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End Stage Liver Failure-Low sodium levels

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Posted 2/13/2008 4:39 PM (GMT 0)
My mother was diagnosed Oct. 07 with end stage liver failure (caused by 30 plus years of drinking). She was given an life expectancy "estimate" of 6 months.  She seems to be doing quite well considering the condition she was orignally found.  She is not a candidate for liver transplant.  She is just now starting to have some problems with controlling her sodium, which I am aware is part of this disease, however, I can't get a direct answer from her Dr. as to what this "could" mean...some people have said that it is the beginning of the end.  Have any of you dealing with this had an issue of low sodium?     The doctor is calling it "Low, but Stable" after the 3rd med adjustment.  I did not think to ask how low (in terms of numbers)  but it sounds to me that there may be a delicate balancing act to come.  Any help would be much appreciated!
Posted 2/13/2008 11:09 PM (GMT 0)
cmyers, Hi and welcome to the forum. Sodium levels can be influenced by several things. One of which is liver failure caused by chirrosis. The normal blood sodium levels are between 135-145. In healthy people the sodium levels are maintained by intake of sodium and excretion thru the kidneys. Sodium is called an "electrolyte". (There are several different electrolytes but we will focus on sodium.) Sodium is used by the body to help with nerves, blood pressue, and muscles. Your levels have to be in that 135-145 for the body to function normally. When the level is below normal we call it "Hyponatremia". If your mom is on blood pressure medicine then the meds may be contributing to her problem. Although not all blood pressure medicines cause hyponatremia. Only diuretics which cause the person to pee alot. It sounds like in your moms case her hyponatremia is caused by her liver failure secondary to chirrosis. Most generally alcoholic liver disease patients have what they call "ascites" which in simple terms is a large collection of fluid in the belly. As a result of their chirrosis their kidneys also have a problem (among other things).
It is called a "Hepatorenal" dysfunction. Hepato = liver, renal=kidneys. Also, they usually have Portal Hypertension which is high bloodpressure in the portal vein. All of this is serious and needs to be followed by a qualified Dr. You may see some confusion and disorientation with her current illness. I hope this helps you to understand what is happening to her body right now. I don't know what other symptoms she is displaying right now so I just addressed the hyponatremia issue. Keep us posted.
Shelly
Posted 2/14/2008 3:40 PM (GMT 0)
Shelly...

Thanks so much for your reply. Yes, my Mom has had all the confustion, disorientation and the ascites..all of which have been pretty stable after her 1 month hospital stay. She has been out of the hospital now for about 3 1/2 months in an adult foster home. She is in Oregon and I am in CA, so it is tough to really "see" how she is doing and to keep up with her Dr. that she is seeing in a regular basis. I am pretty "up" on all that is going on...however, I am just wondering if the low sodium is going to be a tough issue to control and if it is going to be to start of the major problems to come.... She is just now starting to complain of pain in her stomach and a tight feeling and her BP is up to 123 (which is HIGH for her).......... so not sure what is going on.... I am going to find out from the doctor what exactly her sodium level is...
Posted 2/14/2008 11:23 PM (GMT 0)
Hello Cmeyers, just wanted to welcome you to HealingWell. You find this site very helpful with very nice and knowledgeable people.
Thoughts and prayers will be with you and your mom.
Posted 2/15/2008 12:12 AM (GMT 0)

Cmeyers, why is she in an adult foster care home? Is she incapable of caring for herself now? I would suspect that is whats going on. Anyway, if she has been stable for 31/2 months that is good. Her sodium levels may be able to be controlled to some degree but it is difficult for me to give you an honest answer since I don't know the details, labs, etc. So everything is an educated guess. She is most probably in a state of mild to severe confusion on a regular basis. Not just from the sodium levels but in addition to her levels she must have some episodes of encephalopathy. When they gave you her anticipated life expectancy it was just a guess on their part. There is no sure fire method to determine that. Sometimes they say 6 months and it is 2 years, other times they say 6 months and it's 3 days. You just never know for sure. You asked if the sodium levels were heading toward more severe problems right? I would suspect that it is just the beginning of more serious health issues. At least that is what usually happens. They will more than likely just treat each issue as it occurs. Pain is the most difficult to treat long term and unfortunately it is very common in end stage. My mother suffered so much that it literally made us all cry for her just watching her suffer. I don't want to upset you but I want you to be prepared as much as possible. It is heartbreaking to watch. There were days that I prayed GOD would just take her then there were days I prayed she would live. It is a roller coaster ride for everyone. There is no way to sugar coat any of this and the truth is very difficult to swallow I know. The one thing you can do is keep your hope alive and never give up. Stay on top of her condition as much as possible. And above all let her know how much you love her. My thoughts are with you and we are all here for you.

