Could this be the cause of your irritability?
I often get a text from a stressed, overworked and overfull hospital Emergency Department seeking urgent assistance to work. Most of the time I am busy on my wellbeing mission – being the ambulance at the top of the cliff – so I can't oblige. This week, however, I had a few hours free so answered the call to help on a crazy busy weekday afternoon.
My first patient was very difficult, unusual and downright cantankerous. I am well used to that in the wee hours of Saturday or Sunday mornings but at 1pm on a Tuesday, it was a little more challenging and difficult to diagnose.
It would be easy to blame the behaviour on a number of things and a relatively minor presentation with an awkward personality. Given the patient's age, I ran a set of blood tests which weren't indicated for the pain presentation but more to check if there were other issues I was missing. Sure enough, the sodium level in the blood came back at 119 mmol/litre, which indicated a level far below the recommended 135mmol/litre. This man's recent blood tests were 139 mmol/litre so a drop of 20 was clinically significant and explained many things.
This condition is called hyponatraemia and symptoms include weakness, fatigue, headache, nausea, vomiting, muscle cramps, confusion and irritability. It can be caused by many things such as medication, low thyroid, drugs like ecstasy, and drinking way too much water. The red flag for me in this patient was his extreme irritability.
So as much as too much sodium and salt in our system can cause problems such as high blood pressure, so can low sodium cause issues. Before you go sprinkling salt on the food every cranky relative or workmate, you may want to get your own levels checked! There are a number of factors that determine symptoms such as how long it has taken the levels to drop. The shorter the time, normally the worse the symptoms and signs.
As I often point out in this column, unless you measure it you can't manage it. There are many other what we call electrolyte disorders, infection and medications that can cause delirium, confusion and irritability. That's our job as health professionals to try and find a cause and prescribe a cure. That's why we have machines, scanners and probes to do tests and get results. Often, we rule things out rather than find things. That's a job for your GP as well and they have access to many tests to try and solve problems using diagnostics. A simple urinary infection can cause all sorts of cognitive challenges.
Our bodies and brains are complex systems that are finely regulated and managed. Too much potassium and magnesium can cause problems such as dangerous heart rhythms, confusion and coma. When we are fit and healthy we can autoregulate and manage challenges like taking too many supplements or drinking too much water. For example, if you want to take a supplement, check that you are deficient in the first place.
I don't want to cause irritability in my overworked colleagues or confusion in the community but if someone has a change in personality or behaviour it may be due to a metabolic problem, not necessarily a social one. It may not be an emergency but it could become one if not diagnosed and treated to help you become well and good.
Written by Dr Tom Mulholland. Republished with permission of Stuff.co.nz.