Hyponatremia is defined as serum sodium concentration hyponatremia is long but the diagnostic approach can be easily framed in a few simple steps. Age, race and diet are certain factors which affect ones chance of getting hyponatremia. Sodium disorders are associated with an increased risk. Learn what the difference is between these two common disorders. Hyponatremia and hypernatremia are classified based on volume status hypovolemia, euvolemia, and hypervolemia. These can be divided into several major etiologic groups but this is beyond the scope of this article. Hyponatremia and hypernatremia by dr hasen ali mia 1st year pgt at nbmch 2.
Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Recently, serious sequels associated with hyponatremia and variations in sodium concentration in preterm infants have been reported 67. Adipsic hypernatremia complicated by hyponatremia pdf.
An elderly patient with chronic hyponatremia american. 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. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. 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.
Three scenarios illustrate the possible relationships between hyponatremia and mortality. Examples include hyponatremia leading to cerebral edema in acute hyponatremia and the osmotic demyelination syndrome when chronic hyponatremia is corrected too rapidly. Hyponatremia defined as a serum sodium level hyponatremia. Hypernatremia serum sodium concentration 145 meql is a common electrolyte disorder and is especially common among elderly institutionalized individuals. Other electrolyte disorders that impair the kidney concentrating ability frequently are observed.
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. Symptoms are often vague and nonspecific presenting as headache, irritability, lethargy, confusion, agitation or unstable gait leading to a fall. Abnormalities in sodium concentration may be discovered at hospital admission, but more frequently develop during hospital stay 14. Treatment of severe hyponatremia kidney international. The fda has mandated that tolvaptan be initiated in the hospital. Acquired hypernatremia is an independent predictor of mortality in critically ill patients. Hyponatremia is the most common electrolyte disorder in older adults. 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. Hypernatremia due to water loss is called dehydration. 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. Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality.
Hypernatremia can also be seen among hospitalized patients, especially intubated patients in. 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. Hypernatremia is a common occurrence in elderly patients. Dehydration, hypernatremia, and hyponatremia clinics in geriatric. Unlike hyponatremia, hypernatremia is always associated with serum hyperosmolality. The agerelated decrease in totalbody water relative and absolute makes elderly persons markedly susceptible to stresses on water balance. 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.
It is well known that antidepressants can cause hyponatremia, particularly in elderly patients. Age and gender as risk factors for hyponatremia and hypernatremia. 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. One of these patients had the highest serum sodium level 202 meql reported in an adult. Hyponatremia during rehydration is an unusual feature of this case, and has previously been convincingly reported in one patient with adipsic hypernatremia. Hypernatremia symptoms, diagnosis and treatment bmj. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. The overall mortality of 48 percent was not related to the degree of hypernatremia.
Management of abnormalities in water homeostasis is frequently challenging. One year of data for 5635 patients aged 65 years was extracted from the data. Older people are predisposed to developing hypernatremia because of age related physiologic changes such as decreased thirst drive, impaired. The day of admission coincided with the patients onset of menstrual bleeding. Abnormalities in water balance are manifested as sodium disturbances hyponatremia and hypernatremia. This is different from hypovolemia, in which both salt and water are lost. Pdf hypernatremia in the geriatric population researchgate. Less than 20% of hyponatremic patients had their sodium level checked. Hyponatremia is most frequently caused by an excessive supply of water rather than by a reduced sodium intake, while hypernatremia is most. Early recognition of hyponatremia and hypernatremia can provide a clue to an. Chronic hypernatremia, however, should be corrected more slowly due to the risks of brain edema during treatment treatment guidelines of symptomatic hypernatremia. Acute symptomatic hypernatremia, defined as hypernatremia occurring in a period of less than 24 hours, should be corrected rapidly. However, hyponatremia occasionally may develop in the course of treatment with. 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.
Physiological basis most prevalent cation in ecfnormal level of around 5 145 mmoll. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients devel. Hyper and hyponatremia are common clinical problems. Hypernatremia is a common disorder of elderly hospitalized patients, associated with high mortality and morbidity. Hyponatremia and hypernatremia symptom to diagnosis. Prognostic and predictive role of hyponatremia in cancer. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. Know the causes, symptoms, and treatment of hyponatremia in elderly.
Prevalence of mild hyponatremia and its association with falls in. Hyponatremia and hypernatremia are classified based on volume. The reasons for the increased incidence and prevalence of hyponatremia. They significantly contribute to hospital morbidity and mortality 1, 46.
Antidepressants and hyponatremia the american journal of. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. An elderly patient with chronic hyponatremia american society of. Hyponatremia and hypernatremia in the elderly american. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Dehydration, hypernatremia, and hyponatremia request pdf. This complication can be serious, with delirium, seizure, or even death. Pdf disorders of sodium imbalance are commonly encountered in clinical. 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. Hyponatremia is a medical condition characterized by low concentration of sodium in the blood. In the first scenario, hyponatremia is a direct cause of death. Older people are predisposed to developing hypernatremia because of agerelated physiologic changes such as decreased thirst drive, impaired. 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.
Hyponatremia is a complex medical complication that can be lifethreatening. Hyponatremia and hypernatremia may result from changes in water balance in the body and sodium levels in the blood. Hypernatremia is defined as a serum sodium concentration greater than 145 meql. The pain was associated with nausea, vomiting, and an inability to eat or hold down fluids. Disorders of serum sodium concentration in the elderly patient. Hyponatremia associated with longterm medication use in the elderly.
Psychotropics are a relatively common cause of hyponatremia, specifically siadh. The lower the sodium and the faster the fall, the more symptomatic a patient will become. Hypernatremia hypernatremia is a common occurrence in elderly patients. 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. See general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema.
In both children and adults, hypernatremia is seen primarily in persons with restricted access to water for a variety of reasons e. Pdf hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. A 31yearold white woman was admitted to the hospital because of diffuse cramping abdominal pain. Hyponatremia is a low sodium concentration in the blood. In this attending rounds, an illustrative patient with hyponatremia is presented. One week prior to admission, the patient had rhinitis. Elderly persons have decreased thirst, and therefore, ingest less amounts of water than their younger counterparts. Do you worry about these elderly patients becoming hypernatremic. Sodium disorders are associated with an increased risk of morbidity and mortality. Older adults appear to be at highest risk, as most case reports are in patients age.
Hyponatremia is the most common electrolyte disorder. Hyponatremia is defined as a serum sodium concentration of less than 7 meq per l 7 mmol per l. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Euvolaemic hyponatremia is the most common category of hyponatremia seen in hospital inpatients. Psychotropicinduced hyponatremia mdedge psychiatry. Hyponatremia widely affects the geriatric age group, especially hospitalized elderly patients. Hyponatremia in elderly subjects is mainly caused by drugs more. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. Hyponatremia as a prognostic and predictive factor in cancer patients. Dehydration is defined as a decline in total body water and can be caused by. Hypernatremia in critically ill patients emcrit blog.
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