Get a printable copy pdf file of the complete article 604k, or click on a page. We define acute hyponatraemia as hyponatraemia that is documented to exist the number offrati elderly requiring expert nursing care continues to rise, the problem of fluid volume deficit remains relatively unaddressed in the nursing. Hyponatremia is the most common electrolyte disorder. Hyponatremia in elderly subjects is mainly caused by drugs more frequently thiazides and antidepressants, the syndrome of inappropriate antidiuretic hormone secretion siad or endocrinopathies. Pdf hyponatremia and hypernatremia are disorders of water balance and are very. And in hypernatremia, a deficit of water in the body can lead to a high concentration of sodium in the blood. Hypernatremia that has occurred within the last 24 hours should be corrected over the next 24 hours. In severe circumstances, an iv drip may be administered. Hyponatremia and hypernatremia are disorders of water balance and are very common especially in. Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors.
However, hyponatremia occasionally may develop in the course of. 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. Sodium disorders are associated with an increased risk of morbidity and mortality. Special attention is also needed to correct serum sodium levels at the appropriate rate, especially in chronic hyponatremia, in order to avoid the. Severe hyponatraemia in elderly hospitalized medical patients is more frequent in women and of multifactorial aetiology in 50% of cases. Hyponatremia and hypernatremia are classified based on volume status hypovolemia, euvolemia, and hypervolemia.
Desmopressin leads to renal water retention, and iatrogenic hyponatremia may result if fluid intake is not appropriately restricted. An increased prevalence of hyponatremia has been shown in the presence of comorbid condition, although very few studies include uptodate information on the relationship between severity of hyponatremia and comorbidity. The mortality rate for chronic hypernatremia 24 hrs is approximately 10%, however, the mortality rate for severe acute hypernatremia hyponatremia as a prognostic and predictive factor in cancer patients. Hyper and hyponatremia are common clinical problems. Hypernatremia can also be seen among hospitalized patients, especially intubated patients in the intensive care unit without access to water. An elderly patient with chronic hyponatremia american society of. Hypernatremia due to hypovolemia in dementia renal and. See general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients devel. Certain drugs eg, diuretics, antidepressants, and antiepileptics have been implicated as established causes of either asymptomatic or symptomatic hyponatremia.
Whereas in hyponatremia, low concentrations of plasma sodium drive water into brain. Antidepressants and hyponatremia the american journal of. Clinicoetiological profile of hyponatremia in patients admitted in intensive care unit of tertiary health care rural center authors dr. Perioperative care and preoperative evaluation of the older patient 16. Elderly persons have decreased thirst, and therefore. Major function of sodium is to maintain ecf volume and thus bp. Diagnosis and management of disorders of body tonicity. I have a 95 year old nursing home patient jessie with a serum sodium level. Abnormalities in water balance are manifested as sodium disturbanceshyponatremia and hypernatremia. Hyponatremia is common in elderly people, especially those who are hospitalized or living in nursing homes. Hyponatremia is the most common electrolyte disorder in older adults. Clinicoetiological profile of hyponatremia in elderly international.
Even with severe hyponatremia, serum sodium concentration should not be increased by more than 8 meql over the first 24 hours. Adipsic hypernatremia complicated by hyponatremia pdf. Chapter 210 hypernatremia and hyponatremia terry mahan buttaro specialist referral is indicated for serum sodium levels of less than 125 meql or more than 155 meql. Hypovolemia is a common cause of hypernatremia in elderly. Hyponatraemia is associated with osteoporosis, impaired balance, falls, hip fractures and cognitive.
In addition to the symptoms of diabetes insipidus, people who have hypernatremia may experience a feeling of weakness in their muscles, irritability, fever, and general restlessness. An elderly patient with chronic hyponatremia american. Toorapid correction of hyponatremia risks neurologic complications, such as osmotic demyelination syndrome. Dehydration, hypernatremia, and hyponatremia clinics in geriatric. Hypernatremia is most commonly associated with dehydration from gastroenteritis. Dehydration is defined as a decline in total body water and can be caused by.
Patients with hyponatremia and hypernatremia may also have complaints related to concurrent volume depletion and possible underlying neurologic diseases. In the first scenario, hyponatremia is a direct cause of death. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday. The sensation of thirst, renal function, concentrating abilities. Hypernatremia affects people of all ages but is one of the more common electrolyte disorders seen in children and older adults. Hyponatremia and hypernatremia are common electrolyte disorders and are associated with increased morbidity and mortality. Deoke4 1senior resident, 2professor and hod, 3junior resident, 4associate professor. Both hyponatremia and hypernatremia can cause substantial morbidity and mortality, and ironically, incorrect treatment can add to the problem. In acute hypernatremia, the serum sodium can be corrected by 46 meql until near normal. Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased. They significantly contribute to hospital morbidity and mortality 1, 46. Hyponatremia is defined as a serum sodium concentration of less than 7 meq per l 7 mmol per l.