Shelly

Posted 2/17/2008 5:26 PM (GMT 0)
Hi Cmyers, I just wanted to welcome you to the forum. I am so sorry that you mother is having to deal with this terrible disease. My husband has cirrhosis. We are having problems with sodium also. His is not too low. He has swelling in his legs, ankles and abodomen caused from too much sodium. It has been causing him a lot of pain in his knees and legs. At times it is difficult for him to walk.

I agree with Shelly in terms of time. There isn't a sure way of telling. I will pray for God to be with you in this difficult time.
Posted 2/19/2008 4:08 PM (GMT 0)

Thank you all for your nice words and thoughts.  :-) Butterflythree..sending thoughts to you and your husband.

Shelly, yes,  she is in adult foster home as she is unable to completely care for herself.  I would say at this point in time she is suffering mild confusion on a regular basis, otherwise her wits are about her. It seems alot of her short term memory is what is affected.

You don't know how much I appreciate your honesty.  The one thing that I was not aware of was the pain factor....  That is (obviously) good to know and keep a watch out for.

The Dr. has informed me that her sodium is running 125 (not sure how high that is) they have cut back on her Bumex (Diuretic) in order to control the sodium, however, now she is retaining more fluid in her abdomen which is causing the discomfort and the increased blood pressure. It really does seem to be quite a balancing act.

Posted 2/19/2008 5:41 PM (GMT 0)
cmeyers,
I think that it is very likely that the swelling and confusion will become more severe as time goes by. You are right--this is all a tremendous balancing act.The Dr's are on constant alert for changes in labs, actions, mental status, and physcial changes. The adult foster care home is a good place for her right now but as her condition worsens they will not be able to handle it all so be prepared. The Dr's and foster care people will let you know when it is time for alternative care. As I said earlier the normal levels of sodium are 135-145 for the body to function normally. So she is still a little low but manageable. The swelling (fluid) puts a strain on everything. The heart, the lungs, and other organs of course. She may become short of breath (SOB in medical terms). This would be expected. If the SOB is too severe they tap (drain) the fluid from her abdomen. That is one option they will consider anyway and not uncommon. The patient has instant relief after being tapped. The problem is that it doesn't take long for the fluid to build back up. Her Bumex gets rid of the excess fluid but also decreases the sodium levels. It's a catch 22. Take care and know that we are here for you. If I can help at all I will. Sometimes Dr's do a very poor job of explaining things to patients and families so I will help if I can. Please try to find the time to look up everything you can about your moms illness. It will not only prepare you to some degree it will educate you. When you have some understanding of the medical process she is facing it will help you to ask appropriate questions and understand the Dr's answers. I am a big advocate of patient and family education. I NEVER want my patients or family to just follow blindly along with what a Dr says. Smart people make smart choices.
Shelly
Posted 2/19/2008 10:31 PM (GMT 0)

Shelly  We just returned from the hospital for Jerry to be drained.  I requested they take blood because he seems so weak and he's really shaking a lot.  Two weeks ago his ammonia was in the 80's last week in the 60's and today it was 98.  Also his dreatinine was 1.42 , sodium 129 (it has been worse).  Ion balance 4, BUN 33 and GFR 51.  I looked up the ranges.  I'm concerned about his kidney function.  Do you think its serious.  He has a Dr. appt tomorrow.  I'm a little concerned. 

JoAnn

Posted 2/20/2008 1:33 AM (GMT 0)
Dear Joann, Keep the faith!!  You and your Husband have truly been an inspiration!  The path you have traveled is a path i know we will be heading towards soon...i hope my mr. wonderful is released from the bottle as easy as yours.

