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Hyohdoh Y, Hiyama M, Hatakeyama Y, Okuhara Y. Effect of mild hyponatremia on in-hospital falls of elderly hospitalized patients: A retrospective, cohort study. Arch Gerontol Geriatr 2024; 118:105315. [PMID: 38128267 DOI: 10.1016/j.archger.2023.105315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study investigated the association between hyponatremia and falls in elderly hospitalized patients, focusing on mild hyponatremia as a potential risk factor. MATERIALS AND METHODS A retrospective analysis of 16,952 patients admitted to Kochi Medical School Hospital from 2012 to 2021 was performed. Serum sodium levels were categorized, and falls during a 30-day observation period were recorded. A Cox proportional hazards model and a machine learning model were used to estimate risk and explore interactions. RESULTS Mild hyponatremia (130-134 mEq/L) was identified as an independent risk factor for falls (hazard ratio: 1.42, 95 % confidence interval 1.16-1.74), especially in patients with higher activities of daily living. The fall prediction model showed an area under the curve (AUC) of 0.780 (95 % confidence interval 0.751-0.806). CONCLUSION A significant association between mild hyponatremia and falls in elderly hospitalized patients was found. The findings highlight the need for targeted fall prevention and further research into the underlying mechanisms. Mild hyponatremia may serve as a clinical marker for fall risk, especially in patients with independent activities of daily living.
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Affiliation(s)
- Yuki Hyohdoh
- Center of Medical Information Science, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Mariko Hiyama
- Center of Medical Information Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yutaka Hatakeyama
- Center of Medical Information Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yoshiyasu Okuhara
- Center of Medical Information Science, Kochi Medical School, Kochi University, Kochi, Japan
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Tzoulis P, Yavropoulou MP. Association of hyponatremia with bone mineral density and fractures: a narrative review. Ther Adv Endocrinol Metab 2023; 14:20420188231197921. [PMID: 37736657 PMCID: PMC10510353 DOI: 10.1177/20420188231197921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
Recent studies suggest a possible association of hyponatremia with osteoporosis, falls and bone fractures. The objectives of this narrative review were to further explore this association and the related pathophysiological mechanisms and to suggest a practical approach to patients with osteoporosis or chronic hyponatremia in clinical practice. We conducted an extensive PubMed search until October 2022 with the combination of the following keywords: 'hyponatremia' or 'sodium' or 'SIADH' and 'fractures' or 'bone' or 'osteoporosis', as MeSH Terms. Review of numerous observational studies confirms a significant independent association of, even mild, hyponatremia with two- to three-fold increase in the occurrence of bone fractures. Hyponatremia is a risk factor for osteoporosis with a predilection to affect the hip, while the magnitude of association depends on the severity and chronicity of hyponatremia. Chronic hyponatremia also increases the risk for falls by inducing gait instability and neurocognitive deficits. Besides the detrimental impact of hyponatremia on bone mineral density and risk of falls, it also induces changes in bone quality. Emerging evidence suggests that acute hyponatremia shifts bone turnover dynamics towards less bone formation, while hyponatremia correction increases bone formation. The key unanswered question whether treatment of hyponatremia could improve osteoporosis and lower fracture risk highlights the need for prospective studies, evaluating the impact of sodium normalization on bone metabolism and occurrence of fractures. Recommendations for clinical approach should include measurement of serum sodium in all individuals with fracture or osteoporosis. Also, hyponatremia, as an independent risk factor for fracture, should be taken into consideration when estimating the likelihood for future fragility fracture and in clinical decision-making about pharmacological therapy of osteoporosis. Until it is proven that normalization of sodium can lower fracture occurrence, correcting hyponatremia cannot be universally recommended on this basis, but should be decided on a case-by-case basis.
