Hep C Discussion Forum

Hey Mike,

I personally had a low sodium episode, which my doctors called "a perfect storm".  

At the time, I was treating with triple Incevek, Ribo and Interferon.  I was drinking lots of water, watching my salt intake (high blood pressure) and taking prescribed diuretics and other blood pressure meds.  Awoke in the middle of the night to use the bath and found that I had to throw up immediately (the high fat diet was not agreeing with my system).  Next thing I remember, I awakened on the floor, where I must have spent all night.  Rushed to hospital and admitted with a sodium level of 114.  

This was not anticipated by any of my doctors.  My advice is to get a BMP (basic metabolic panel) every week until the electrolytes even out.  Take very good care of yourself; I selfishly want you to be here for a long time.

Hi Mike,

I am looking forward to hearing about your SVR as much as I am my own! Way to go with the PT crew - they love people like you. It's the ones who won't fight for their health that upset them. After my son got hit by a gas truck we wore his team out too. They were so happy for him, and it really paid off.

Good for you Mike, I think you are going to have a great Hep C free life! 

Take care,

~ Rudi

Dzdayscomin wrote:

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One thing I would consider as to the build up of acities would be the fact that in trauma they probably were pumping IV fluids in....?correct?

I know that some of the procedures I had I had to tell them to be wary of overdoing it, my experience is t hat they like to keep you hydrated and pretty much pumped full, not sure if it's for blood pressure reasons etc....or what, but I do know it goes in a l It easier than it comes out when your liver I s fouled.

Keep doin your best Mike.

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 My doctor said the same as you when I asked him during my appointment last Friday. With the history of my procedures while I was at the trauma center he said that with that amount of IV fluids it was definitely the cause of my 4 liter ascites fluid accumulation. But since that  paracentesis was done and my last labs and MRI was done I was re-admitted for right foot / lower leg amputation although I was only there 10 days this time so hopefully I didn't accumulate too much on this trip. I don't know what IV fluids they gave me in Nov and Dec, but here's a list of fluids from my last admission on 1-15 thru 1-25:

Ertapenem Sodium (Invanz) 1G IV Q24H (this was continued for a week, until 2-4-2015, after I had been transferred from the trauma center back to this rehab hospital )

NACL 0.9% IV 1000 ML Over 10H

Hydromorphone (Dilaudid) 1MG = 1ML IV Q24H

Naloxone (Narcan) 0.4 MG = 1 ML IV

Ondansetron (Zofran) 4 MG = 2 ML IV Q6H

Enoxaparin (Lovenox) 30 MG = 0.3 ML SubQ Q12H

 The only other changes to any of my other medicine was increasing the 5 mg oxycodone I've been taking (prescribed for unrelated old lumber spine injuries) to Oxycodone 10MG = 1 TAB Oral Q4H PRN.

 I don't know much about what some of these are for but I googled Ertapenem Sodium (Invanz) since it has 'sodium' in the name and see it's an antibiotic used for infection. Even if that's the medicine that causes the ascites fluid, it could not be avoided in my case considering my leg / foot was amputated due to infection.

Anyway, my viral load is still UND and my doctor has me scheduled for more labs and 3 month HCC MRI April 15 and the MRI final reports always mention the amount of ascites fluid seen. For example this is the last line on the MRI final report from 1-8-2015 and resembles all the previous MRI's.  "Trace ascites noted within the right paracolic gutter". So we'll know more April 15. Three things are for sure: #1 - I'm still overjoyed about my pending UND Hep C viral load, #2 - I'm wearing my physical therapist out trying to get out of this hospital and enjoy my Hep C free life (pending future labs), #3 - LOOSING THE SALT!!!

 Thanks for the heads up on the info Duane!

EDIT: Oops. Sorry about the repost on the foot information. I didn't realize I had already posted it.

-- Edited by wmlj1960 on Friday 20th of February 2015 03:46:38 AM

Hi Mike, I have decompensated cirrhosis too.  What I have found is that many types of food have high salt levels anyway and so I don't put any salt when I cook.  I try to only eat food that I have prepared from fresh and (although expensive) organic.  My ascites has reversed down to a non-critical level because of the drugs and an awareness of what I am eating.  I wish you well and know what it is like to find yourself in this position.  You have come through so much and have been so brave. 

