Tuesday, April 26, 2011

Dehydration and Low Adrenal Function

(see articles on Fludrocort and Blood Pressure)

People with low adrenal function will need to constantly deal with mild dehydration caused by sodium depletion.

Signs and Symptoms of Adrenal Fatigue
Salt cravings, increased thirst, muscle weakness,
decreased force of heart contractions, irregular heart beat, light-headedness when stand up; lethargy (fatigue or sleepyness).

The Adrenal glands regulate the mineral balances in the body and therefore affect your water balance and blood pressure. If your adrenal function is low, you will not get enough salt into your cells and will build up potassium in your body. You can develop chronic and severe dehydration.

Cortisol effects the cardiovascular system in many ways. It controls the contraction of the walls of arteries which helps regulate blood pressure. If you do not have enough cortisol, then arteries will be relaxed and your blood pressure will be low. Cortisol directly affects the heart. It helps regulate sodium and potassium in the heart cells and increases the strength of contractions of the heart muscle. Calcium and magnesium counter the effects of Cortisol by relaxing muscles.

Aldosterone is the major Mineralocorticoid produced by the adrenal glands. It is responsible for the maintenance of fluid (water)  and electrolyte balance (the mineral balance of sodium, potassium, magnesium and chloride) both within the cells and in the body fluids. Electrolyte balance is essential for proper biochemical reactions within the cells and therefore helps avoid muscle cramping and gives you more energy.

If you adrenal function is low, your aldosterone levels fall and therefore sodium is removed from your bloodstream and excreted in urine taking water with it. Over time you can become  more and more dehydrated. When your blood sodium falls to 50% of normal concentration, even a small loss of sodium can have severe consequences and lead to cell dehydration.

Aldosterone can be replaced if there is a deficiency by taking fludrocortisone . The dose is 0.1 to 0.2 mg of this replacement hormone. It is taken just once a day since it long lasting. If you have normal hydration and do not have orthostatic hypotension (dizzy when stand), then you are taking enough fludrocortisone. If you begin to have high blood pressure (hypertension) you may need to reduce the dosage or starting a nondiuretic antihypertensive. Some clinicians tend to give too little fludrocortisone in an effort to avoid use of antihypertensives. Sometimes an alternating dosage of .1mg one day then .15 the next day may be needed.

Fludrocortisone will need several days to one or two weeks to establish  stable electrolyte, water, and blood pressure levels. Taking your blood pressure several times a day will assist in determining the correct dose. If your blood pressure becomes too high or you begin retaining water, it will take a few days at a lower dose before you will lose the water and  lower your blood pressure.

It is important that you do not skimp on salt in your diet. You might even feel better if you add a little salt to your water. Salt will help to raise blood pressure. If you are struggling with low blood pressure (as most people with low adrenal function are) more salt will help you feel better, help decrease your fatigue, and help restore electrolyte balance within cells.

Monitor your blood pressure and if it rises to over 140/90, then cut back on salt and/or fludrocortisone. You may feel best if you avoid fruit until later in the morning since they are high in potassium. It will also help to rehydrate your body if you drink non-chlorinated water.

The body must have a balance of sodium and potassium. Drinking lots of water can cause the electrolytes in your blood to become diluted since you lose electrolytes in urination. This may make you feel worse. It may help to add 1/4 to 1/2 teaspoon of salt to each glass of water. If you are feeling very fatigued, add more salt to your water. If it makes you feel nauseated, you have too much salt for your body. If you salt your water and food to taste you will get what your body needs. Remember that if you are craving salt, your body needs it. Giving your body the salt it needs,will help you feel better. It is especially helpful to have salted water as soon as you wake up to help you feel better in the mornings, and around 2pm to help avoid afternoon fatigue.

If taking Fludrocortisone, you will need to also take potassium since Fludrocortisone eliminates potassium from your body. Drink water, but not sports drinks which do not have the mineral balance you need and will make your dehydration worse. Electrolyte drinks contain large amounts of potassium, magnesium, chlorine and sodium. They are especially high in potassium and low in sodium which is the opposite of what we need. They also contain sugars.

Fruit juices and soda are high in potassium may further unbalance your potassium/sodium ratio. They will also raise your blood sugar and cause a stress on your body. Since you may not be able to adequately utilize large amounts of sugar, you may end up more dehydrated.  Soda is not a good rehydrating drink.

