Does anybody else who is suffering from smoldering myeloma or multiple myeloma have a low sodium and chloride level?
My counts dropped below the normal range last fall when there was first an indication that I may have some high protein counts that later led to my smoldering multiple myeloma diagnosis. My sodium has ranged between 130-132 (normal is 136-145), and my chloride has ranged from 93-96 (normal is 98-107) since last fall when I first got diagnosed.
I don't drink an excessive amount of fluids, which is the first thing my family physician asked me last fall. I'm going back to see him later this week to see if we can get to the bottom of this, since my head has been elsewhere with my overall smoldering myeloma diagnosis. I was curious if others have this same phenomena going on since they got multiple myeloma or smoldering myeloma.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low sodium or low chloride levels?
Hi Multibilly,
Yes, my husband was also told his sodium was low more than once when he had labs before his chemo treatment. I think his chloride was, too. Also his creatinine usually runs 1.2 and 1.4, so that is watched closely.
We learned the sodium and creatinine are influenced by your hydration. He tends to sweat a lot even with mild exertion, so doctors suggested drinking Gatorade or Powerade. He drinks 1-2 bottles of it a day instead of plain water, and that helps keep both the sodium and creatinine in the normal range.
Powerade plus drinking tonic water also helps keep his muscle cramps to a minimum, usually. But if he's sweating a whole bunch (say doing yard work on a warm summer day) he'll still get bad cramps, despite drinking several bottles of them.
Best wishes for future good health,
Chris M.
Yes, my husband was also told his sodium was low more than once when he had labs before his chemo treatment. I think his chloride was, too. Also his creatinine usually runs 1.2 and 1.4, so that is watched closely.
We learned the sodium and creatinine are influenced by your hydration. He tends to sweat a lot even with mild exertion, so doctors suggested drinking Gatorade or Powerade. He drinks 1-2 bottles of it a day instead of plain water, and that helps keep both the sodium and creatinine in the normal range.
Powerade plus drinking tonic water also helps keep his muscle cramps to a minimum, usually. But if he's sweating a whole bunch (say doing yard work on a warm summer day) he'll still get bad cramps, despite drinking several bottles of them.
Best wishes for future good health,
Chris M.
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Chris M
Re: Low sodium or low chloride levels?
Yes, when I was smoldering, both my chloride and sodium levels were slighty below normal - like you. The levels returned to normal once treatment began. Even though one is smoldering, your blood values will be messed up, especially when you have a lot of protein, which can alter the relative concentration of blood components.
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Dan D
Re: Low sodium or low chloride levels?
Hello Multibilly,
There are many causes of hyponatemia. Interestingly though, myeloma is one of them. The abnormally high level of blood proteins secreted by the myeloma can artificially lower the sodium measurement. This is referred to as "pseudohyponatremia" and it is not a danger to you.
Your primary care MD should be studying the low sodium and chloride to determine if they are significant. Often, mildly decreased levels are simply observed. I have placed a list of many of the things that can cause a low sodium level below. As you can see, this is a complex topic.
Major causes of hyponatremia:
Disorders in which ADH levels are elevated
Effective circulating volume depletion
True volume depletion
Heart failure
Cirrhosis
Thiazide diuretics
Syndrome of inappropriate ADH secretion, including reset osmostat pattern
Hormonal changes
Adrenal insufficiency
Hypothyroidism
Pregnancy
Disorders in which ADH levels may be appropriately suppressed
Advanced renal failure
Primary polydipsia
Beer drinker's potomania
Hyponatremia with normal or elevated plasma osmolality
High plasma osmolality (effective osmols)
Hyperglycemia
Mannitol
High plasma osmolality (ineffective osmols)
Renal failure
Alcohol intoxication with an elevated serum alcohol concentration
Normal plasma osmolality
Pseudohyponatremia (laboratory artifact)
High triglycerides
Cholestatic and obstructive jaundice (lipoprotein X)
Multiple myeloma
Absorption of irrigant solutions
Glycine
Sorbitol
Mannitol
There are many causes of hyponatemia. Interestingly though, myeloma is one of them. The abnormally high level of blood proteins secreted by the myeloma can artificially lower the sodium measurement. This is referred to as "pseudohyponatremia" and it is not a danger to you.
