A patient I was following had a sodium level of 132 mEq/L and a student asked me how much we should worry about this? It is a bit of a deep question, but in general, a slightly low sodium level of 132 is not going to be a life-threatening situation. Here are some of the things that I think about when dealing with labs that are slightly low.
Symptoms are important. If there are new clinical concerns for symptoms of hyponatremia, I would be a little more concerned. With a level of 132, I would guess that in most situations the patient will have no symptoms. Symptoms of hyponatremia might include fatigue, confusion, headache, vomiting, or worsening mental status. Seizures and more severe reactions are generally limited to very significantly low sodium levels.
The context of the low sodium is important. Was the previous sodium level in the low 140s? If this were the case, I’d be slightly more concerned that we have a significant downward trend. If the last sodium levels were in the 130-135 range for the last 5 years and the patient is asymptomatic, there is less need for an urgent recheck. If this is a new dip in the sodium, most will do a follow-up lab in the next few weeks, or maybe up to a month or two, and also provide education to the patient about alarm symptoms to look out for.
As a pharmacist, I’m always looking for reasons to get rid of medications. SSRIs and carbamazepine are two classic examples of medications that can cause SIADH and hyponatremia (excellent board exam question). If the benefits of these medications have not been very significant, then it would be a potential reason to get rid of them.
A sodium level of 132 mEq/L is considered mild hyponatremia, since normal sodium levels are typically around 135–145 mEq/L. In many cases, a sodium level of 132 is not an emergency, especially if the patient is feeling well, but it is still something that deserves attention and follow-up. In most cases, a sodium level will be rechecked, and the patient will be monitored for hyponatremia symptoms.
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