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Affiliation(s)
- Ploutarchos Tzoulis
- Department of Metabolism & Experimental Therapeutics, Division of Medicine, University College London Medical School, Gower Street, London, WC1E6BT, UK
| | - Maria P. Yavropoulou
- Department of Propaedeutic and Internal Medicine, Medical School of University of Athens, Endocrinology Unit, Athens, Attica, Greece
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Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocr Rev 2023; 44:819-861. [PMID: 36974717 PMCID: PMC10502587 DOI: 10.1210/endrev/bnad010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023]
Abstract
Hyponatremia is the most common electrolyte disorder, affecting more than 15% of patients in the hospital. Syndrome of inappropriate antidiuresis (SIAD) is the most frequent cause of hypotonic hyponatremia, mediated by nonosmotic release of arginine vasopressin (AVP, previously known as antidiuretic hormone), which acts on the renal V2 receptors to promote water retention. There are a variety of underlying causes of SIAD, including malignancy, pulmonary pathology, and central nervous system pathology. In clinical practice, the etiology of hyponatremia is frequently multifactorial and the management approach may need to evolve during treatment of a single episode. It is therefore important to regularly reassess clinical status and biochemistry, while remaining alert to potential underlying etiological factors that may become more apparent during the course of treatment. In the absence of severe symptoms requiring urgent intervention, fluid restriction (FR) is widely endorsed as the first-line treatment for SIAD in current guidelines, but there is considerable controversy regarding second-line therapy in instances where FR is unsuccessful, which occurs in around half of cases. We review the epidemiology, pathophysiology, and differential diagnosis of SIAD, and summarize recent evidence for therapeutic options beyond FR, with a focus on tolvaptan, urea, and sodium-glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Annabelle M Warren
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel 4031, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel 4031, Switzerland
| | - Nicholas Russell
- Department of Medicine, University of Melbourne, Victoria 3010, Australia
- Department of Endocrinology, The Austin Hospital, Victoria 3084, Australia
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Fratangelo L, Nguyen S, D'Amelio P. Hyponatremia and aging-related diseases: key player or innocent bystander? A systematic review. Syst Rev 2023; 12:84. [PMID: 37173774 PMCID: PMC10182618 DOI: 10.1186/s13643-023-02246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Hyponatremia is frequent in older age; whether it is a key player, a surrogate marker, or an innocent bystander in age-related diseases is still unclear. OBJECTIVE To understand the role of hyponatremia in falls, osteoporosis, fractures, and cognitive impairment in old patients. METHOD Eligibility criteria for study inclusions were: written in English, peer-reviewed observational and intervention studies, clinical trial, prospective and retrospective controlled cohort studies, and case-controlled studies without limitations regarding the date of publication. INFORMATION SOURCES Protocol available on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42021218389). MEDLINE, Embase, and PsycINFO were searched. Final search done on August 8, 2021. Risk-of-bias assessment: Risk-of-Bias Assessment tool for Non-randomized Studies (RoBANS) and the Bradford Hill's criteria for causality. RESULTS Includes studies: One-hundred thirty-five articles retained for the revision. Synthesis of results - Falls: Eleven studies were included. Strong association between hyponatremia and falls in all the studies was found. Osteoporosis and fractures: nineteen articles were included. The association between hyponatremia and osteoporosis is unclear. Cognitive impairment: Five articles were included. No association between hyponatremia and cognitive impairment was found. DISCUSSION Interpretation: Falls, osteoporosis, and fractures are multifactorial. Hyponatremia is not temporally related with the outcomes; we suggest that hyponatremia may be regarded as a marker of unhealthy aging and a confounder instead of a causal factor or an innocent bystander for falls and fractures. Concerning cognitive impairment, there are no evidence supporting a real role of hyponatremia to be regarded as an innocent bystander in neurodegeneration.
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Affiliation(s)
- Luigia Fratangelo
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Sylvain Nguyen
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrizia D'Amelio
- Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medical Science, Geriatric Unit, University of Torino, 10126, Turin, Italy
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5
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Sendag R, Babus SB, Köse A, Temel GO, Turgutalp K, Tenekeci S. Retrospective analysis of patients diagnosed with severe hyponatraemia in the emergency department. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:83-88. [PMID: 38692595 DOI: 10.25259/nmji_632_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background . We investigated the demographic, aetiological and clinical characteristics of patients who presented to the emergency department and had severe hyponatraemia. Methods . We retrospectively evaluated 1171 patients who presented to the emergency department and were diagnosed with severe hyponatraemia. Results . Over half the patients studied were women (53.5%). The mean age of women was higher (p<0.0001). The most common complaint was dyspnoea (16.8%) and 42.5% of the patients had an oral intake disorder. In addition, 22.3% of the patients were on loop diuretics. About 76.3% of patients were conscious, and the mean sodium level of these patients was higher than the mean sodium level of those who responded to verbal and painful stimuli (p<0.001). Severe isolated hyponatraemia was observed in 61.8% of the patients. The mortality rate was 12.8%. There was no difference between the mean sodium levels of the deceased and discharged patients (p=1.0). The mortality rate was higher in patients who had a history of cirrhosis and cancer, but was lower in patients with a history of coronary artery disease (p=0.0002, p<0.0001 and p=0.04, respectively). Conclusion . Severe hyponatraemia was more prevalent in women, serum sodium levels were higher in conscious patients, and the mortality rate was higher in patients who had a history of cirrhosis and cancer. We found that the mean serum sodium levels did not help in distinguishing between the deceased and discharged patients.
