ORIGINAL ARTICLE: Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome

Shapiro, Dvorah Sara; Sonnenblick, M; Galperin, Ilia; Melkonyan, L.; Munter, Gabriel

doi:10.1111/j.1445-5994.2010.02217.x

Cited by 75 publications

(70 citation statements)

References 28 publications

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“…Of 1400 elderly ($65 years) patients admitted to an Israeli hospital, 6.2% had such a disorder (4). The increasing prevalence of hyponatremia with age is best illustrated in an analysis of .300,000 samples obtained from .120,000 patients of various ages (5).…”

Section: Question 1 How Common Is Chronic Hyponatremia In the Elderly?mentioning

confidence: 99%

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An Elderly Patient with Chronic Hyponatremia

Berl

2013

Clinical Journal of the American Society of Nephrology

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SummaryHyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this Attending Rounds, an illustrative patient with hyponatremia is presented. The reasons for the increased incidence and prevalence of hyponatremia in the elderly are discussed, with emphasis on the effects of aging on urinary dilution, the frequently multifactorial nature of hyponatremia in this population, and the absence of a definite cause for inappropriate and persistent vasopressin release in many such patients. The rationale for treating the hyponatremia, even when apparently asymptomatic, is discussed, with attention to cognitive function, gait, and bone structure disturbances that increase the risk for fractures. The various available treatment approaches, including water restriction, demeclocycline, loop diuretics with NaCl supplementation, urea, and vasopressin antagonists are summarized, with emphasis on the efficacy and limitations of each of these therapies.Clin J Am Soc Nephrol 8: 469-475, 2013469-475, . doi: 10.2215 Case Description L.G. is a 73-year-old woman referred for management of chronic hyponatremia. She was known to have had hyponatremia for several years, with serum sodium levels in the range of 121-127 mEq/L. She has had four pulmonary bacterial infections during the last 7 years and was found to have radiologic evidence of bronchiectasis. She has also had several episodes of transient cerebral ischemia leading to numbness and weakness. In the last year she has had increased gait instability and sustained a fall that resulted in a pelvic fracture. She had no history of cardiac or liver disease. She has long-standing rheumatoid arthritis. Medications included omeprazole, 20 mg daily; conjugated estrogens (Premarin), 0.3 mg daily; folic acid, 0.4 mg three times daily; aspirin, 81 mg daily; and monthly vitamin B 12 injections. On physical examination she appeared to be a fragile elderly woman in no acute distress. BP was 148/78 mmHg, pulse rate was 98 beats/min, and she weighed 65 kg. She appeared to be euvolemic by examination. There were deformities of the proximal interphalangeal joints. Her neurologic examination revealed that she was fully oriented, with no focal findings, but she had an obvious gait disturbance that necessitated a walker for ambulation. Laboratory results were as follows: serum sodium, 124 mEq/L; chloride, 95 mEq/L; potassium, 4.1 mEq/L; bicarbonate, 22 mEq/L; creatinine, 0.7 mg/dl; glucose, 66 mg/dl; and uric acid, 3.8 mg/dl. Urinary sodium concentration was 75 mEq/L with a urine osmolality of 382 mOsm/kg. Result of a cosyntropin stimulation test was normal, with a baseline cortisol level of 9.2 mg/dl and a stimulated level of 18.7 mg/dl. Thyroid-stimulating hormone was normal at 3.29 mIU/L. Magnetic resonance imaging of the brain and pituitary revealed no significant abnormalities. DiscussionGiven the absence of liv...

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Section: Question 1 How Common Is Chronic Hyponatremia In the Elderly?mentioning

confidence: 99%

“…Chronic hyponatremia is frequently multifactorial in the elderly (4,8). In one observational study, more than half of the patients with hyponatremia had more than one cause for the condition.…”

Section: Question 1 How Common Is Chronic Hyponatremia In the Elderly?mentioning

confidence: 99%

An Elderly Patient with Chronic Hyponatremia

Berl

2013

Clinical Journal of the American Society of Nephrology

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“…[21] SIADH was found in only 4.2% patients in our study in contrast to nearly half of the patients studied by Clayton et al [6] A study from Israel concluded that cause of hyponatremia in elderly is multifactorial and reported SIADH in nearly 45% of patients. [24] However, Sozio et al challenged the study on the premise that the diagnosis of SIADH is largely dependent on assessment of volume status of the patients and no marker can assess the volume status of the elderly patients reliably. [25] Most of the previous studies have hinted towards higher mortality due to hyponatremia ranging from 33% to 86%.…”

Section: Discussionmentioning

confidence: 99%

“…Common causes of hyponatremia in geriatric hospitalized patients include drugs (thiazide and loop diuretics, proton pump inhibitors, non steroidal anti-inflammatory agents), co-existing morbidities (congestive cardiac failure, chronic kidney disease, chronic liver disease, respiratory infections, volume overload and dehydration etc. [5][6][7][8][9][10] The most important cause of euvolemic hyponatremia in the elderly is Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) often over diagnosed as the elderly are often dehydrated. [11] With the increase in the proportion of the population that is nearing the age of 60 years or above, paucity of data on major health issues in local population plague proper planning and management.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia in Elderly – Its Prevalence, Aetiology and Outcome

Kaeley¹,

Akram²,

Ahmad³

et al. 2017

AIMDR

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Background:The most common electrolyte disorder in geriatric age group is hyponatremia thought to be responsible for increased mortality. Lack of data on the prevalence, etiology and outcome of hyponatremia in the elderly from the state of Uttarakhand led us to investigate the same on the elderly hospitalised in a tertiary care hospital in the state of Uttarakhand. Aims and Objectives: The purpose of the study was to find out the prevalence of hyponatremia in geriatric population, its etiology and outcome in elderly population. Methods: This cross sectional observational study was carried on 526 elderly patients admitted in a tertiary care hospital over a period of 1-year. Demographic, clinical and outcome data of the elderly patients with hyponatremia was collected and efforts were made to elicit its etiology. Results: 240 of 526 elderly hospitalized were found to have hyponatremia; 136 (56.6%) were females. Diuretics were found to be the most common cause of hyponatremia, detected in 82 (34.2%) patients, of whom 28(27.1%) were hypovolemic and 54(56.8%) hypervolemic. Other potential causes of hyponatremia included respiratory infections (n=57, 23.7%), chronic liver disease (n=34, 14.1%), syndrome of inappropriate anti-diuretic hormone SIADH (n=10,4.1%), malignancy (8.2%), low sodium diet (n=10,4.1%) and congestive heart failure (n=22,9.2%). Diabetes mellitus (33.7%) and hypertension (27.9%) were the most common co-morbidities associated with hyponatremia. Severe neurological manifestations were detected only in 25(10.4%) while the majority was asymptomatic or had minor symptoms pertaining to hyponatremia. Seventeen (7.1%) patients with moderate (n=12) and severe (n=5) hyponatremia succumbed. Conclusion: Hyponatremia is the major electrolyte disorder of the elderly, specially the females. It contributes to morbidity and mortality, however, the severity of hyponatremia is not related to an increase in mortality.

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“…Especially antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), entail a fivefold risk for hospital admission subsequent to hyponatremia (2).…”

Section: Hyponatremia Is a Common Causementioning

confidence: 99%