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Dear Dr. Roach: My husband had a nonstop coughing incident for a night and day after a feast, which landed him in the emergency room. He was found to have extremely low sodium levels (118-120 mEq/L), confusion, and a lot of heartburn. They are treating him for the low sodium by holding back his water consumption, but we are concerned that no one is looking into the underlying condition. Any suggestions? -- M.C.
Answer: I think your husband has the syndrome of inappropriate antidiuretic hormone (SIADH). Antidiuretic hormone (ADH), also called vasopressin or arginine vasopressin, helps regulate water in the body. When the body makes too much ADH, the urine is concentrated because the body cannot excrete water. Too much water means too little sodium in the blood.
Very low sodium levels can cause confusion, and in severe cases, seizures and even comas can occur. Free water restriction is the primary treatment, although sometimes sodium is necessary. The sodium level has to slowly return to normal, or the brain can suffer a severe shock, causing a dangerous condition called demyelination of the brain.
Your question of the underlying condition is the right one, and although sometimes we can't find one, the coughing incident suggests that he might not have swallowed all of his feast correctly. Aspiration of food into the lung causes lung damage, which is a well-known trigger of SIADH. Other triggers include brain issues, like a stroke; some lung tumors; hormone deficiencies (thyroid and cortisone); and certain drugs.
Many experts will get a CT scan of the chest and brain as well as some hormone levels to look for the most common causes of SIADH. In the case of your husband and his severe cough, I think the lungs are the most likely culprit if one can be found.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.