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