Sodium

Sodium is a natural essential mineral belonging to the supplement class.

Sodium is also known as Na, salt and soda.

Sodium is a vital element for healthy immunological function, blood sugar regulation, cellular energy, reproduction, digestion, bone formation, blood clotting, hemostasis, and protection against reactive oxygen species.

Sodium deficiency leads to Hyponatremia. It is characterized by headache, confusion, loss of energy, drowsiness, fatigue, restlessness and irritability.

Table salt, processed foods (such as canned soups, snacks, and fast food), condiments such as soy sauce and ketchup, and certain natural foods such as celery and milk are all common sources of sodium in our diet.

Sodium is absorbed in the small intestine by active transport, controlled by hormones such as aldosterone. It is found in extracellular fluid and is essential for osmotic balance. Sodium-potassium pumps maintain electrochemical gradients for neuron and muscle function. Excess sodium is mostly removed by the kidneys via urine, with control provided by the renin-angiotensin-aldosterone system.

The common side effects of sodium include nausea, vomiting, diarrhoea, mild tremors and mood changes.

Sodium is available in tablets, injectable solutions, sprays and ointments.

Biochemical action of Sodium

Sodium belonging to the supplement class helps in several physiological processes. Sodium acts via the SGLT1 pathway using a sodium-potassium pump.

Sodium is absorbed in the small intestine via the sodium-glucose cotransporter 1 (SGLT1) on the brush border membrane of enterocytes. SGLT1 actively transfers two sodium ions and one glucose molecule into the enterocyte. The sodium-potassium pump (ATPase) expels sodium from the enterocyte into the bloodstream via the basolateral membrane. This pump expends ATP to transfer three sodium ions out of the enterocyte and two potassium ions in. The kidneys are the primary regulator of sodium balance, which is closely related to water balance. Approximately half of the sodium in the body is found in extracellular fluid, 10% within cells, and the remainder in bones. Minor salt deficits occur through urine, faeces, and sweat. This complicated mechanism emphasizes the critical importance of sodium in maintaining physiological homeostasis.

Elemental sodium is never found by itself. Instead, it is usually found in combination with another substance. The most typical sodium component is table salt, often known as sodium chloride.

It is available in tablets, injectable solutions, sprays and ointments.

• Tablets: To be swallowed whole with water/liquid, as applicable.
• Injectable solutions: To be administered parenterally, as applicable.
• Nasal spray: To be sprayed into one nostril, as applicable.
• Ointment: To be applied as directed by the doctor. It should be used in a small amount to the affected area after cleaning it properly, as applicable.

Sodium can be used as a supplement when the amount of sodium taken from the diet is insufficient.

Sodium supplements may be used to prevent and treat hyponatremia, a condition in which the body needs sodium.

Adequate oral intake of Sodium supplements enhances normal brain and nerve function.

Sodium supplement helps regulate fat and carbohydrate metabolism, calcium absorption, and regulate blood sugar.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Sodium may be useful as a supplement for the following health benefits:

• Cardiovascular disease: Studies on the effects of sodium intake on heart disease have resulted in contradictory findings. More research is needed to determine whether consuming more Sodium through food or supplements increases or decreases the risk of cardiovascular disease.
• Fluid regulation: Including sodium in one's diet improves fluid regulation outside of the body's cells. Sodium is required for the transport of fluids into bodily cells. Sodium helps in the flow of fluids through permeable membranes to locations with a high salt concentration. As a result, sodium in combination with chlorine enhances the prevention of water loss from the human body.
• Ion balance: Sodium, when combined with bicarbonate, helps in the maintenance of a proper equilibrium of negatively and positively charged ions. As a result, sodium plays a vital function in maintaining the charge differential across cell membranes. As a result, it allows nerve cells to transfer messages while also allowing muscle cells to contract properly.
• Loss of water prevention: Sunstroke is a condition caused by the loss of water and salt from the human body. As a result of repeated exposure to extreme temperatures, the human body is unable to maintain a normal temperature. Sunstroke can be avoided by drinking fluids containing sugar and salt, which perform by replacing the loss of vital electrolytes.
• Muscle contraction and cramps prevention: Dehydration and electrolyte imbalance cause muscle cramps. These are typical during the summer, when temperatures appear near high peaks. Sodium facilitates hydration and muscular contraction. Fluids and juices high in salt content help in the restoration of electrolyte balance in the human body.
• Oral health: Sodium is excellent for cleaning the teeth and mouth. The sodium salt content promotes in the cleaning of the mouth and teeth. Sea salt or regular salt can be used in place of toothpaste to properly clean the teeth.

