Hyponatriemic Nausea: a Hypothesis

Author: Guido Emanuele Galasso
Date: 10/11/2011


Nausea can be caused by Hyponatriemia.

My hypothesis is the role of Transporter dysfunction Na+ H+ Exchanger One (HNE1),
and the consequent urge of vomiting to eliminate rapidly acids from body.

The HNE-1 is one of the enzynes responsible for maintaining in normal range intracellular pH against acid attacks (together with monocarboxylate transporter MCT-1,4, Carbonic Anydrase IX and XII, and sodium-bicarbonate cotransporters (NBC)).

When natriemia goes down, this exchanger works worse, and so it does not eliminate enough well Protons from cytoplasm towards extra cellular space.

Cells are unable to tolerate the resulting trend to acidosis: so that nausea and till need to vomit is a finalistic objective vagal nerve mediated to remove the acid through the stomach contents so expelled out with violence.

When normonatriemia allows cells to estrude enough H+, protons are escreted in fecal masses, sweats and urine.

Hyponatriemia can cause nausea and cephalea: for example "fasting cephalea" can be referred to lowering of glucose and sodium.

In the past, some pregnant women trust in talidomide to alleviate nausea during pregnancy.
Talidomide is a teratogenic pro-thrombotic and neuropathic but can be used as antiangiogenetic in Multiple Mieloma.
Nausea in pregnancy is caused by Beta HCG. Between tolerate nausea alleviating it by taking Sodium Bicarbonate during pregnancy, or experiment to take the teratogenic talidomide, was it worthy to try take talidomide? Obviously no! If sodium bicarbonate or other alkalinizings are taken, remember to supplement diet in Iron to avoid deficit.

Please let me remember that in pregnancy, are useful against nausea alkalinizings (a trade name is "Biochetasi") and ginger extract (a trad name is "Emegrav").

Oral Bicarbonate is necessary to be taken daily chronicly in these patients (in gout too):
- enteroresecated (digiunal by-pass)
- with a neo-bladder
- short intestine with unbalance cholitis
because fermentative (gram + bacteria) enteric microflora produces to much acids (lactic acid and CO2) and inhibits putrefactive (especially gram -) microflora that is alkalinizing. In this cases osmotic agent lactulose is
contraindicated for fermentative microflora overgrowing.

When bicarbonate is taken, the lungs have to be able to ventilate enough to eliminate CO2 formed by Carbonic Anydrase.
Loss of acidification is of clinical interest, two examples of deficit in monocitic cell acidification are:
- a farmacogenic consequence: chronic use of PPI increases risk for pneumonias and other infetive diseases. PPIs can cause: Osteoporosis and fractures, Gastric Cancer, iron and vitamin B12 deficiency, enteric infections, Eosinophilic Oesophagitis, microscopic and collagenous colitis.
- a genetic disease: in Autosomic Recessive Osteopetrosis with Renal Tubular Acidosis (ARO with RTA) the disfunction is in Carbonic Anhydrase type II and Osteoclasts are no more able to create the acid lacune to resorpt bone matrix. ARO with RTA manifest with piastrinopenia, splenomealia, absence of bone marrow canal with in Rx funnel like appearance of metaphises.

Oppioid-induced nausea is a dopaminergic nausea.
Especially non-alcol-drinker women can suffer from severe nausea after taking a too high dose of oppioid analgesic drug. This nausea can be treated with Haloperidol, because it diminishes the dopaminic action on Chemoreceptive Trigger Zone in the fourth ventricule. Naloxone is not effective against oppioid-induced nausea but it can be helpful in itch (prurigo) and stipsis (especially from oxicodone).

Guido Emanuele Galasso MD

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