Why is Vandy being so difficult...in previous posts i know you have questioned this counselor...have you looked into the mayo at scottsdale???  Quite frankly, Vanderbilt is academically sound, but without a good bedside manner...

clearly i am talking out of my a**, like i'm an old pro...i'm just a rookie...but i am thinking alot about you and your mr. wonderful, and we pray that you find the guidance you seek. 

love and light!

rainbeau

Posted 2/20/2008 2:37 AM (GMT 0)

Rainbeau  What a dear you are.  I just have my moments.  I've even had a mini-meltdown with the Dr.  When I get scared I want results  RIGHT NOW.  Things just don't happen that way.  As far as Vandy  I have wanted to leave them but Jerry won't budge.  It has taken so long for a couple of reasons.  The Drs here didn't beleive Jerry was so bad at first.  His numbers were good.  Problem is, which does happen occasionally he is much worse then his numbers.  There are no liver specialists here.  We only see the Gastrologists.  Once they decided he was going down hill fast they scheduled an appt with a liver specialists at Vandy.  Jerry has someone working for him that his wife is a head hunter for hospitals so she researched the Dr. at Vanderbilt for us.  The surgeon has very good cridentials.  Also Vanderbilt is extremely busy.  It took three months to get the first appt and another  two months for the second appt.  All the tests are done now its just that WOMAN.  I got news for her we are just about done with ALL of her requirements.  We go back next week to see the liver specialist.  Don't have an appt with her.  I'm not going to make on either.  Right now Jerry needs to get stabilized.  I think he will probably go in the hospital tomorrow.    I will keep you posted how it goes.  Say a prayer for Jerry tonight.

JoAnn

Posted 2/20/2008 3:49 AM (GMT 0)

JoAnn, hi sweetie. I am concerned with his lab values. Creatinine (kree-AT-uh-nin)= the normal range is 0.6 to 1.2 mg/dL. Higher levels may be a sign that the kidneys are not working properly. As his kidneys struggle right now his level of creatinine in the blood increases. Creatinine comes from protein in the diet (mainly meat) and from muscles. Blood Urea Nitrogen (BUN) levels are between 7-20 and is also from the breakdown of protein. Both levels indicate kidney function and as you can see his BUN is 33 which is high. His creatinine level is only slightly elevated at 1.42 (I've seen much higher levels of both tho). They are both waste products. I think that with liver disease that is advanced the kidneys are often affected too. Normal amonia levels vary (as do most lab values) from hospital to hospital or lab to lab) but generally amonia levels are between 20-40. The amonia in the body forms when the protein is broken down by bacteria in the intestines. Normally the liver converts ammonia into urea and then eliminates it in the urine. But because of his liver disease his liver is sick so it can't convert the amonia into urea. What amonia is converted is not being excreted thru the kidneys properly because now his kidneys are sick too. What does it all mean? Well, his disease process is advancing. He is not eating and drinking water much either I would suspect. Often times they do NOT have any appetite and have to force themselves to eat and drink.There are appetite stimulants the Dr can RX which do help quite a bit. He probably has some muscle wasting too. His weakness will increase as well. Confusion increases with the elevated amonia levels as you know. Lethargy is common and can become worse as well. Most of this you already know but I was hoping if I explained the process a little it may help you to understand what's happening. PLEASE ask the Dr to give him something to increase his appetite. It will help a little. One drug I am aware of is Magace ES. There are probably others but I know that Megace is utilized fairly often. Ultimately it is up to the Dr but at least ask OK?

 Hugs, Shelly

Posted 2/20/2008 4:16 AM (GMT 0)
JoAnn we all will be thinking and praying for Jerry. Hang in there. We are thinking and praying for you also.
Posted 8/5/2012 7:21 AM (GMT 0)
My husband also has cirrosis of the liver and problems with his sodium levels. After we read the reply to cmyers, we've realised his sodium level is very low, no where near the 135-145 mentioned. Hubby also has ascites, and had his stomach drained twice last month. I've asked both his Dr and his specialist about a "safe level" of sodium for him to have in his diet, and neither, were willing or able to tell me. I've joined this forum from Australia (Point Frederick NSW), to be able to talk to people dealing with what my family is dealing with. My husband no longer drinks and is in the process of giving up smoking, both of which have been part of his life for over 40 years (no he is not a heavy drinker or smoker), and habits are hard to break. But he's getting there...Hubby is 63yo...
Posted 8/5/2012 1:27 PM (GMT 0)
Scorpio,

You have responded to a post from 2008.