Your primary care MD should be studying the low sodium and chloride to determine if they are significant. Often, mildly decreased levels are simply observed. I have placed a list of many of the things that can cause a low sodium level below. As you can see, this is a complex topic.
Major causes of hyponatremia:
Disorders in which ADH levels are elevated
Effective circulating volume depletion
True volume depletion
Heart failure
Cirrhosis
Thiazide diuretics
Syndrome of inappropriate ADH secretion, including reset osmostat pattern
Hormonal changes
Adrenal insufficiency
Hypothyroidism
Pregnancy
Disorders in which ADH levels may be appropriately suppressed
Advanced renal failure
Primary polydipsia
Beer drinker's potomania
Hyponatremia with normal or elevated plasma osmolality
High plasma osmolality (effective osmols)
Hyperglycemia
Mannitol
High plasma osmolality (ineffective osmols)
Renal failure
Alcohol intoxication with an elevated serum alcohol concentration
Normal plasma osmolality
Pseudohyponatremia (laboratory artifact)
High triglycerides
Cholestatic and obstructive jaundice (lipoprotein X)
Multiple myeloma
Absorption of irrigant solutions
Glycine
Sorbitol
Mannitol
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Low sodium or low chloride levels?
My mother has low sodium and is being tested for myeloma. Are you saying that myeloma can cause low sodium and that can be a symptom of myeloma, or, once you start treatments for myeloma, you can get low sodium?
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twalker
Re: Low sodium or low chloride levels?
Twalker,
In my case, my smoldering multiple myeloma itself caused a condition known as pseudohyponatremia, which artificially makes my sodium lab numbers look lower than what they actually are.
The easy way to figure out if pseudohyopnatremia is happening is for the doctor to request what is known as serum osmolality test and to then calculate what is known as the osmolal gap from those test results (the calculation also involves some other test results that you would normally get when monitoring multiple myeloma). If one's osmolal gap is > 10 mOSm/kg H, then pseudohyponatermia is likely to blame. Any hematologist would know how to figure this out and do this calculation.
In my case, my smoldering multiple myeloma itself caused a condition known as pseudohyponatremia, which artificially makes my sodium lab numbers look lower than what they actually are.
The easy way to figure out if pseudohyopnatremia is happening is for the doctor to request what is known as serum osmolality test and to then calculate what is known as the osmolal gap from those test results (the calculation also involves some other test results that you would normally get when monitoring multiple myeloma). If one's osmolal gap is > 10 mOSm/kg H, then pseudohyponatermia is likely to blame. Any hematologist would know how to figure this out and do this calculation.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low sodium or low chloride levels?
Interesting. My sodium levels have been mildly low, chloride is borderline low. But I'm MGUS.
This is a really nice explanation. Clearly there are a lot of factors that can contribute to these low levels.
This is a really nice explanation. Clearly there are a lot of factors that can contribute to these low levels.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Low sodium or low chloride levels?
I have a sodium level of only 125 (should be at least 135) and a chloride level of 88 (should be at least 96) I keep going to doctors and am very confused. We don't have any idea as to why.
Does anyone have any ideas why these levels could be so low?
Does anyone have any ideas why these levels could be so low?
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Grandmama01
Re: Low sodium or low chloride levels?
Grandmama,
Are you currently diagnosed with multiple myeloma?
Are you currently diagnosed with multiple myeloma?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low sodium or low chloride levels?
Thank you for the very helpful information. My mother has multiple myeloma, and has asked about the low sodium levels, but just gets all this technical jargon for a reply. I read this information to her, and she was very relieved to get an answer she could understand. So thank you! 
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SonyaWM
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