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Affiliation(s)
- Refika Sendag
- Mersin City Education Research Hospital Emergency Service, Mersin University Medical Faculty, Mersin, Turkey
| | - Seyran Bozkurt Babus
- Department of Emergency Medicine, Mersin University Medical Faculty, Mersin, Turkey
| | - Ataman Köse
- Department of Emergency Medicine, Mersin University Medical Faculty, Mersin, Turkey
| | - Gülhan Orekici Temel
- Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Kenan Turgutalp
- Department of Nephrology, Mersin University Medical Faculty, Mersin, Turkey
| | - Sevcan Tenekeci
- Department of Obstetrics and Gynaecology, Mersin University Medical Faculty, Mersin, Turkey
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Morbidity Associated with Chronic Hyponatremia. J Clin Med 2023; 12:jcm12030978. [PMID: 36769626 PMCID: PMC9917626 DOI: 10.3390/jcm12030978] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
This article will discuss the consequences of chronic hyponatremia. In conditions such as cancer, heart failure, liver cirrhosis, or chronic kidney disease, the presence and magnitude of hypotonic hyponatremia are considered to reflect the severity of the underlying disease and are associated with increased morbidity as well as mortality. Hyponatremia can be acute (<48 h) or chronic (>2-3 days). Chronic hyponatremia is associated with attention deficit, dizziness, tiredness, gait disturbance, falls, sarcopenia, bone fractures, osteoporosis, hypercalciuria (in the syndrome of inappropriate antidiuresis-SIADH), and kidney stones. In vitro studies have shown that cells grown in a low concentration of extracellular sodium have a greater proliferation rate and motility. Patients with chronic hyponatremia are more likely to develop cancer. We will not review the clinical consequences of respiratory arrest and osmotic demyelination syndrome (ODS) of the too-late or excessive treatment of hyponatremia.
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7
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Exploring hyponatremia in older hospital in-patients: management, association with falls, and other adverse outcomes. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cunningham E, Gallagher N, Hamilton P, Bryce L, Beverland D. Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty. Perioper Med (Lond) 2021; 10:25. [PMID: 34340717 PMCID: PMC8330106 DOI: 10.1186/s13741-021-00197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/31/2021] [Indexed: 11/12/2022] Open
Abstract
Background Hyponatraemia, defined as a serum sodium [Na] concentration below 135 mmol/L, is common following surgery. As inpatient peri-operative stays shorten, there is a need to recognise pre-operative risk factors for post-operative hyponatraemia and complications associated with a peri-operative drop in Na. This audit aimed to investigate the prevalence of, risk factors for, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty. Methods Data were collected within a retrospective audit of inpatient complications and unplanned reattendance or readmission at hospital in consecutive elective primary hip and knee arthroplasty patients in a single high throughput elective primary joint unit. The hospital’s electronic database identified 1000 patients who were admitted electively between February 2012 and June 2013 under the care of a single consultant orthopaedic surgeon for either total hip arthroplasty, total knee arthroplasty, or uni-compartmental knee arthroplasty. Groups were compared using appropriate tests, including chi-square analysis (or Fisher’s exact test), Mann-Whitney U test, Kruskal-Wallis test, and Wilcoxin signed-rank test. Logistic regression analysis was used to determine factors associated with hyponatraemia. Results Of the total 1000 patients, 217 (21.7%) developed post-operative hyponatraemia. Of these, 177 (81.6%) had mild (Na 130–134 mmol/L), 37 (17.1%) had moderate (Na 125–129 mmol/L), and 3 (1.4%) had severe (Na < 125 mmol/L) hyponatraemia. In multivariate analysis, age, pre-operative Na, and fasting glucose on day 1 remained significantly associated with having hyponatraemia post-operatively. There were no significant differences in reattendance at emergency departments and/or readmission within 90 days between those who had post-operative hyponatraemia whilst in hospital (39/217 = 18.0%) and those who did not (103/783 = 13.2%), or between those who were discharged with hyponatraemia (18/108 = 16.7%) and those discharged with normal Na (124/880 = 14.1%). Conclusion Approximately one fifth of elective joint arthroplasty patients had post-operative hyponatraemia. In these patients, older age, lower pre-operative Na and higher fasting glucose predicted post-operative hyponatraemia. We found no evidence that those discharged with hyponatraemia had more reattendance at emergency departments or readmission to hospital. We suggest that otherwise well patients with mild hyponatraemia can safely be discharged and followed up in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00197-1.
