Hyponatremia in the elderly: challenges and solutions

Abstract

Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia and also because of other mechanisms such as the “tea and toast” syndrome. The aim of this review is to present certain challenges in the evaluation and treatment of hyponatremia in the elderly population and provide practical solutions. Hyponatremia in elderly subjects is mainly caused by drugs (more frequently thiazides and antidepressants), the syndrome of inappropriate antidiuretic hormone secretion (SIAD) or endocrinopathies; however, hyponatremia is multifactorial in a significant proportion of patients. Special attention is needed in the elderly population to exclude endocrinopathies as a cause of hyponatremia before establishing the diagnosis of SIAD, which then requires a stepped diagnostic approach to reveal its underlying cause. The treatment of hyponatremia depends on the type of hyponatremia. Special attention is also needed to correct serum sodium levels at the appropriate rate, especially in chronic hyponatremia, in order to avoid the osmotic demyelination syndrome. In conclusion, both the evaluation and the treatment of hyponatremia pose many challenges in the elderly population.

Beverage Type and Hydration Parameters in Older Persons Following a Texture-Modified Diet and Living in Long-term Care Residences

“…Similarly, with other biomarkers of hydration status such as blood sodium (normal values 135-142 mEq/L), only 27% of the analyses showed adequate sodium levels; 40% with a diagnosis of hypernatremia and 33% with hyponatremia. Both situations, hyponatremia and hypernatremia, in addition to increasing health risk, are indicators of hydro-electrolyte imbalance in this population group [14]. Other biomarkers of hydration status, such as haematocrit showed normal values in most of the population (95% CI values between 39.3 and 41.0).…”

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

“…Symptoms typically associated with hyponatremia (including somnolence, headache, nausea, vomiting, convulsion, and partial seizures with secondary generalization) were reported more frequently in patients with the lowest minimum postdose [Na + ] levels (Group A) than in patients with no postdose [Na + ] measurements below 135 mEq/L (Group D) in the adjunctive trials. Similarly, dizziness, nausea, blurred vision, and diplopia were more frequent in patients with a moderate reduction in minimum postdose [Na + ] level (Group B) compared with Group D. In the monotherapy trials, dizziness, nausea, vomiting, fatigue, blurred vision, and nasopharyngitis were more frequent in Group A than in in Group D, and dizziness and nasopharyngitis were more frequent in patients in Group B vs Group D. Overall, somnolence, headache, nausea, and vomiting, all of which can be symptoms of acute hyponatremia, 26 were generally more frequent in patients with low [Na + ] in these trials of ESL, suggesting that [Na + ] ≤125 mEq/L, and even ≤130 mEq/L, may sometimes be symptomatic.…”

Indapamide-induced Severe Hyponatremia in a Middle-aged Male Patient within Two Weeks

“…The body is more prone to have hyponatremia with increasing age and therefore it is commonly seen in the elderly population [2,3,7,9,11,12]. Elderly population often have co-morbid conditions like multiple endocrinopathies, hypothyroidism, heart failure, chronic kidney disease, liver failure, hypertension, diabetes mellitus, multiple medications usage like diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic anti-depressants (TCAs), tea and toast diet with more water and less protein intake from many years and age-related decrease in glomerular filtration rate (GFR), all of which plays a crucial role in causing low sodium state chronically or even acutely [4,12]. On the contrary, our case report is unique as it specifically highlights the association of severe hyponatremia with indapamide to the level of 100 meq/l within two weeks of commencement in a middle-aged man without co-morbid illnesses.…”

“…Thiazide diuretics are commonly prescribed in controlling blood pressure and hyponatremia has been reported in patients receiving diuretics as a natural consequence of the therapy. Few case reports and studies have shown that thiazide or thiazide-like diuretics cause profound hyponatremia (110-125 mmol/l) and most of those cases were attributed to thiazide diuretic usage in females, elderly (≥65 years) and with multiple co-morbid conditions [2][3][4][5].…”