The most common cause of severe hypernatremia in the emergency department is an elderly patient with dementia who has difficulty eating and drinking. This complication can be serious, with delirium, seizure, or even death. 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. Nov 15, 20 the treatment of hyponatremia involves the removal of free water, treatment of underlying causes, and use of saline infusion. Hypernatremia is a common occurrence in elderly patients. Use of desmopressin 1deamino8darginine vasopressin.
It is estimated that nearly 7 percent of healthy elderly persons have serum sodium concentrations of 7 meq per l or less. They are related to the severity and, in particular, the rapidity of the change in the serum sodium concentration. Hypernatremia in the elderly has numerous etiologies and can sometimes be difficult to diagnose. Hashim, msc, phd, dabcc, facb, gives a comprehensive overview of how lab test results can elucidate the etiology and pathogenesis of this common and potentially fatal electrolyte disorder. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. 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. Hypernatremia is a greater than normal concentration of sodium in the blood. In most cases, hypernatremia is mild and can be treated by simply increasing fluid intake until symptoms disappear. Hyponatraemia is the commonest electrolyte abnormality seen in clinical practice, and is especially prevalent in frail, older people.
Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Hyponatremia is the most common electrolyte disorder in clinical practice, occurring in up to 30% of hospitalized patients. Pdf hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. 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. Study of clinical symptoms and etiology of hyponatremia in. Hyponatremia is a commonly encountered problem in both the inpatient and outpatient geriatric population. The causes of hyponatremia without hypotonicity are presented in this topic. These patients may gradually develop profound hypernatremia e. Jun 15, 2000 hyponatremia and hypernatremia are common in the elderly, particularly among those who are hospitalized or living in longterm care facilities. Management of abnormalities in water homeostasis is frequently challenging. Study of clinical symptoms and etiology of hyponatremia in elderly in intensive care unit authors dr p.
In hypernatremia, high blood sodium levels draw water out of the brain cells, causing dehydration and shrinkage. The evaluation of adults with hypotonic hyponatremia, the most common presentation of hyponatremia, is discussed elsewhere. Water and sodium balance, hypernatremia and hyponatremia. Because agerelated changes and chronic diseases are often associated with impairment. Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. 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. Hypernatremia and hyponatremia whats the difference. This is encountered frequently in hospitalized patients especially elderly patients on low. Hyponatremia is a low sodium concentration in the blood. Relation between severity of hyponatremia and comorbidity. Caused by a relative deficit of water in relation to sodium which can result from 1. Pdf theodosios d filippatos, andromachi makri, moses s elisaf, george liamis department of internal medicine, school of medicine, university of. Hypernatremia is defined by having sodium serum levels measured at 145 meql or above.
Hypernatremia serum sodium concentration 145 meql is a common electrolyte disorder and is especially common among elderly institutionalized individuals. To assess the etiological factors responsible for hyponatremia among the elderly hospitalized patients and to describe the clinical manifestations. It is common practice to stop a medication that is causing toxicity, and this advice is. Clinical practice guideline on diagnosis and treatment of. Hyponatremia occurs when there is too little sodium in the blood in proportion to water. High volume hypernatremia is due to hyperaldosteronism, excess iv 3% ns or excess sodium bicarb or eating too much salt e. Persistent hypernatremia, therefore, implies an inability to sense thirst or lack of access to water, since ingestion of water will prevent development of significant hypernatremia even in the absence of antidiuretic hormone release or lack of renal response to its effect. The increased risk of developing hyponatremia in the elderly can be attributed to physiologic changes associated with aging, disease processes that are more frequently. One of these patients had the highest serum sodium level 202 meql reported in an adult.
Understand hypernatremia with this clear explanation. Hypernatremia endocrine and metabolic disorders msd. Hyponatremia in the elderly has been associated with increased falls and fractures. Calculating water deficit in hypernatremia due to pure water loss serum na 150, normal na 140, 70 kg man total body water deficit bw in kg x 0. Hyponatremia hyponatremia is the most common documented electrolyte abnormality in hospitalized patients.
Abnormalities in sodium concentration may be discovered at hospital admission, but more frequently develop during hospital stay 14. Hypernatremia is a common clinical problem, observed in up to 2% of the general hospital population and 15% of patients admitted to the intensive care unit. Hypernatremia in critically ill patients emcrit blog. It is well known that antidepressants can cause hyponatremia, particularly in elderly patients. The mortality rate for acute hypernatremia is 8% to 45%, but estimates are based on older literature, and current practices may produce better results. It is associated with increased morbidity and mortality in the inpatient setting. Hyponatremia means that the sodium level in the blood is below normal. Your body needs sodium for fluid balance, blood pressure control, as well as the nerves and muscles. In this article, dr fall outlines a general approach to evaluation and management of both conditions, with recommendations on safe and effective therapy. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells.