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Affiliation(s)
- Emma Cunningham
- Centre for Public Health (Queen's University, Belfast), Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Nicola Gallagher
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland.
| | - Paul Hamilton
- Centre for Medical Education, Queen's University Belfast, Mulhouse Road, Belfast, BT12 6BA, Northern Ireland.,Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Leeann Bryce
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland
| | - David Beverland
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland
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Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study. J Clin Med 2021; 10:jcm10143059. [PMID: 34300225 PMCID: PMC8303423 DOI: 10.3390/jcm10143059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Hyponatremia is the most common electrolyte disorder, commonly affecting older hospitalized individuals; however, the literature is not clear regarding its effect on mortality. The aim of this 2-year observational prospective cohort study was to evaluate the mortality and re-admission rates, the clinical and laboratory characteristics and the causes of hyponatremia in patients older than 65 years admitted with a corrected serum sodium of 130 mEq/L or less in an internal medicine ward of a tertiary Greek university hospital. During the observation period, 138 patients (mean age 80.5 years, 36.2% male) fulfilled the inclusion criteria and were prospectively followed for 1 year after admission. Symptoms of hyponatremia were present in 59.4% of patients. Hypovolemia was the main sole cause of hyponatremia, but in about one third of patients, hyponatremia was multifactorial. Only a low proportion of patients (12.3%) fulfilled the criteria of the syndrome of inappropriate antidiuresis (SIAD) at admission according to the current guidelines. The re-admission rates at 3- and 12-months following discharge was 34.2% and 51.8%, respectively. Mortality during hospitalization was 17.4% and was higher compared to non-hyponatremic admitted older patients, while the total mortality at 1 year after admission was 28.3%, indicating that hyponatremia at admission is a marker of significant mortality during and after hospitalization in elderly patients.
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Aranda-Gallardo M, Gonzalez-Lozano A, Oña-Gil JI, Morales-Asencio JM, Mora-Banderas A, Canca-Sanchez JC. Relation between hyponatraemia and falls by acute hospitalised patients: A case-control study. J Clin Nurs 2021; 31:958-966. [PMID: 34245058 DOI: 10.1111/jocn.15952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the possible association between hyponatremia and falls, in a sample of hospitalised adult patients. BACKGROUND In-hospital falls are a problem of major importance, provoking a significant decline in the quality of life of many patients. Recent studies have identified a relationship between such falls and the presence of hyponatremia. DESIGN Analytical retrospective observational case-control study. METHODS The study population consisted of hospitalised patients who had suffered an in-hospital fall during the period 2014-2016. For each case, two controls who had not suffered any such fall were recruited. These cases and controls were matched according to gender, age, hospitalisation unit and date of admission. Study data were obtained from the hospital's record of falls, regarding the patients' socio-demographic factors, physical and psychological conditions and blood levels of sodium, potassium, urea and creatinine. The study is reported in accordance with STrengthening the Reporting of OBservational studies in Epidemiology guidelines. RESULTS The study sample consisted of 555 patients (185 cases and 370 controls). Hyponatraemia was detected in 57 cases (30.8%). A statistically significant relationship was found between the presence of hyponatraemia and the occurrence of falls: OR = 2.04. Other risk factors for falls were hypercreatinaemia OR 2.49, hyperuraemia OR 1.82, disorientation, need for ambulatory assistance and longer hospital stay. CONCLUSIONS From the study findings, we conclude that hyponatraemia is a predictor of falls by acute hospitalised patients. Further research is needed on the relationship between hypercreatinaemia, hyperuraemia and falls. RELEVANCE TO CLINICAL PRACTICE The assessment of risk factors for falls, such as hyponatraemia, can alert us to the possibility of this event occurring and facilitate the implementation of preventive measures. This parameter should be included as a significant new factor in assessment instruments designed to assess the risk of falls, thus enhancing the reliability and diagnostic validity of these instruments.