Nxxx 

Hi Mike,

Hey buddy, it's always good to hear from you! Sorry about the loss of your foot. I vote that all of this be over for you, you've had enough hardship from this accident. Your attitude and will to succeed in life is very impressive my friend. I can only hope that were I in a similar position, I could show the strength you obviously have shown.

Glad that the HCC is behaving itself and not causing you any problems. I'm confident that your VL will be undetected and look forward to hearing you have achieved SVR when the time comes. On top of everything else, I'm very impressed that you've been strong enough to continue with Tx. But that's what sets you apart from others, you have incredible strength and resolve. Keep it up old friend!

Keep us informed of any updates. In the meantime, rest and get that strength built back up. You're going to need it when you walk out of that hospital. Get well soon Brother, we're always here for you. Good luck...

Tig

 Hi everybody,

Partial update...

 My hepatologist appointment was Jan 23 but was rescheduled due to me being in the hospital for a right foot amputation at that time. I got the appointment reset to Feb 13 and was able to find out from my hepatologist nurse that the MRI done Jan 7 showed no significant change to the lesion from the previous 3 month check. So that's good news. I didn't have time to get a viral load but she is sending me a copy of labs in the mail so I'll post them then. Wow, won't that be cool to know the HC is sound asleep, and maybe even that my EOT viral load is und after the rocky road this 24 weeks has been - I'd say It's worth a crummy old foot anyway (more potential from a prosthetic in my case).

I'll post the results of my hepatologist visit when I know after Feb 13.

Hey Mike,

I'm saddened to hear about your accident and like the others am almost stunned into a complete loss for words. I don't know if you're a religious man, but those of us that are will tell you that the good Lord has a plan for you and wants you around to help Him make things right with the world. With your attitude and determination I know you will succeed. I don't know what I can possibly do for you Mike, but should you need anything, I will do my best to help you find it. God bless ya buddy....

Tig

Thanks Matt and Tim.  My future will require a lot of work to do in the not quitting area. I consider the way I stuck to HepC Tx an excellent source of real life, real world education and knowledge to assist me in my upcoming times.

Hello Mike

My thoughts and prayers are with you, hopeful of a recovery after all your tribulations. Life is going to turn for the better for you this year one way or another.

matt

Hi Mike,

Man, what a story! If anyone deserves treatment to work it's you.

You've asked some questions which I'll try to answer.

Firstly, Ribavirin does not have a direct effect on serum albumin. It's listed in the Riba side effects, but studies have found ~0.4% of patients on long term Riba have a slightly decreased albumin, and that most of these patients had fairly severe liver disease anyhow.

You also asked a question about salt intake and blood sodium levels.  This is a very complex subject.  The body needs a certain amount of sodium for normal action of muscles and nerves, to maintain blood pressure and volume of extracellular fluid. Sodium cannot be manufactured in the body, so it's suggested a normal adult will need to eat ~2gms/day.  The difference between sodium and salt can be confusing.  Sodium can be found in table salt (40% NaCl), baking soda, MSG, all food additives and virtually all foods.  However it's ingested, sodium is quickly absorbed in the small intestine and circulates in the blood as free sodium.  The level is strictly controlled by various hormones- Aldosterone from the adrenal glands, ADH from the pituitary and Renin (Angiotensin I and II) from the kidneys.  Sodium is excreted by the kidneys and the blood levels are fine-tuned by the amount of sodium resorption in the Loop of Henle.

If you're taking a diuretic like lasix, this blocks the resorption of sodium in the kidneys.  As a result, you lose sodium and water (and also potassium). Blood levels of sodium will decrease and this may explain while your sodium levels are a bit low.

This is a simplified version of what happens. I'm sure there's more detail on the Internet.

Good luck for your VL test and hope your 24 weeks of Sovaldi/Riba did the trick. Cheers.

mallani wrote:

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 The main cause for ascites is decreased albumin in the blood and portal hypertension.

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 I'm just curious: Since Ribavirin is a red blood cell killer, does it also affect albumin levels?

I was in the trauma center pretty sedated while my labs/hepatologist appointments were pretty much ignored by those Dr's.  So I don't know anything about current lab values. Even not knowing, I chose to stay on the original 1000 mg day until my last dose this morning. So if Riba's cell killing also affects albumin, maybe that could partially explain how I accumulated 4 liters Ascites fluid fairly quickly.

