Hyponatremia has been shown to be associated with gait disturbances, decreased mentation, and falls. The study objective was to determine the incidence of hyponatremia in patients who experienced a substantial skeletal fracture (hip/pelvis/femur). During an 18-month period from March 2007 to August 2008 serum sodium levels were evaluated in 364 cases of bone fracture in patients aged 65 years or older and in 364 nonfracture patients aged 65 years and older seen in an urban emergency room setting. The incidence of hyponatremia in patients with fractures was more than double that of nonfracture patients (9.1% and 4.1%, respectively; P = 0.007). The degree of hyponatremia was noted to be mild to moderate. Mean serum sodium of the entire fracture group was 131 +/- 2 mEq/L. In the fracture group the patients were 75.3% female, while females comprised 66.2% of the nonfracture group (P = 0.02). Of fracture patients with hyponatremia, 24.2% were taking antidepressants [3/4 of which were selective serotonin receptor inhibitors (SSRIs)], while none were taking these medications in the nonfracture group. Attention regarding careful follow-up of serum sodium levels in elderly patients seems appropriate.

We randomized patients with chronic kidney disease (serum creatinine ≥ 1.5 mg/dl or glomerular filtration rate (GFR) <60 ml/min/1.73 m²) in a double-blind fashion to receive saline or sodium bicarbonate prior to and after cardiac or vascular angiography. The primary endpoint was contrast-induced nephropathy (CIN), defined as an increase in serum creatinine by 25% or by 0.5 mg/dl from baseline. Patients with congestive heart failure (CHF), cardiac ejection fraction (EF) <30%, or GFR < 20 ml/min/1.73 m² were excluded. The study was discontinued (after 142 patients were randomized) due to a low incidence of CIN (1.5%). We retrospectively identified all cases of CIN (n = 30) at our institution during the same time period to see if these patients differed from our trial sample. There was no difference in serum creatinine (1.7 ± 0.4 vs. 1.7 ± 0.6 mg/dL), GFR (42.7 ± 9.7 vs. 45.3 ± 3.2 ml/min), incidence of diabetes (51.8% vs. 63.3%), contrast volume (121.7 ± 63.8 vs. 122.7 ± 68.3 ml), ACE inhibitor or angiotensin receptor blocker use (54.0% vs 63.3%), and periprocedure diuretic use (33.1% vs 26.7%). On multivariate analysis, only a cardiac ejection fraction (EF) of less than 40% was significantly associated with CIN (odds ratio, 4.52; 95% confidence interval, 1.30-15.71; P = 0.02). In all, 22/30 patients (73.3%) who developed CIN had at least one or more characteristics that would have excluded their enrollment in our randomized trial including evidence of congestive heart failure (17/30 patients), EF less than 30% (9 patients), age greater than 85 years (2 patients), or advanced renal failure with a baseline GFR of less than 20 cc/min (1 patient). In summary, patients with CKD without evidence of CHF who receive adequate hydration appear to have a very low risk of CIN associated with angiography. A low EF (less than 40%) appeared to be the most significant risk factor for CIN in our population.