Hyponatremia in older patients, specifics in diagnostics and treatment

Česká verzia

Authors: E. Topinková
Published in the journal: Geriatrie a Gerontologie 2018, 7, č. 1: 21-26
Category: Review Article

Summary

Decreased serum sodium concentration is a rather frequent electrolyte disorder in elderly patients. The reason for this is rather frail serum sodium homeostasis, frequent presence of factors contributing to increased level of antidiuretic hormone, prescription of drugs associated with the risk of hyponatremia (particularly thiazide diuretics and antidepressants) and also other mechanisms such as nutritional i.e. the “tea and toast” syndrome.

In the diagnostic process, the first step is to evaluate the type of hyponatremia as hypovolemic, euvolemic and hypervolemic and focus on detection of individual causes, drug effect or endocrinopathies. In the syndrome of inappropriate antidiuretic hormone secretion (SIAD) a stepwise evaluation program is recommended to detect the cause and start causal treatment. In some patients, multiple causes can contribute to hyponatremia.

The management 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 to avoid the osmotic demyelination syndrome.

Keywords:
hyponatremia – elderly – SIAD – diagnosis and treatment

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