Hyper and hyponatremia are common clinical problems. Sodium disorders are associated with an increased risk of morbidity and mortality. Management of abnormalities in water homeostasis is frequently challenging. Pdf hypernatremia in the geriatric population researchgate. Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql.
They significantly contribute to hospital morbidity and mortality 1, 46. Hyponatremia is a medical condition characterized by low concentration of sodium in the blood. Three scenarios illustrate the possible relationships between hyponatremia and mortality. This complication can be serious, with delirium, seizure, or even death. Pdf disorders of sodium imbalance are commonly encountered in clinical. Hospitalized elderly patients and frail nursing home residents are at an increased risk for the development of hypernatremia because they rely on others for their water needs. Early recognition of hyponatremia and hypernatremia can provide a clue to an. The day of admission coincided with the patients onset of menstrual bleeding. Hyponatremia and hypernatremia symptom to diagnosis. Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. Treatment of severe hyponatremia kidney international. Learn what the difference is between these two common disorders. Hyponatremia is defined as serum sodium concentration hyponatremia is long but the diagnostic approach can be easily framed in a few simple steps.
Hyponatremia and hypernatremia in the elderly american. Dehydration is defined as a decline in total body water and can be caused by. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Hypernatremia in critically ill patients emcrit blog. Hyponatremia widely affects the geriatric age group, especially hospitalized elderly patients. Pdf hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. In the classic study by fabian et al,1 paroxetine, a selective serotonin reuptake inhibitors ssri, was found to induce hyponatremia in 12% of elderly patients within a mean duration of 9 days.
See general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema. 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. Recent evidence highlights that even mild, chronic hyponatremia can lead to cognitive impairment, falls and fractures, the latter being in part due to bone demineralization and reduced bone quality. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. Know the causes, symptoms, and treatment of hyponatremia in elderly.
An elderly patient with chronic hyponatremia american society of. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Hypernatremia can also be seen among hospitalized patients, especially intubated patients in. Euvolaemic hyponatremia is the most common category of hyponatremia seen in hospital inpatients. Hyponatremia is the most common electrolyte disorder. One week prior to admission, the patient had rhinitis. The lower the sodium and the faster the fall, the more symptomatic a patient will become. One of these patients had the highest serum sodium level 202 meql reported in an adult. Unlike hyponatremia, hypernatremia is always associated with serum hyperosmolality.
Hyponatremia is defined as a serum sodium concentration of less than 7 meq per l 7 mmol per l. In hyponatremia, one or more factors ranging from an underlying medical condition to drinking too much water cause the sodium in your body to become. Older people are predisposed to developing hypernatremia because of agerelated physiologic changes such as decreased thirst drive, impaired. Severe symptoms include confusion, seizures, and coma. Hyponatremia and hypernatremia are common in the elderly, particularly among those who are hospitalized or living in longterm care facilities.
Age, race and diet are certain factors which affect ones chance of getting hyponatremia. Elderly persons have decreased thirst, and therefore, ingest less amounts of water than their younger counterparts. Prevalence of mild hyponatremia and its association with falls in. Hyponatremia is a low sodium concentration in the blood. Hypernatremia represents a deficit of water relative to sodium and can result from a number of causes, including free water losses, inadequate free water intake, and, more rarely, sodium overload. Hyponatremia associated with longterm medication use in the elderly. Acute symptomatic hypernatremia, defined as hypernatremia occurring in a period of less than 24 hours, should be corrected rapidly.
Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Abnormalities in water balance are manifested as sodium disturbances hyponatremia and hypernatremia. Antidepressants and hyponatremia the american journal of. Dehydration, hypernatremia, and hyponatremia request pdf. Less than 20% of hyponatremic patients had their sodium level checked. Prognostic and predictive role of hyponatremia in cancer. Hyponatremia is most frequently caused by an excessive supply of water rather than by a reduced sodium intake, while hypernatremia is most. Disorders of serum sodium concentration in the elderly patient. Older adults appear to be at highest risk, as most case reports are in patients age. Hypernatremia is defined as a serum sodium concentration greater than 145 meql. Older people are predisposed to developing hypernatremia because of age related physiologic changes such as decreased thirst drive, impaired. Hypernatremia serum sodium concentration 145 meql is a common electrolyte disorder and is especially common among elderly institutionalized individuals.
