Diagnosis and management of hyponatraemia in the older patient

Abstract

Hyponatraemia (serum sodium concentration below 135 mmol/L) is the most common electrolyte disturbance and occurs commonly in older people. The causes can be complex to diagnose and treat and many published guidelines do not focus on the issues in an older patient group. Here, we are principally concerned with diagnosis and management of euvolaemic and hypervolaemic hyponatraemia in hospitalised patients over 70 years old. We also aim to increase awareness of hyponatraemia in residential aged care facilities and the community. Hyponatraemia can have many causes; in older people, chronic hyponatraemia can often be the result of medications used to treat chronic disease, particularly thiazide or thiazide-like drugs (such as indapamide) or drugs acting on the central nervous system. Where a reversible trigger (such as drug-induced hyponatraemia) can be identified, hyponatraemia may be treated relatively simply. Chronic hyponatraemia due to an irreversible cause will require ongoing treatment. Fluid restriction can be an effective therapy in dilutional hyponatraemia, although poor compliance and the burdensome nature of the restrictions are important considerations. Tolvaptan is an oral vasopressin receptor antagonist that can increase serum sodium concentrations by increasing electrolyte-free water excretion. Tolvaptan use is supported by clinical trial evidence in patients with hypervolaemic or euvolaemic hyponatraemia below 125 mmol/L. Clinical trial evidence also supports its use after a trial of fluid restriction in patients with symptomatic hyponatraemia above 125 mmol/L. The use of tolvaptan is affected by regulatory restriction of chronic therapy due to safety concern and the non-subsidised cost of treatment.

Serum sodium levels and related treatment‐emergent adverse events during eslicarbazepine acetate use in adults with epilepsy

“…To gain further understanding of the types of patients who had hyponatremia during the ESL trials, we examined patient age, concomitant use of CBZ, OXC, and sodium‐wasting medications, and seizure frequency in all patients who experienced hyponatremia (patients with a hyponatremia‐related TEAE or a [Na + ] measurement ≤125 mEq/L). First, despite the general acceptance that older patients are at particular risk of hyponatremia, we found that only 6 of 55 patients with hyponatremia in the controlled trials were 60 years of age or older (of a total of 80 patients aged ≥60 years). In addition, only 3 of 31 patients (10%) with hyponatremia in the adjunctive trials were also taking a sodium‐wasting medication, compared with 7 of 24 (29%) patients with hyponatremia in the monotherapy trials, suggesting that (in the monotherapy trials at least) concomitant use of SSRIs or thiazides may have been associated with the onset of hyponatremia.…”

Hyponatraemia – drug-related side effect in older adults

“…Hiponatremia, definiowana jako stężenie sodu w surowicy krwi < 135 mmol/l, jest najczęściej spotkanym w praktyce klinicznej zaburzeniem gospodarki wodno-elektrolitowej [3,4,6,9,11,16]. Hiponatremia występuje u około 15-20% pacjentów hospitalizowanych ze wskazań nagłych i nawet do 20% pacjentów w stanie krytycznym.…”

“…Istnieje wiele danych na temat występowania hiponatremii po zastosowaniu selektywnych inhibitorów wychwytu zwrotnego serotoniny (SSRI) [3,6,8,9,17,31,33]. Najwięcej przypadków odnotowano po fluoksetynie (75,3%), paroksetynie (12,4%) i sertralinie (11,7%) [3,33].…”

Investigation and treatment of hyponatraemia in hospital patients

“…1 Of interest, Woodward et al discuss the importance of correct investigation and management of hyponatraemia in older people. 1 Of interest, Woodward et al discuss the importance of correct investigation and management of hyponatraemia in older people.…”

“…We read with interest the recently published article by Woodward et al entitled 'Diagnosis and management of hyponatraemia in the older patient'. 1 Of interest, Woodward et al discuss the importance of correct investigation and management of hyponatraemia in older people. We observed in our recent audit of inpatient hyponatraemia investigation and management that it was most prevalent in older people, with 50% of inpatients identified with hyponatraemia being over 80 years old.…”