Relationship between sodium and potassium

[dizzytizzy]

Hi all,

Can anyone explain the relationship between sodium and potassium? I've been instructed by my EP to consume 4000-6000mg of sodium each day, which I get will help to increase blood volume along with the extra water I'm drinking. I recently had a follow-up with him and asked if increasing my sodium intake would cause me to lose/waste potassium. I was thinking there was an inverse relationship where if you increase one, it decreases the other.

He said increasing my sodium intake would actually help my body hold on to potassium. I didn't dig any deeper into his response, but does that make sense to you all? I might need to email him for more details. In case it matters. I had been following a low sodium diet prior to diagnosis. 

[MomtoGiuliana]

My specialist also an EP told me the opposite.  He says too much salt will cause the kidneys to waste potassium.  He said it's a delicate balance and that I should not over-do salt.  It's hard to know what that means or what to do exactly.  But I try to maintain a high potassium diet and pay even more attention to that when in a flare and taking in additional salt.

[DizzyPopcorn]

Most sports drink have a 1:4 ratio of sodium:potassium. i.e : 400mg of potassium for each 100mg of sodium.

There are many studies out there comparing the ratios of electrolytes in healthy individuals and what's beneficial, but no real answer as everyone as a different idea of what's "healthy".

[MomtoGiuliana]

Most sports drinks are fairly low in potassium-- I am not sure this ratio you note is typically true.  When sweating, more sodium is lost than potassium which is why sodium is typically higher in sports drinks and potassium lower, from what I understand. When I am feeling poorly I drink coconut water which is far higher in potassium than sports drinks.  There are other rehydration drinks that are higher in potassium too.

[DizzyPopcorn]

Oh, yes the commercialy available drinks (like powerade and others) do have more sodium / sugar than potassium. I'm talking more about "home made" mix.

[MomtoGiuliana]

If the mix or drink is intended to replenish electrolytes it would be higher in potassium than a sports drink, yes, as far as I am aware.  Still may not be as high in potassium as coconut water or other foods rich in potassium.

[dizzytizzy]

Yeah, @MomtoGiuliana and @whoami: It's all so confusing. I've had issues in the past with low potassium (just one of the reasons I am reluctant to try florinef), so the increased salt had me concerned I'd end up with even lower potassium. My EP does frequently remind me to eat a high potassium diet, which I do my best to abide by. I drink at least 8 ounces of V8 juice each day - getting some sodium and potassium in one go. I try to eat bananas, raisins, potatoes, beans, etc often too. 

I have to email him some of my vitals, so I'm going to ask again about it. I'll let you all know what I find out. 

[Pistol]

@MomtoGiuliana - you mentioned about sports drinks and sweating - I do not sweat due to my POTS and I cannot tolerate being outdoors in heat or humidity because of that. But in the summer I do drink Gatorade a lot, along with eating salty snacks. So far that has been working for me to avoid total crisis ( seizures, syncope, extreme fatigue etc ). I believe it has to do with the right electrolyte balance in our blood stream pulls more water from our tissues into our blood vessels, therefore improving blood volume. 

[MomtoGiuliana]

Yes many POTS patients do benefit from Gatorade plus extra salt.  When I was first diagnosed I did this for months and it really helped.  

@dizzytizzy--I also have tendency to low potassium.  My EP also told me to increase salt.  And increasing salt helps greatly.  I don't take salt tablets anymore ,I just add salt generously to food (if symptomatic).  I think for me I do just have to make sure  I am eating high potassium foods as well.

[dizzytizzy]

@MomtoGiuliana @Pistol @whoami: As promised, I'm updating with my EP's response to the sodium/potassium conundrum. Here is his explanation of why increasing sodium will assist in potassium retention, at least in my case:

"The relationship between the sodium and potassium is indirect. Increasing the sodium helps maintain the BP/stabilize HR which decreases release of stress hormones. These hormones increase the loss of potassium through the kidneys. So if we improve BP/HR, we will keep potassium levels normal by limiting the losses in the urine."

[MomtoGiuliana]

Thank you!  That makes sense.

I did have one experience where I had used a lot of salt due to symptoms, finally went to ER for fluids, and my potassium was slightly low and they gave me a potassium supplement.  Later my EP said I should be careful not to oversalt.  But that may be something specific to my physiology!