If you are severely dehydrated, sipping salted water sprinkled with kelp powder which is high potassium and sodium, or salted vegetable juice may help. Within one or two days your hydration and electrolyte balance should be stabilized. You will need to drink salted water two to four times each day and avoid high potassium foods in the morning when your aldosterone levels are low. Alcohol and coffee will deplete electrolytes and should be avoided.


  1. Thanks for the info.

    I notice I feel a lot worse at certain times of the day / week which are matched by a craving for salty food. I will try the salted water approach and see how I get on.

    Still feel a million times better than prediagnosis state of barely existing.

  2. Hope some salt helps you. I've learned to not cut salt and have a little extra when it is really hot. Hope you are feeling better. As you learn what your body needs, you can feel pretty well.

  3. Hi, thanks for your article. I would like to know if taking magnesium tablets could brake mineral balance and make me more dehydrated?

    1. I was wondering the same thing.Did you ever get an answer?

    2. Though you need to have your minerals balanced, I couldn't find and link to dehydration. Your doctor might know.

  4. I always feel very drained when I wake up in the morning and the only way I feel better is to drink a lot of water to rehydrate my body... I'm taking 30mg of cortisol, 75mg of sythroid and 1mcg of fludrocortisone... I rarely crave salts and sometimes have cramps in my feet but its rare. How can I feel better and bounce out of bed instead of having to drag myself awake every morning? Its getting really frustrating.

  5. Corey
    You may not feel really perky in the mornings, but I find some things help me do better in the mornings.

    don't get over tired the day before

    I take a nap in the afternoon

    I go to be at a regular reasonable time

    I drink a large glass of water before bed

    When I get up in the middle of the night, I drink another large glass of water and take a small dose of hydrocortisone

    This helps me to not be as dehydrated and my cortisone to get too low

    Hydrocortisone only has an effective life of a couple of hours

    As I become more rested, I do better in the mornings

    I still can not do anything very active until my morning medication has time to work

    You might want to discuss this problem with your doctor and try taking your medications at different times to see if it helps you feel better in the mornings.

    Hope this helps

  6. I would like you to keep up the good work.You know how to make your post understandable for most of the people.I will definitely share it with others. See more

  7. You are an inspiration. My daughter is 11 and was diagnosed with Addison's just five months ago. This particular blog post has been more helpful than you know! Her waking hours have been tough - dehydrated, headache, dizziness. We will try the water before bed, during the night, and then salt in the morning. Thank you so much!

  8. You will need to discuss her condition with her doctor. Is she on Fludrocort? Most people with Addison's disease need to have fludrocortisone (replaces another adrenal hormone) which controls your mineral and water levels . I had to have both the hydrocortisone to replace the cortisone and manage my blood sugar, but also the fludrocortisone to manage my blood pressure and keep me from becoming seriously dehydrated. People with Addison's Disease can easily go into shock when they become dehydrated. Dehydration can be fatal. Check with your doctor soon. My prayers are with you.

  9. I have had Addisons Disease for 18 years and my salt intake is very important. There are days that's all I crave is salt. I take 1 mg of Fludrocortisone and 20 mg of Hydrocortisone in the morning and 10 mg in the afternoon. One thing I hate is cramping in the legs and feet. Also, I hate the bladder hurting all the time. I need an answer to that. Because sometimes I feel like the only one that has this disease in Wyoming. Doctors sometimes don't know what to do about it. They freak out on my blood pressure and my heart rate because they are so low. Could my bladder hurt due to my meds.

  10. hi , please guys , we people with addison's disease are sooooooooooo little numbred , how about we create a group on facebook and use it to communicate and share help?
    thank you .

    1. Hi. I also just commented on the bloggers article. I am looking for a support system for Addison's as well and am wondering if you or someone has created a Facebook page? I would like to join if so, or would help to maintain the group page if needed. Thank you!

    2. Hi. I also just commented on the bloggers article. I am looking for a support system for Addison's as well and am wondering if you or someone has created a Facebook page? I would like to join if so, or would help to maintain the group page if needed. Thank you!

    3. I am 31 and have had Addison's Disease for 14 years. I agree with everyone that a support page needs to be set up. I am going to open one on Facebook right now!! Look for Addison's Disease Support!!!