Sodium supplementations may be administered orally, topically or parenterally.

• Orally: Sodium supplements are available as tablets and capsules that can be taken orally. It is best taken with a meal or food.
• Parenterally: Sodium supplements are generally taken by mouth but may have to be administered intravenously and intramuscularly.
• Nasal Spray: When using the nasal spray solution of sodium, one nostril must be closed while the solution is sprayed into the other. During administration, the individual should lean their head slightly forward and breathe slowly through the nostrils.
• Topically: Put a 1/4 inch of sodium ointment in the pocket of the lower lid. 1–2 minutes with eyes closed. Seal the tube after wiping the tip.

• Tablet: 500mg, 1000 mg
• Injectable solutions: 0.9%
• Spray (nasal): 0.9%, 3%
• Ophthalmic solution: 2%, 5%
• Ophthalmic ointment: 5%

Sodium is available in tablets, injectable solutions, sprays and ointments.

Sodium should be used as a supplement that helps in a number of physiological processes along with appropriate dietary restrictions.

• Avoid alcoholic beverages.
• Stay within your daily calorie needs.
• Limit foods and beverages higher in added caffeine, sodium/salt, saturated fat, vitamin K and dairy products.
• Avoid grapefruit,

The dietary restriction should be individualized as per patient requirements.

Recommended Daily Allowance (RDA)

The RDA of Sodium is 1500 mg/day.

Upper Tolerable Intake (UTL):

No UTL is set for sodium, as data concerning adverse effects is insufficient.

Sodium supplementation may be contraindicated in the following conditions:

• Hypersensitivity; sensitive to sodium
• Wilson disease
• Chronic kidney disease
• Hepatic impairment
• Idiopathic Sodium toxicosis
• Childhood cirrhosis
• Pheochromocytoma
• Insulinoma
• Multiple sclerosis

For individuals on hemodialysis, sodium from supplements might need to be absorbed better in people.

Sodium supplements should be used cautiously in liver/biliary tract dysfunction.

Individuals with preexisting neurological conditions, especially the elderly, should use sodium supplements cautiously as they may adversely impact sodium levels.

More than 1 person should not use injection solutions of sodium supplements as it may spread infection.

People who are overweight or at risk of becoming obese should take salt in moderation.

Safe to use during pregnancy.

Limit the consumption of foods and beverages higher in added caffeine, saturated fat, and sodium, alcoholic drinks, as this substance could hinder sodium absorption.

The adverse reactions related to sodium can be categorized as-

• Common: Thirst, fluid retention
• Less Common: High blood pressure, kidney issues, electrolyte imbalance.
• Rare: Hypernatremia, cardiovascular issues

The clinically relevant drug interactions of Magnesium are briefly summarized here:

• Blood Thinners: Blood thinners are high in vitamin K, and when used concurrently, it can affect the medication's effectiveness.
• ACE inhibitors and ARBs: These drugs can affect sodium levels by influencing the body's balance between sodium and water.
• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can potentially lead to sodium retention, impacting blood pressure regulation.
• Antidepressants: Some studies have shown that some classes of antidepressant medications may impact sodium levels, especially in older adults or those with preexisting conditions, leading to issues like hyponatremia.
• SGLT-2 inhibitors: It can increase the excretion of glucose and sodium in the urine, potentially affecting sodium balance.

The common side of sodium includes the following:

• Increased Blood Pressure (Hypertension)
• Fluid Retention (Edema)
• Electrolyte Imbalance
• Kidney Strain
• Osteoporosis Risk
• Stomach Discomfort or Nausea
• Dehydration
• Increased Stroke Risk
• Heart Disease Risk
• Exacerbation of Certain Conditions (heart failure, kidney disease, liver disease)

The use of Sodium should be prudent in the following group of special populations.

• Pregnancy: When consumed more than RDA, it could be harmful, increasing the risk of elevated blood pressure with larger dosages, so it is advised to use it cautiously.

The RDA for Sodium in pregnant women is 1500 mcg/day.

• Paediatrics: When taken by mouth, sodium is most likely safe for children. When taken in larger doses, sodium could be harmful. The risk of elevated blood pressure is increased with larger dosages. Sodium supplements are the best way to help children get enough Sodium daily.

