Hyponatremia: Special Considerations in Older Patients
#MMPMID26237487
Soiza RL
; Cumming K
; Clarke JM
; Wood KM
; Myint PK
J Clin Med
2014[Aug]; 3
(3
): 944-58
PMID26237487
show ga
Hyponatremia is especially common in older people. 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. Hyponatremia is therefore of special significance in frail older people.
Management of hyponatremia in elderly individuals is particularly challenging.
The underlying cause is often multi-factorial, a clear history may be difficult
to obtain and clinical examination is unreliable. Established treatment
modalities are often ineffective and carry considerable risks, especially if the
diagnosis of underlying causes is incorrect. Nevertheless, there is some evidence
that correction of hyponatremia can improve cognitive performance and postural
balance, potentially minimizing the risk of falls and fractures. Oral vasopressin
receptor antagonists (vaptans) are a promising innovation, but evidence of their
safety and effect on important clinical outcomes in frail elderly individuals is
limited.
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