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Affiliation(s)
- Marta Aranda-Gallardo
- Internal Medicine Unit, Agencia Sanitaria Costa del Sol, Instituto de Investigación Biomédica de Málaga (IBIMA), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Instituto de Salud Carlos III, Marbella, Spain
| | | | - Jose Ivan Oña-Gil
- Centro de Atención Primaria Manresa-2, Instituto Catalán de la Salud, Barcelona, Spain
| | - Jose Miguel Morales-Asencio
- Faculty of Health Sciences, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Ana Mora-Banderas
- Quality Unit, Agencia Sanitaria Costa del Sol, Instituto de Investigación Biomédica de Málaga (IBIMA, Marbella, Spain
| | - Jose Carlos Canca-Sanchez
- Faculty of Health Sciences, Agencia Sanitaria Costa del Sol, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Marbella, Spain
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Thorpe O, Cuesta M, Fitzgerald C, Feely O, Tormey WP, Sherlock M, Williams DJ, Thompson CJ, Garrahy A. Active management of hyponatraemia and mortality in older hospitalised patients compared with younger patients: results of a prospective cohort study. Age Ageing 2021; 50:1144-1150. [PMID: 33367538 DOI: 10.1093/ageing/afaa248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hyponatraemia is associated with increased morbidity and mortality; the aetiology and outcomes of hyponatraemia in older patients have not been defined in prospective studies. METHODS A single-centre 9-month prospective observational study in which clinical outcomes in hospitalised patients ≥ 65 years (older patients with hyponatraemia (OP-HN)) and those <65 years (young patients with hyponatraemia (YP-HN)) with hyponatraemia were analysed, and compared with eunatraemic controls (older patients with normonatraemia (OP-NN) and young patients with normonatraemia (YP-NN)). RESULTS In total, 1,321 episodes of hyponatraemia in 1,086 patients were included; 437 YP-HN, median age 54 years (IQR 44,60) and 884 OP-HN, median age 77 years (IQR 71,82). A total of 1,120 consecutive eunatraemic control patients were simultaneously recruited; 690 OP-NN, median age 77 years (IQR 71,83) and 430 YP-NN, median age 52 years (IQR 41,58). Euvolaemic hyponatraemia was the commonest cause of hyponatraemia in both age groups (48% in YP-HN and 46% in OP-HN). Sixty-two percent of OP-HN received hyponatraemia-directed treatment within the initial 48 h, compared with 55% of YP-HN, P = 0.01. Despite the greater treatment rates in OP-HN, younger patients were 24% more likely to be discharged with normal plasma sodium concentration (pNa) compared with older patients, relative risk (RR) 1.24 (95% confidence interval (CI) 1.12-1.37), P < 0.001.Using OP-NN as the reference group, the RR of in-hospital death in OP-HN was 2.15 (95% CI 1.3-3.56), P = 0.002. Using YP-NN as the reference group, the RR of in-hospital death in YP-HN was 4.34 (95% CI 1.98-9.56), P < 0.001. CONCLUSION Despite greater rates of HN-targeted treatment, the risk of in-hospital death is increased in older hyponatraemic patients compared with older eunatraemic controls. The impact of hyponatraemia on mortality is even greater in younger patients.