I know that 4 liter quantity is accurate. The Dr. let me watch the entire paracentesis on the ultrasound screen. All 4 containers were filled to the full 1 liter mark, and when he was finished there was only a very small pocket remaining in a different area, which was certainly not worth the infection risk of re-accessing.

 I remember my diagnosis at that first trip to the hospital in Jan. included portal hypertension.

 I know I was so happy to take that last Ribavirin this morning. I know it will take some time to get that crap and the feelings out of my system. But I imagine going from 24 weeks of those feelings and the fatigue + getting run over by a Mack truck (lol) to eventual recovery is going to be such a sweet ride!

Geez Mike.....Man the deck was already stacked against you before this accident.

I was wondering where you had gone......Not really words for this ....but prayers will be said for you.

Hope you find some peace.

Duane

mallani wrote:

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Hi Mike,

Liver damage needs to be severe

The advice usually given is to avoid adding salt to meals. Severe limitation of salt intake has not been proven to be effective, and may cause further problems.

 

http://www.easl.eu/assets/application/files/21e21971bf182e5_file.pdf

 

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 Thanks for the response mallani.

  According to you and the link, the advice usually given is to avoid adding salt to meals. Severe limitation of salt intake has not been proven to be effective, and may cause further problems.
 
 I've been mainly trying to understand the relationship between oral salt (sodium) ingestion, vs the Sodium level shown on our lab results. My lab blood sodium level has continually shown slightly low since last Feb. after I quit drinking, drugs, junk food and my hepatologist started me on Lasix, Aldactone and Lactulose and after an initial paracentesis (maybe 2-3 liters) when I was 1st hospitalized with abdominal pain in January.
 Since about June my 3 month HC MRI'S Final Reports have all mentioned a reference to minimal Acsites fluid seen.
 
 
 Now my main misunderstanding of this:
 About 11pm on Nov, 3,  I was almost killed in a bad freak accident that broke both my feet very badly. During this my body wound up in the center of the 4 lane highway in front of a loaded 18 wheeler traveling 70 mph which tore my left arm off above the elbow and broke my back, then dragged me approx 150-200 yards before he could get stopped.. Other than a brief memory in the helicopter I remember nothing else for 2 days and  3 surgeries.

 I spent 6 weeks and had more surgeries in the regional trauma center while my Sovaldi/Ribavirin was badly managed (This place had excellent surgeons for Orthopedics and broken backs but none of these Doctors had no clue about HepC, HepC Treatment or decompensated cirrhosis  My blood sodium became so low for other reasons, that they were worried about cardiac arrest and something was said about renal failure. (I don't remember the detals). I asked if increased oral sodium intake would help to increase blood sodium and was told no. So I have to assume that oral sodium is only processes as well as my decompensated cirrhotic liver can still handle. The excess winds up as Ascites fluid accumulation within the abdominal cavity.

 I'm now being cared for 24/7 by a healthcare / rehab hospital who has no clue what a low sodium diet is either. They see it as no extra table salt added to meals pretty much with no attention given to sodium content of the actual food and here lies yet plenty more ignorance of HepC.
 So last week they had to send me to the hspital for a paracentesis and got 4 liters. Phone contact to my HepC Dr all during TX has always been pretty non existant and that hasn't changed during this ordeal. I have an HC MRI and labs scheduled Jan 7, then my hepatologist on the 23rd. That's if this place provides transportation without cancelation, which is possible, due to their complete lack of knowledge about HepC Cirrhosis and the seriousnes of it. Other than waiting to see what happens, I'm getting short on options.

I managed my treatment very well until Nov 3. I hope that was enough along with poor management since Nov.to cure me. My last dose of Sov/riba is tomorrow so I will know a little on Jan 23rd. Hopefully I will see UND at EOT +12 wks.

 Sorry about the long post mallani and everybody else.     
 

Wow Thanks Malcom........ that's a good read, Is that a membership required type of journal ? I really got a lot out of it...and this kind of information is super helpful in advocating for one's selve at the Dr.'s office etc..

Duane

Hi Mike, sodium is an essential mineral..... here is a couple good links.

http://www.curezone.com/foods/salt/vital_functions_of_salt_in_the_b.htm

I do know that your body retains or excretes fluid to balance the amount of sodium in your body.

http://www.liversupport.com/wordpress/2009/08/important-facts-about-salt-and-cirrhosis/

Duane

 Edit, oops reposted the same link