Hypernatremia is a common electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mmoll. Physiological basis most prevalent cation in ecfnormal level of around 5 145 mmoll. Diagnosis and management of hyponatraemia in the older patient. Disorders of water metabolism in children american. Diagnosis and management of disorders of body tonicityhyponatremia and hypernatremia. Hyponatremia during rehydration is an unusual feature of this case, and has previously been convincingly reported in one patient with adipsic hypernatremia. When hypernatremia is caused by losses of both sodium and water with the water loss in excess of sodium loss and circulatory collapse is present, volume expanders and even isotonic saline may be necessary initially. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Hyponatremia defined as a serum sodium level hyponatremia. Pdf hypernatremia in the geriatric population semantic. Hyponatremia can be life threatening and requires prompt recognition and proper treatment. See diagnostic evaluation of adults with hyponatremia. The primary reasons that children develop hyponatremia encompass underlying conditions that impair the kidneys ability to excrete free water table 2.
Total body water and tonicity is tightly regulated by renal action of antidiuretic hormone adh, reninangiotensinaldosterone system, norepinephrine and by the thirst mechanism. Three scenarios illustrate the possible relationships between hyponatremia and mortality. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Older adult patients may also have a diminished thirst response to. Sodium is an electrolyte that helps with nerve and muscle function, and also helps to maintain blood pressure. In hyponatremia, an excess of water in the body can lead to a low concentration of sodium in the blood, he said. Fluid and electrolyte problems are often more severe and more difficult to manage in the elderly than in younger patients. Depending on its severity and chronicity, hyponatremia can lead to significant. Hypernatremia is defined as a serum sodium level greater than 145 meq per l. Pdf hyponatremia in elderly its prevalence, aetiology and. Hyponatremia usually occurs in the setting of excess water intake, with or without sodium losses, in. Patients with hyponatremia and hypernatremia may also have complaints related to concurrent volume depletion and possible underlying neurologic diseases that predispose to. Prevalence of mild hyponatremia and its association with falls in. Disorders of water balance v agrawal, m agarwal, shashank r joshi, ak ghosh abstract total body water and tonicity is tightly regulated by renal action of antidiuretic hormone adh, reninangiotensinaldosterone system, norepinephrine and by the thirst mechanism.
Hyponatremia is a topic covered in the diseases and disorders to view the entire topic, please sign in or purchase a subscription nursing central is an awardwinning, complete mobile solution for nurses and students. See more ideas about hyponatremia, fluid and electrolytes and nursing mnemonics. The reported frequency of the disorder is determined by a number of 112 hyponatremia and hypernatremia factors, including the definition of hyponatremia, frequency of testing, the health care setting, and the patient population. Symptoms of hyponatremia or hypernatremia are primarily neurologic. Factors contributing to the development of hyponatremia in the elderly include ageassociated decreases in gfr and free water clearance, as well as sodium. Disorders of serum sodium concentration in the elderly patient. However, hypernatremia that is chronic or of unknown duration should be corrected over 48 h, and the serum osmolality should be lowered at a rate of no faster than 0. Hyponatremia may affect every age group but it has a higher incidence among elderly. 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. If your hyponatremia came on suddenly and its severe, you will need emergency treatment to improve the sodium level and monitoring to make sure that it happens safely.
Hypernatremia definition and epidemiology hypernatremia affects people of all ages but is one of the more common electrolyte disorders seen in children and older adults. 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. Excessive water loss seldom leads to hypernatremia because the resulting increase in plasma osmolality stimulates thirst figure 1, which leads to increased intake of fluids that lowers the serum sodium into. Hypernatremia is defined as a plasma sodium concentration greater than 145meqliter. Core topics in geriatrics 2 unc school of medicine. It has been associated with worse clinical outcomes across the entire range of inpatient care. Hyponatremia occurs when your blood sodium level goes below 5 meql. Shock, diabetic ketoacidosis dka, medical acid base, vq mismatch, hyponatremia, liver function tests, pulmonary function tests pfts.
Pdf hypernatremia in the geriatric population researchgate. Symptoms symptoms are not usually seen until the sodium levels exceed 150 mmoll. We also aim to increase awareness of hyponatraemia in residential aged care facilities and the. Disorders of plasma sodium causes, consequences, and. Hypernatremia due to hypovolemia dehydration in a demented patient. Bone fracture risk with hyponatremia is not only due to fall risk, but also due to an increase in bone fragility as a result of the hyponatremia 9,10. Elderly persons have decreased thirst, and therefore, ingest less amounts of water than their younger counterparts.
This will trigger panic and a desire to admit the patient to the icu. In this attending rounds, an illustrative patient with hyponatremia is presented. However, the serious implications of hyponatraemia in this age group are seldom recognized by clinicians. The overall mortality of 48 percent was not related to the degree of hypernatremia. Hypernatremia is most often due to unreplaced water that is lost from the. Hyponatremia and hypernatremia by dr hasen ali mia 1st year pgt at nbmch 2. The causes of hyponatremia in patients treated in psychiatric wards include. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin siadh. The normal blood sodium level is 5 to 145 milliequivalentsliter meql. Pdf on feb 19, 2017, nidhi kaeley and others published hyponatremia in elderly its prevalence, aetiology and outcome find, read and. Ddavp, a synthetic vasopressin receptor agonist, has expanded in recent years. About 10% of infants with dehydration from gastroenteritis have hypernatremia. Examples include hyponatremia leading to cerebral edema in acute hyponatremia and the osmotic demyelination syndrome when chronic hyponatremia is corrected too rapidly.
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