Maharashtra, India — After working an hour in a sugar cane field, Shakuntala Admane began to feel the lighthead, but she stuck for another four hours. She then collapsed as the temperature spiked above 104 degrees Fahrenheit (40 degrees Celsius).
Medical testing confirmed that a 60-year-old agricultural worker had hyponatremia. This is a condition in which sodium levels in the blood are too low. If left untreated, hyponatremia can lead to brain swelling, seizures, coma, muscle collapse, and even death.
Admane – from Yadrav, a village in Maharashtra, West India – was not alone. With temperatures rising above 95 F (35 C) in several parts of India between March and May, local health workers said they were beginning to notice many patients coming in with persistent disruption, weakness and seizures.
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“Every day someone collapses on the field,” Admane said.
India has not tracked hyponatremia rates nationwide, but some small studies suggest that the incidence of warm moon conditions in the country is increased.
This observation is not limited to India. Studies around the world have found cases of hyponatremia surged as temperatures rise. The link between hot climates and hyponatremia is particularly pronounced among older adults.
Related: Climate change ruins food faster and makes hundreds of millions of people sick all over the world
This means that as climate change worsens and extreme fevers become more common, cases of hyponatremia also skyrocket.
To avoid a tsunami of severe cases in the coming decades, it is important that people at risk of hyponatremia be better informed about the condition and given tips on how to avoid it, experts told Live Science.
High heat, low sodium
The link between temperature and hyponatremia has been discovered worldwide. A 2024 analysis of the Journal Clinical Endocrinology examined studies conducted in almost 20 countries on six continents and found that high temperatures were consistently associated with low sodium levels.
The study concluded that such cases are likely to rise with global growth and the frequency of extreme thermal events secondary to climate change.
Another 2024 study analyzed records from 2 million patients in Germany between 2000 and 2023. It has been found that cases of hyponatremia have skyrocketed as the fever index. This exceeded the typical level of temperature being a measure of “feeling” when humidity was taken into account.
As a result of climate change, over the past 12 months alone, Germany has experienced almost twice the extreme heat in a climate-free world.
Meanwhile, a Swedish study published in the American Kidney Association Journal in March derives blood test results from all patients who checked sodium levels in Stockholm County between 2005 and 2018. When outdoor temperatures exceeded 68 F (20 C), the Scandinavian country saw a sharp rise in warm cases.
Sweden is also increasing on hot days. And this trend only gets worse. The country’s annual average temperature is projected to increase from 3.6 to 12.6 f (2-7 c) by the end of the century. A 2022 study found that even the lower end of its forecast (an increase of 3.6 F) would promote an almost 14% increase in hyponatremia cases in the country, a 2022 study found.
“Given predictions of further global warming and demographic changes due to aging populations, the estimated prevalence of severe hyponatremia in Stockholm could increase by 66%,” Dr. Buster Mannheimer, a senior lecturer at the Karolinska Institute in Sweden and co-author of both Swedish studies, told Live Science via email.
Globally, the global weather organization report published in May shows that between 2025 and 2029 it could exceed the significant threshold of 2.6 F (1.5 c) for at least one year. That threshold established in the Paris Agreement defines the point at which the likelihood of a catastrophic and irreversible climate collapse dramatically increases. And it comes with more extreme heat waves from around the world.
There are several reasons why high temperatures set the stage of hyponatremia. In that root, hyponatremia is a disproportionate sodium and water level in the body when blood sodium concentrations fall below 135 mm quartile (MEQ/L).
During the hot season, people sweat and cool. In doing so, they drained both water, such as sodium, and electrolytes. If sodium levels in the blood drop too much, the body usually counteracts this imbalance by washing away water in the urine. However, if your blood volume is also low, your body is at risk of dehydration, so your body releases hormones and retains water. This water retention can exacerbate sodium imbalances.
Risk factors
Common drugs can exacerbate this thermal hyposotrimere feedback loop by often causing the release of a hormone that is fueled by water retention. In a 2018 paper published in the Journal of Clinical Endocrinology and Metabolism, researchers noted that individuals taking diuretics (drugs that help the body eliminate excess water to flush out electrolytes) are more likely to develop hyponatremia during hot climates in the heat.
At higher outdoor temperatures, a combination of diuretic use, sweating, hypofluidity and electrolyte intake could increase the risk of hyponatremia, the researchers wrote in their paper.
Dr. Kai Kappad, professor of medicine at the University of Charite in Berlin and one of the authors of the German study, agreed. In an email, he told Live Science that the electrolyte imbalance caused by heat can be exacerbated by people rehydrating with low-sodium liquids such as water.
Mannheimer told Live Science that older people and frail people are more likely to develop hyponatremia because they have other medical conditions and are more likely to take prescribed medications. Beyond diuretics, other common drugs such as antidepressants, antipsychotics, and anticonvulsants can also increase the risk of this condition.
“During periods of high temperatures can be seen as another factor that adds to the increased overall risk that could disproportionately affect older adults,” Mannheimer said.
At baseline, aging can also reduce the body’s ability to deal with heat and eliminate excess water.
Furthermore, health issues that are common in geriatric age, such as kidney disease, infections, and cancer, can put the elderly at risk of hyponatremia. It is because it impairs the body’s ability to regulate water and sodium, either through direct kidney effects or by causing hormonal and metabolism changes that destroy body fluid balance.
What can you do?
As one in six people worldwide, or about 1.4 billion, by 2030, will be over 60 years old by 2030, and as the planet continues to warm, many individuals become vulnerable to hyponatremia.
Mannheimer suggested that a system should be developed to warn people during the heat wave and provide appropriate lifestyle advice to help them deal with it.
“When you consider the underlying cause [of hyponatremia] He is water retention and in most cases advocating high liquid intake noncritically would have a direct counterproductive effect,” he said. Instead, he advocated a balanced approach to liquid intake.
Coppert emphasized that the public should be notified of an increased risk of hyponatremia during heat waves and suggested that people take precautions to reduce heat exposure. It is challenging for farm workers like Admane, who have to struggle for hours in the field to achieve their goals.
And as the climate warms, it becomes a bigger problem.
Five years ago, Admane was able to work at least 8 hours a day without any problems.
Now, “If I’m working in the field in extreme heat today, I won’t be able to work the next day. First, I have to take the medicine or electrolyte solution given to me intravenous drip. “Now, it’s become difficult to even work for four hours.”
Admane’s daughter, Jayashree Pandav, 40, lives and works with her and has experienced episodes of hyponatremia over the past year. She works at least 10 hours a day in the field, but recently she has become more difficult for her to manage.
“Frequent doctor visits are now a common part of the lives of all farm workers,” she told Live Science.
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