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Affiliation(s)
- Owen Thorpe
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - Martin Cuesta
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - Ciaran Fitzgerald
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - Owen Feely
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - William P Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - Chris J Thompson
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
| | - Aoife Garrahy
- Academic Department of Endocrinology, RCSI Medical School and Beaumont Hospital, Dublin, Ireland
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12
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Garrahy A, Galloway I, Hannon AM, Dineen R, Javadpour M, Tormey WP, Gan KJ, Twomey PJ, Mc Kenna MJ, Kilbane M, Crowley RK, Sherlock M, Thompson CJ. The effects of acute hyponatraemia on bone turnover in patients with subarachnoid haemorrhage: A preliminary report. Clin Endocrinol (Oxf) 2021; 94:616-624. [PMID: 33176010 DOI: 10.1111/cen.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Animal data and cross-sectional human studies have established that chronic hyponatraemia predisposes to osteoporosis; the effects of acute hyponatraemia on bone turnover have not been determined. Our objective was to test the hypothesis that acute hyponatraemia leads to dynamic effects on bone turnover. DESIGN A prospective observational pilot study. METHODS Bone turnover markers [C-terminal crosslinking telopeptide of type 1 collagen (CTX-1), N-propeptide of type 1 collagen (P1NP) and osteocalcin] were measured prospectively over one week in 22 eunatraemic patients with subarachnoid haemorrhage. Patients treated with glucocorticoids were excluded. RESULTS Eight patients developed acute hyponatraemia, median nadir plasma sodium concentration 131 mmol/L (IQR 128-132), and 14 remained eunatraemic, nadir plasma sodium concentration 136 mmol/L (IQR 133-137). Significant main effects of hyponatraemia were found for P1NP (p = .02) and P1NP:CTX-1 ratio (p = .02), both fell in patients with acute hyponatraemia, with significant interaction between hyponatraemia and time from baseline for P1NP (p = .02). Significant main effects of time from baseline (p < .001) but not hyponatraemia (p = .07) were found for osteocalcin. For CTX-1, significant main effects of time from baseline (p = .001) but not hyponatraemia (p = .65) were found. There was a positive correlation between change in P1NP:CTX-1 ratio and nadir plasma sodium concentration, r = +.43, p = .04. Median serum cortisol (measured on days 1, 3 and 7) was higher in the hyponatraemia group than in those who remained eunatraemic, 545 nmol/L (IQR 373-778) versus 444 nmol/L (IQR 379-542) p = .03. CONCLUSION These data suggest that acute mild hyponatraemia is associated with a reduction in bone formation activity.
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Affiliation(s)
- Aoife Garrahy
- Academic Department of Endocrinology, Beaumont Hospital and RCSI, Dublin, Ireland
| | - Iona Galloway
- Academic Department of Endocrinology, Beaumont Hospital and RCSI, Dublin, Ireland
| | - Anne Marie Hannon
- Academic Department of Endocrinology, Beaumont Hospital and RCSI, Dublin, Ireland
| | - Rosemary Dineen
- Academic Department of Endocrinology, Beaumont Hospital and RCSI, Dublin, Ireland
| | - Mohsen Javadpour
- Department of Neurosurgery, Beaumont Hospital and RCSI, Dublin, Ireland
| | - William P Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - K J Gan
- Department of Endocrinology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Patrick J Twomey
- Department of Clinical Chemistry, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Malachi J Mc Kenna
- Department of Endocrinology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Mark Kilbane
- Department of Clinical Chemistry, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Rachel K Crowley
- Department of Endocrinology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology, Beaumont Hospital and RCSI, Dublin, Ireland
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13
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Boyer S, Gayot C, Bimou C, Mergans T, Kajeu P, Castelli M, Dantoine T, Tchalla A. Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit). BMC Geriatr 2019; 19:265. [PMID: 31615437 PMCID: PMC6792197 DOI: 10.1186/s12877-019-1282-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hyponatremia is the most common electrolyte disorder in older adults and it can increase morbidity and mortality. Approximately one in three older adults fall each year; mild chronic hyponatremia can predispose this group to injurious falls and fractures and serum levels of sodium can also influence bone health. Little is known regarding the association between mild chronic hyponatremia and injurious fall prevalence in elderly patients admitted to the Emergency Department (ED). Therefore, the present study investigated the link between mild hyponatremia and the risk of injurious falls in elderly patients admitted to the Emergency Geriatric Medicine Unit (The MUPA Unit). Methods This cross-sectional study was conducted over 4 months and included patients ≥75 years of age who were admitted to the MUPA Unit of University Hospital Center of Limoges (France). Sociodemographic factors, fall events, comorbidities, medications, and sodium levels were assessed (hyponatremia was considered as sodium level < 136 mEq/L). Additionally, the short Comprehensive Geriatric Assessment (short-CGA), the Frailty score on the Short Emergency Geriatric Assessment (SEGA), and the Katz Activity of Daily Living (ADL) scale were administered. Results Of the 696 cases included in the final analysis, the mean age was 86.1 ± 5.6 years and 63.1% were female. The prevalence of falls was 27.9% (95% confidence interval [CI]: 24.6–31.2%) and that of mild hyponatremia was 15.9% (95% CI: 13.2–18.6%). The prevalence rate of mild hyponatremia was 13.2% (95% CI: 10.1–16.3%) in patients without falls and 26.1% (95% CI: 19.8–32.4%) in patients admitted for falls. Mild hyponatremia was significantly associated with falls (P < 0.001) and the adjusted odds ratio (OR) was 3.02 (95% CI: 1.84–4.96). Conclusions Because mild hyponatremia might be a risk factor for injurious falls and ED admission, determination of sodium levels during basic biomarker assessment on ED admission could be an important component of fall prevention strategies for the elderly.
