Hyponatremia in a Nursing Home Population

Miller, Myron; Morley, John E.; Rubenstein, Laurence Z.

doi:10.1111/j.1532-5415.1995.tb06623.x

Cited by 174 publications

(105 citation statements)

References 31 publications

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“…18 It may therefore be desirable for the abnormality to be corrected, particularly in the susceptible elderly population. 19 The availability of oral vasopressin antagonists provides an effective way to increase serum sodium over the long term. Whether the correction of the hyponatremia will result in decreased hospitalizations and translate into an increase in long-term survival awaits the completion of further studies.…”

Section: Discussionmentioning

confidence: 99%

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia

Berl

Quittnat-Pelletier²,

Verbalis³

et al. 2010

Journal of the American Society of Nephrology

324

228

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Vasopressin antagonists increase the serum sodium concentration in patients who have euvolemia and hypervolemia with hyponatremia in the short term (Յ30 days), but their safety and efficacy with longer term administration is unknown. SALTWATER was a multicenter, open-label extension of the Study of Ascending Levels of Tolvaptan in Hyponatremia (SALT-1 and SALT-2). In total, 111 patients with hyponatremia received oral tolvaptan for a mean follow-up of 701 days, providing 77,369 patient-days of exposure. All patients had hyponatremia at randomization in SALT-1 and SALT-2, and 85% continued to have hyponatremia at entry in SALTWATER. The most common adverse effects attributed to tolvaptan were pollakiuria, thirst, fatigue, dry mouth, polydipsia, and polyuria. Six drug-related adverse effects led to study discontinuation. The increase in serum sodium exceeded the desired 1 mmol/L per h at initiation in five patients. Hypernatremia (Ͼ145 mmol/L) led to discontinuation in one patient. Mean serum sodium increased from 130.8 mmol/L at baseline to Ͼ135 mmol/L throughout the observation period (P Ͻ 0.001 versus baseline at most points). Responses were comparable between patients with euvolemia and those with heart failure but more modest in patients with cirrhosis. In conclusion, prolonged administration of tolvaptan maintains an increased serum sodium with an acceptable margin of safety.

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Section: Discussionmentioning

confidence: 99%

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia

Berl

Quittnat-Pelletier²,

Verbalis³

et al. 2010

Journal of the American Society of Nephrology

324

228

View full text Add to dashboard Cite

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“…Up to 30% of those patients have sodium levels below 135 mEq/L and the number of geriatric patients with hyponatremia may be even higher [1,2]. One study showed that up to 50% of nursing home residents have sodium levels below 130 mEq/L [3]. …”

Section: Introductionmentioning

confidence: 99%

Ticks and salt: an atypical case of neuroborreliosis

Siddiqui

Peter

Marur

2017

Journal of Community Hospital Internal Medicine Perspectives

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It is well documented that central nervous system (CNS) infections may lead to syndrome of inappropriate anti-diuretic hormone secretion (SIADH), but diagnosing these can prove difficult in patients with atypical presentations. We present a case of SIADH and muscle weakness in a patient without typical signs of CNS infection who was tested and diagnosed with neuroborreliosis based largely on her likelihood of exposure. This case indicates the need for Lyme testing in patients with unexplained SIADH who live in endemic areas. The patient was an 83-year-old female with a history of type 2 diabetes and hypertension, who presented from her primary care physician’s office when her sodium was found to be 123 mEq/L. Her sole symptom was proximal muscle weakness. The diagnosis of SIADH was reached based on laboratory data. A trial of fluid restriction was initiated, but neither her sodium nor her muscle weakness improved. Lyme testing was performed as the patient lived in an endemic area and was positive. Lumbar puncture showed evidence of neurologic involvement. After realizing the appropriate treatment for hyponatremia in this case, intravenous ceftriaxone was started, and patient’s sodium levels improved and muscle weakness resolved. Studies show that SIADH is associated with CNS infections, likely related to the inflammatory cascade. However, the atypical presentation of neuroborreliosis for our patient delayed the appropriate diagnosis and treatment. Our case demonstrates the need to screen for Lyme disease in endemic areas in patients presenting with neurologic symptoms and SIADH.

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“…11 Age-related changes and chronic diseases are often associated with abnormalities in water homeostasis. Miller et al 12 have reported that more than 50% of nursing home residents had at least one episode of hyponatraemia over a 12-month study period.…”

Section: Introductionmentioning

confidence: 99%

Hyponatraemia – presentations and management

2017

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Hyponatraemia is the most common electrolyte disturbance encountered in clinical practice. It is associated with signifi cant morbidity and mortality, thus appropriate investigation and treatment is essential. Hyponatraemia presents with a spectrum of clinical presentations ranging from no symptoms to life-threatening neurological sequelae. Hyponatraemia has multiple aetiologies and distinguishing the underlying aetiology facilitates appropriate treatment. This review provides an overview of the presentations and approaches to management of this common clinical condition. IntroductionHyponatraemia (defined as serum sodium <135 mmol/L) is the most common electrolyte abnormality and is encountered in all areas of clinical practice.1 Hyponatraemia is associated with increased morbidity and mortality.2 The assessment of patients with hyponatraemia can pose a clinical challenge and strategies for its management are often suboptimal. In recent years, expert guidance and recommendations have been published that provide an evidence-based approach to diagnosis and treatment of hyponatraemia 3,4 although it should be highlighted that highquality evidence is lacking for many aspects of hyponatraemia management. Additionally, new therapies have emerged promising a more targeted approach to regulating body water and sodium balance in certain patients with hyponatraemia. EpidemiologyHyponatraemia occurs in approximately 15-30% of hospitalised patients, with 1-2% of patients having a serum sodium level <125 mmol/L. 5,6 In addition, hyponatraemia is often underreported in the hospital setting. 7 In the intensive care unit, approximately 25-30% of patients will have a serum sodium <134 mmol/L. 8,9 In neurosurgical units, hyponatraemia is reported in up to 50% of patients with subarachnoid haemorrhage in retrospective 2 and prospective studies.10 Hyponatraemia is also a common occurrence in ABSTRACT Hyponatraemia -presentations and management heart failure with an incidence of approximately 20% in patients hospitalised for heart failure. 11 Age-related changes and chronic diseases are often associated with abnormalities in water homeostasis. Miller et al 12 have reported that more than 50% of nursing home residents had at least one episode of hyponatraemia over a 12-month study period. Morbidity and mortality associated with hyponatraemiaHyponatraemia is associated with increased morbidity and mortality. Acute severe symptomatic hyponatraemia is a medical emergency that carries a high mortality rate if not addressed acutely. A recent prospective observational study found a positive correlation of serum sodium and mortality, with a serum sodium <125 mmol/L associated with a substantial 1-year mortality, recurrence of hyponatraemia and rehospitalisation rate.13 'Asymptomatic' chronic mild hyponatraemia has previously been thought to be clinically insignificant; however, recent evidence shows that mild chronic 'asymptomatic' hyponatraemia, particularly in an older population, may contribute to impaired cognition, 14 increased risk o...

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Hyponatremia in a Nursing Home Population

Cited by 174 publications

References 31 publications

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia

Ticks and salt: an atypical case of neuroborreliosis

Hyponatraemia – presentations and management

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