The remarkable efficiency with which electrolyte homeostasis is restored following a disturbance in electrolyte hemodynamics has been the subject of many important papers (1–6). Much less is known, however, about the ability of the aged person to maintain this homeostasis. Because sodium is the cornerstone of electrolyte balance and imbalance, we decided to investigate the manner in which elderly people cope with both scarcity and abundance of electrolytes in their diets. The roles of calcium and potassium in maintaining electrolyte balance are less well delineated than that of sodium, so calcium and potassium determinations were also included in this study.
The difficulties in interpreting electrolyte homeostasis in the aged are magnified by two factors, a ) the erratic maintenance of sodium and potassium levels in elderly subjects (1) , and b ) the frequency of cerebrovascular disease, which tends to cause either salt wasting ("cerebral salt wasting") or salt hoarding ("cerebral hypernatremia") . Regardless of the effect of aging on the kidney's capacity to handle a surfeit or deficit of electrolytes-a subject SO ably discussed by Behnke (2)-the problem of thirst in an unconscious or semiunconscious person, or even in a conscious person too weak to quench his thirst, adds to the complexity of the interpretation of hyper-or hypo-osmolality.We do not intend to enter into a physiologic or physiopathologic discussion of the mechanisms for cerebral control of extracellular or intracellular water volume and the regulation of sodium balance. The interested reader will find an excellent discussion of this subject by Cort (3) who has contributed so much to the elucidation of this problem. An illuminating description also has been given by Pitts (4). Nonetheless, very little is known concerning the behavior of the elderly person after his recovery from the acute and subacute stages of a cerebrovascular accident. Therefore, we decided to investigate the serum electrolyte levels as well as the urinary excretion of sodium, potassium and calcium in elderly patients about two months after they had suffered a "stroke." MATERIAL AND METHODSThe 14 patients studied (mean age, 82 years) were from the wards of the Hebrew Home for the Aged in Riverdale, N. Y. All were survivors of a "stroke" in the not too recent past. We did not include patients with encephalitis-a recently re-studied cause of cerebral hyponatremia, as described by Rovit and Sigler (5). However, the waiting period of two months eliminated the immediate effect of brain edema upon electrolytes and the extracellular space (6).All the patients underwent a thorough physical examination and also the various laboratory tests that are routine in this institution, e.g., blood count, two-hour postprandial blood sugar concentration, blood urea nitrogen level, urine analysis, chest roentgenogram, and an electrocardiogram. A careful neurologic examination-unfortunately without the benefit of spinal fluid determination-was also performed. The data are included in Table 1. The serum levels of sodium, potassium and calcium and the 24-hour urinary excretion of these electrolytes were also determined.* Attending Physician.
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