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Affiliation(s)
- Sophie Boyer
- EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Université de Limoges, F-8705, Limoges, France.,Unité de Recherche Clinique et Innovation (URCI) en Gérontologie (Axe Silver économie, e-santé et Télémédecine), Pôle HU Gérontologie Clinique, CHU de Limoges, 2 Avenue Martin-Luther King, 87042, Limoges, France
| | - Caroline Gayot
- Unité de Recherche Clinique et Innovation (URCI) en Gérontologie (Axe Silver économie, e-santé et Télémédecine), Pôle HU Gérontologie Clinique, CHU de Limoges, 2 Avenue Martin-Luther King, 87042, Limoges, France.,CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Charlotte Bimou
- EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Université de Limoges, F-8705, Limoges, France
| | - Thomas Mergans
- CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France.,Unité de Médecine d'Urgence de la Personne Âgée, Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Patrick Kajeu
- Unité de Recherche Clinique et Innovation (URCI) en Gérontologie (Axe Silver économie, e-santé et Télémédecine), Pôle HU Gérontologie Clinique, CHU de Limoges, 2 Avenue Martin-Luther King, 87042, Limoges, France.,Unité de Médecine d'Urgence de la Personne Âgée, Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Muriel Castelli
- Unité de Recherche Clinique et Innovation (URCI) en Gérontologie (Axe Silver économie, e-santé et Télémédecine), Pôle HU Gérontologie Clinique, CHU de Limoges, 2 Avenue Martin-Luther King, 87042, Limoges, France.,Unité de Médecine d'Urgence de la Personne Âgée, Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Thierry Dantoine
- EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Université de Limoges, F-8705, Limoges, France
| | - Achille Tchalla
- EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Université de Limoges, F-8705, Limoges, France. .,Unité de Recherche Clinique et Innovation (URCI) en Gérontologie (Axe Silver économie, e-santé et Télémédecine), Pôle HU Gérontologie Clinique, CHU de Limoges, 2 Avenue Martin-Luther King, 87042, Limoges, France. .,CHU de Limoges, Pôle HU Gérontologie Clinique, 2 Avenue Martin-Luther King, F-87042, Limoges, France. .,Unité de Médecine d'Urgence de la Personne Âgée, Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France. .,Geriatric Medicine, University of Limoges CHU Limoges, IFR 145 GEIST, EA 6310 HAVAE (Handicap Activité Vieillissement Autonomie et Environnement), F-87025, Limoges, France.