  11. Hello. I am trying to find how I can link to your blog and if there was a Facebook Group created? I am trying to learn how to live and cope with Addison's Disease. I live in Ohio and in my city and surrounding area there is not a specialist or an Endocrinologist that knows much about Addison's and how to treat it. I am a week out of the hospital that was thought to have been a stroke but is now contributed to my Addison's. I know I need help but can't seem to find it with the physicians in this area. I have been taking Cortef (Hydrocortisone 5mg) for several years now but whenever I do even a small job (wash dishes for example) I get so sick and exhausted leading me to think the 20 MG of Cortef is not working that well.
    Can you please lead me to a group or a place that might be able to help me live with this?
    Thank you so much and I am very happy I found your blog and article!!

  12. Hi,

    Wondering does anyone here have both Addisons and Diabetes Insipidus as well?


  13. I had trouble with my blood sugar being unstable and it would go down quickly if I didn't eat and and up to 600 after a regular meal. As I stabilized my adrenal function, my blood sugar and blood pressure were also more stable.Every endocrine gland affects the others. It is common for people with Addison's disease to have trouble with more than one endocrine gland such as the thyroid or pancreas glands.

  14. Hello everyone, I am Stef and I am a type 1 diabetic of 30 years (i was 11) and i was diagnosed with Addisons in May 2015. 2 years on I know very little about it and have had very little help from my consultants. Work are trying to force me out too due to my conditions.

    Has a group been set up or is the best place to reach out to people? I want to get more and more help now, as I know so little about the illness. I am on a insulin pump and under active thyroid. For my addisons I take 10mg of Hydro in am, 5mg at lunch, 5mg at 5pm and also floudo 50micro first thing too. I eat a lot of veg and fish and meat. I do drink lots but I'm constantly tired. I had heard Magnesium flakes were good to bathe in - would this help? Did Addisons sufferers need more magnesium?

    Desperate for help and to meet a fellow Addisons sufferer to discuss. Good health to you all. Stef

    1. People will respond to you here, but you might want to also look online for other Addison groups. Be careful. I found that many comments were not backed by research, but by emotionalism. You might want to read my articles and let me know if you have other questions. It might be something I'll want to write an article about or remember from my experiences having Addison's Disease. Since your adrenal glands, thyroid, and pancreas, all interrelate as being part of your endocrine system, you should probably feel better when your adrenal glands receive the support they need by your dose of hydrocortisone. Yes, people with Addison's need magnesium. Discuss this with your doctor. My doctor gave me good vitamin and mineral supplements. Keep a health journal of what you do and how you feel so you can discuss what you need with your doctor. Don't give up. It takes time, but is worth it.

    2. Some evidence supports that your body may absorb a little magnesium through the skin. It may make you feel better, but may not be enough. Discuss this with your doctor.

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  16. Hi Lori Dupuis
    I know your comment was last year but when I asked my dr about 5mg hydrocortisone tablets he said they were available but only very slow release so totally unsuitable for Addison

  17. I cut my 10mg hydrocortisone tablets in half with a pill cutter. Some people do better with slow release meds since it provide more even coverage. You may have to experiment (under the direction of your doctor) and see what works best for you.

  18. Is swimming in a salt water pool good or NOT good for someone with Addisons? My friend just bought a house with one and has been experiencing some brief crisis periods after spending several afternoons in her pool. Does it really DE-hydrate as I have seen on other sites or does the body take in fluids and salt by these swims? What requency of swimming would be ok for her? Daily, tri weekly, weekly? And if it does DE-hydrate, then would drinking water after each swim rebalance the body?

  19. My understanding is that just being in salty water, whether in a pool or the ocean, will not harm you. Drinking salt water can lead to dehydration and is not something you want to do. Exercising and not replacing the water you have lost through activity, heat, and exercising beyond your medicine cover (amount you need to feel ok) could lead to a crisis. She should discuss her problem with her doctor. Addison's Crisis is something you do not take lightly.

  20. I have heard wonderful things about Magnesium for stress,anxiety,and sleeplessness.The problem is,there are SO many different types? Can anyone break it down for me,and perhaps let me know which has worked for them?? I suffer from both a great deal.

  21. It looks like the best magnesium seems to depend on what you are using it for.

    Here are some good articles on the types of magnesium:





    My doctor gave me Magnesium Chelate which is one that is often recommended. I works well for me.

    Ask your doctor which type would be best for you.