The RDA for Sodium in paediatrics ranges from 110- 1500 mg/day.

Dosage Adjustment for Paediatric Patients

Nasal Dryness & Congestion

Isotonic solution (0.9%) relieves nasal congestion by thinning mucus and moisturizes membranes.

Children: 2 sprays/nostril prn

Infants: Use drop application; 1-2 drops each nostril with gentle bulb syringe suction to extract mucus

Pretreatment for Nasal Steroid

Helps reduce nasal swelling

Hypertonic saline (3%): 1 spray/nostril 2-6 times daily

Temporary Relief of Corneal Edema

Ophthalmic solution: Instill 1-2 gtt in affected eye(s) q3-4h or as directed by physician

Ophthalmic ointment: Pull down the lower lid of the affected eye(s). Apply a small amount (1/4 inch) of ointment to the inside of the eyelid. Apply once daily or as directed by a physician.

• Geriatrics: The elderly are at greater risk of hyponatremia because they are more likely to take medications or have health issues that increase their risk.

The RDA for Sodium in geriatrics is 1500 mcg/day.

• Lactating mothers:

Consuming more than RDA could potentially be harmful, increasing the risk of elevated blood pressure with larger dosages, so it is advised to use it cautiously.

The RDA for sodium in lactating mothers is 1500 mcg/day.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment for Adult Patients

Nasal Dryness & Congestion

Isotonic solution (0.9%) relieves nasal congestion by thinning mucus and moisturizes membranes

2 sprays/nostril prn

Pretreatment for Nasal Steroid

Helps reduce nasal swelling

Hypertonic saline (3%): 1 spray/nostril 2-6 times daily

Temporary Relief of Corneal Edema

Ophthalmic solution: Instill 1-2 gtt in affected eye(s) q3-4h or as directed by physician

Ophthalmic ointment: Pull down the lower lid of the affected eye(s); apply a small amount (1/4 inch) of ointment to the inside of the eyelid; apply once daily or as directed by a physician.

The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of Sodium. Overdosage of sodium can result in hypernatremia, an abnormally high sodium concentration in the blood. Extreme thirst, dry mouth, disorientation, nausea, vomiting, muscle twitching or spasm, and in severe cases, seizures or coma.

There is no specific antidote or treatment for excessive intake of supplemental sodium. When an overdose is suspected, sodium should be terminated immediately. Fluid intake should be increased along with electrolyte monitoring. Supportive therapy should also be given, addressing any symptoms that persist or worsen. Physical treatment might be added if necessary.

Biochemistry Profile of Sodium

Sodium (NaCl), or table salt, is essential in biochemistry. Sodium and chloride ions are vital electrolytes in the body, regulating fluid equilibrium, nerve impulses, and muscle function. Sodium is an essential cell membrane potential component, allowing nerve cells to relay impulses and muscles to contract. Chloride helps to maintain correct cellular osmotic balance and acid-base equilibrium in physiological fluids. These ions are absorbed in the digestive tract and controlled by the kidneys. Excess salt consumption may result in elevated blood pressure and fluid retention. Sodium's biochemistry is crucial in maintaining cellular homeostasis, neuronal transmission, and other vital physiological functions.

Kinetic profile:

• Absorption: Sodium is absorbed predominantly through the small intestine. Its absorption is facilitated by active transport systems such as sodium-glucose cotransporters. Hormones such as aldosterone, which stimulates sodium reabsorption in the kidneys and gut, regulate absorption.
• Distribution: Sodium is transported throughout the extracellular fluid when it is absorbed. It is an essential component of bodily fluids such as blood plasma and interstitial fluid. Sodium ions are required to maintain osmotic pressure and regulate water balance in cells and tissues.
• Metabolism: Sodium does not undergo any significant metabolic alterations. Its principal function is to keep electrochemical gradients across cell membranes necessary for nerve impulses, muscle contractions, and other cellular activities. Sodium-potassium pumps actively maintain these gradients, which exchange sodium ions for potassium ions.

• Elimination: Sodium is primarily removed by the kidneys via urine.The renin- -aldosterone pathway promotes sodium excretion regulation.

1. https://www.ncbi.nlm.nih.gov/books/NBK554545/
2. https://www.mayoclinic.org/drugs-supplements/sodium-chloride-oral-route/proper-use/drg-20122545
   
3. https://www.ncbi.nlm.nih.gov/books/NBK545442/table/appJ_tab3/?report=objectonly