty of time for you to be more active on the boards later.

Big Hugs

Deb C

AnnNYC

Annie,

I'm so glad you're doing okay.

PULLING YOUR WEIGHT??!!!  Are you kidding?  I agree with all of the above responses to that concept!!!  That nobody "needs to" -- and that in any case, you DO!!!  More than you know.

Rest up!

And -- hurray!!! -- you're done with chemo!

Love,

Ann

TenderIsOurMight

Eat a couple of bananas for me, Annie, since the Lasix flushes out potassium too. 

 

Great news you avoided the dreaded ER, and even greater news like Ann said: Hurrah! You're done with chemo!

 

Now those tastebuds can re-awaken.

 

Best to you and yours,

Tender 

leaf

For what its worth, my friend with pancreatic cancer (otherwise quite healthy) has had a very low blood sodium level pretty much since her chemo started (mainly Gemzar). (She's still walking, driving, etc.) They had her eating as much salt as possible, TV dinners, broth, etc. I don't think she's gotten up to a normal sodium level (after several months).

I'd ask your onc about it.  In *some* instances, when people *aren't* doing chemo, they do water restriction.

I never understood electrolyte stuff with the kidneys very well. 

I look forward to reading EVERY post you write, Annie. 

Shirlann

Annie, for goodness sake, I love to read your posts.  You are funny, sweet, and kind.  Don't you ever say you don't pull your weight.  You are a treasure to all of us.

Leaf, you too.  I love to read your posts.

And our precious Alaska Deb, how you doin?  I hope well.  I love to see you too.  We have all become very dear to each other.

Hugs, Shirlann