Hyponatremia as a prognostic and predictive factor in cancer patients. The increased risk of bone fracture in elderly patients with hyponatremia may not only be due to the increased risk of falls, but also due to the effects hyponatremia has on bone mineral density and the increased risks for osteoporosis. Hyponatremia in elderly subjects is mainly caused by drugs more. Do you worry about these elderly patients becoming hypernatremic. In the first scenario, hyponatremia is a direct cause of death. Hyponatremia is the most common electrolyte disorder in older adults. An elderly patient with chronic hyponatremia american. The reasons for the increased incidence and prevalence of hyponatremia. Hyponatremia and hypernatremia are classified based on volume status hypovolemia, euvolemia, and hypervolemia. The cause for hyponatremia in elderly can be multifactorial, ranging from diminished thirst, agerelated decrease in total body water and reduction in glomerular filtration rate due to the.
Examples include hyponatremia leading to cerebral edema in acute hyponatremia and the osmotic demyelination syndrome when chronic hyponatremia is corrected too rapidly. It is well known that antidepressants can cause hyponatremia, particularly in elderly patients. Sodium disorders are associated with an increased risk. This is different from hypovolemia, in which both salt and water are lost. In both children and adults, hypernatremia is seen primarily in persons with restricted access to water for a variety of reasons e. The agerelated decrease in totalbody water relative and absolute makes elderly persons markedly susceptible to stresses on water balance. Physiological basis most prevalent cation in ecfnormal level of around 5 145 mmoll. In this attending rounds, an illustrative patient with hyponatremia is presented. Other electrolyte disorders that impair the kidney concentrating ability frequently are observed. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established.
Symptoms are often vague and nonspecific presenting as headache, irritability, lethargy, confusion, agitation or unstable gait leading to a fall. Hyponatremia and hypernatremia may result from changes in water balance in the body and sodium levels in the blood. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Acquired hypernatremia is an independent predictor of mortality in critically ill patients. Psychotropics are a relatively common cause of hyponatremia, specifically siadh. Hypernatremia symptoms, diagnosis and treatment bmj. Adipsic hypernatremia complicated by hyponatremia pdf.
However, hyponatremia occasionally may develop in the course of treatment with. Hypernatremia due to water loss is called dehydration. Hyponatremia defined as a serum sodium level hyponatremia. The pain was associated with nausea, vomiting, and an inability to eat or hold down fluids. Hyponatremia is a complex medical complication that can be lifethreatening. Hyponatremia and hypernatremia by dr hasen ali mia 1st year pgt at nbmch 2. Recently, serious sequels associated with hyponatremia and variations in sodium concentration in preterm infants have been reported 67. Frequency and timing of hypernatremia in critically ill patients traditionally, hypernatremia has been considered to be mainly a problem of the elderly or infants with diarrhea 1,7,8.
Hyponatremia is usually defined as a plasma sodium level hyponatremia results from the inability of the kidney to excrete a sufficient amount of fluid, or is due to excessive fluid intake. Hyponatremia during rehydration is an unusual feature of this case, and has previously been convincingly reported in one patient with adipsic hypernatremia. Hypernatremia is a common occurrence in elderly patients. These can be divided into several major etiologic groups but this is beyond the scope of this article. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Because agerelated changes and chronic diseases are often associated with impairment of water metabolism in elderly patients, it is absolutely essential for clinicians to be aware of the pathophysiology of hyponatremia and hypernatremia in the elderly. Older people are predisposed to developing hypernatremia because of agerelated physiologic changes such as decreased thirst drive, impaired urinary concentrating ability, and reduced total body water. Hyponatremia is a common, multifactorial clinical condition. The fda has mandated that tolvaptan be initiated in the hospital. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients devel. Age and gender as risk factors for hyponatremia and hypernatremia. Psychotropicinduced hyponatremia mdedge psychiatry. Dehydration, hypernatremia, and hyponatremia clinics in geriatric. A 31yearold white woman was admitted to the hospital because of diffuse cramping abdominal pain.
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