Filling the Gap – Improving Awareness and Practice in Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in the Older Patient: A European Consensus View

Abstract

Causes of hyponatraemia in older patients are multivariate and in the case of SIADH may often be drug induced. Diagnostic and treatment algorithms are unclear for this important age group. The author group identified 6 broad themes for consensus and formulated 42 separate consensus statements within these 6 themes. Statements were then circulated to geriatricians, general practitioners and other doctors to test agreement at the European level. 64 responses were evaluated from around Europe. Agreement was achieved in 86% of the statements following amendment and redistribution of 6 of the statements. The survey and its feedback prompted the development of 13 recommendations related to the diagnosis and treatment of hyponatraemia including SIADH. The series of 13 recommendations developed here is intended to increase clarity for clinicians managing older patients with hyponatraemia and SIADH. Surprisingly, despite the lack of clear guidelines or recommendations for this age group consensus levels for the author-based statements were high among the respondents.

Hyponatremia: Prevalence and characteristics in internal medicine patients in northeast of China

“…Our results for SIADH were similar to previous studies. [20,21] However, our results must be interpreted with caution since we did not have all the data necessary to definitively diagnose SIADH.…”

Diagnosis and management of hyponatraemia in the older patient

“…CNS-active drugs, such as antipsychotics, antidepressants, anticonvulsants, opiates and some cancer drugs, may cause SIADH. 9 Disease processes known to cause SIADH include pulmonary abnormalities (carcinoma, abscess, empyema, pneumonia, etc. ), cerebral space occupying lesions, other CNS disorders and other malignancies.…”

“…The normal serum sodium concentration is 135–145 mmol/L. The cut‐off concentrations for the definitions of mild, moderate and severe hyponatraemia vary slightly between guidelines . Here, we define mild hyponatraemia as sodium concentrations from 130 to 135 mmol/L and moderate hyponatraemia as 125 to 130 mmol/L; 120 to 125 mmol/L is considered moderately severe if there are no acute symptoms, or severe if symptoms are present; hyponatraemia below 120 mmol/L is severe.…”