As a new member it would be better for you to cut and paste your post into a NEW post and introduce yourself.

Sodium levels can cause a lot of trouble for those with liver disease so we will want to hear your story and members who are currently active and dealing with this topic will post in.

And...welcome to the forum.

Mama Lama

Posted 8/5/2012 7:00 PM (GMT 0)
Scorpio, welcome to the forum. As MamaLama/Carol mentioned, copy and paste your post into a new thread by clicking on New Topic instead of Reply. Thanks!

Hugs,
Connie
Posted 2/1/2014 3:43 AM (GMT 0)
Hello,

I don't have any advice or info. for you; just found out about this site. We just found out on Weds. this wk Jan 2014, my boyfriend of 4+ yrs. is dying of liver failure, on Monday the facility he was admitted to told me I can have many more yrs. w/ him (20 yrs between us), I don't know what he did in the past, but this whole time I've been w, him I have never seen him fall, throw-up, or shake; we are together 24/7 and thankfully he has been moved to an extended care facility 1 mi. from our house. I don't know how to help him. It changes every day, if I call him and ask if he needs anything from the store, he speaks pretty clearly, if I wait until after 2PM, he hardly know's me and can hardly speak, sometimes he gets really mean to me, the staff, etc.

I hope you're still on this site, it'd be nice to talk w/ someone who know's about this. It just makes me so sad, mad, hopeless. I'm the only person to see him, his mother lives upstairs and won't go see him, she'd rather focus on her salon appt. (she's about 90 yrs. old and very ill...I think it mostly drama). I told my guy, he better give me many more yrs. w/ him, he promised 31 yrs. He's always been a character. He's recently become really confused, disoriented. I feel like (and his mom blames me for this all), how could I not stop this? I know for a fact; he has never been in a treatment program, or A.A. (me 36 yrs. old, treatment @ least 8 times). I know I have a "fatty" liver and hepatitus C.
Posted 2/1/2014 3:44 AM (GMT 0)
Hello,

I don't have any advice or info. for you; just found out about this site. We just found out on Weds. this wk Jan 2014, my boyfriend of 4+ yrs. is dying of liver failure, on Monday the facility he was admitted to told me I can have many more yrs. w/ him (20 yrs between us), I don't know what he did in the past, but this whole time I've been w, him I have never seen him fall, throw-up, or shake; we are together 24/7 and thankfully he has been moved to an extended care facility 1 mi. from our house. I don't know how to help him. It changes every day, if I call him and ask if he needs anything from the store, he speaks pretty clearly, if I wait until after 2PM, he hardly know's me and can hardly speak, sometimes he gets really mean to me, the staff, etc.

I hope you're still on this site, it'd be nice to talk w/ someone who know's about this. It just makes me so sad, mad, hopeless. I'm the only person to see him, his mother lives upstairs and won't go see him, she'd rather focus on her salon appt. (she's about 90 yrs. old and very ill...I think it mostly drama). I told my guy, he better give me many more yrs. w/ him, he promised 31 yrs. He's always been a character. He's recently become really confused, disoriented. I feel like (and his mom blames me for this all), how could I not stop this? I know for a fact; he has never been in a treatment program, or A.A. (me 36 yrs. old, treatment @ least 8 times). I know I have a "fatty" liver and hepatitus C.
Posted 2/1/2014 8:54 PM (GMT 0)
Milan, You are replying to a post dated from 2008. Please start a new posting and tell us about your and your boyfriends situation.



Ziff
Posted 2/1/2014 9:42 PM (GMT 0)
Thanks Ziff...I tried to create a new post for Milan myself earlier, from my phone...and it got mixed up so I got frustrated.

I hope she posts again..they are in for a bumpy ride!
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