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14
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Corona G, Norello D, Parenti G, Sforza A, Maggi M, Peri A. Hyponatremia, falls and bone fractures: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 89:505-513. [PMID: 29920727 DOI: 10.1111/cen.13790] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To perform a meta-analysis based on published studies that compared falls and bone fractures between patients with and without hyponatremia. CONTEXT There is evidence suggesting that hyponatremia is associated with an increased risk of falls and bone fractures. DESIGN An extensive Medline, Embase and Cochrane search was performed to retrieve all studies published up to, 30 April 2017, using the following words: "hyponatremia" or "hyponatraemia" AND "falls" and "bone fractures." A meta-analysis was performed including all studies comparing falls and bone fractures in subjects with or without hyponatremia. PATIENTS AND RESULTS Of 216 retrieved articles, 15 studies satisfied inclusion criteria encompassing a total of 51 879 patients, of whom 2329 were hyponatremic. Across all studies, hyponatremia was associated with a significantly increased risk of falls (MH-OR = 2.14[1.71; 2.67]. This result was confirmed when only hospitalized patients were considered (MH-OR = 2.44 [1.97; 3.02]). A meta-regression analysis showed that the hyponatremia-related risk of falls was higher in those studies considering a lower serum [Na+ ] cut-off to define hyponatremia. Interestingly, the estimated risk of falls related to hyponatremia was already significantly higher when a serum [Na+ ] cut-off of 135 mmol/L was considered (MH-OR = 1.26[1.23;1.29]). The presence of hyponatremia was also associated with a higher risk of fractures, particularly hip fractures (MH-OR = 2.00[1.43;2.81]). CONCLUSIONS This study confirms that hyponatremia is associated with an increased risk of falls and bone fractures. The clinical, social and economic relevance of such association is strengthened by the increased incidence of hyponatremia in older people.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Dario Norello
- Endocrine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", "Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies" (DENOThe), University of Florence, Florence, Italy
| | | | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", "Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies" (DENOThe), University of Florence, Florence, Italy
| | - Alessandro Peri
- Endocrine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", "Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies" (DENOThe), University of Florence, Florence, Italy
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15
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Al Mawed S, Pankratz VS, Chong K, Sandoval M, Roumelioti ME, Unruh M. Low serum sodium levels at hospital admission: Outcomes among 2.3 million hospitalized patients. PLoS One 2018; 13:e0194379. [PMID: 29566068 PMCID: PMC5864034 DOI: 10.1371/journal.pone.0194379] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 02/20/2018] [Indexed: 12/30/2022] Open
Abstract
Background Hyponatremia is the most common electrolyte disorder among hospitalized patients. Controversies still exist over the relationship between hyponatremia and outcomes of hospitalized patients. Methods To analyze the association of low serum sodium levels at hospital admission with in-hospital mortality and patient disposition and to compare the distribution of the risk of death associated with hyponatremia across the lifespan of hospitalized patients, we conducted an observational study of 2.3 million patients using data extracted from the Cerner Health Facts database between 2000 and 2014. Logistic regression models were used in the analyses. Results At hospital admission 14.4% of hospitalized patients had serum sodium levels [Na] <135 mEq/L. In adjusted multinomial logistic regression analysis, we found that the risk of in-hospital mortality significantly increases for [Na] levels < 135 or ≥143 to ≤145 mEq/L compared to the reference interval of 140 to <143 mEq/L (p<0.001). We observed similar trends for the relationship between [Na] levels and discharge to hospice or to a nursing facility. We demonstrated that younger age groups (18 to <45, 45 to <65) had a higher risk of in-hospital mortality compared to older age groups (65 to <75, ≥75) for [Na] levels <130 mEq/L or 143 to ≤145 mEq/L (p<0.001). Conclusions Hyponatremia is common among hospitalized patients and is significantly associated with in-hospital mortality, discharge to hospice or to a nursing facility. The risk of death and other outcomes was more evident for [Na] <135 mEq/L. The mortality associated with low [Na] was significantly higher in younger versus older patients.
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Affiliation(s)
- Saleem Al Mawed
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - V. Shane Pankratz
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Kelly Chong
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Matthew Sandoval
- University of New Mexico Clinical and Translational Science Center (CTSC), Albuquerque, New Mexico, United States of America
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
- * E-mail:
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16
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Hosseini SR, Baghitabar N, Mirzapour A, Oliaei F, Nooreddini H, Bijani A, Mouodi S. Hyponatremia, bone mineral density and falls in the elderly; Results from AHAP study. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2018; 56:41-46. [DOI: 10.1515/rjim-2017-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background. Hyponatremia (HN) can be associated with osteoporosis, falls and bone fractures in the elderly. Recent researches demonstrated different results about the correlation of HN with bone mineral density and bone fractures.
Methods. This analytic research came from the AHAP project in northern IRAN. All people aged 60 years and over were included in the study. Individuals with severe comorbidities and then who had concurrent conditions which could have impact on bone mineral densities (BMD) such as long-term use of steroids, calcium and/or vitamin D supplements, bisphosphonates, calcitonin, thiazides and hormonal medications were excluded.
Results. One thousand and one hundred and thirteen older persons entered in the study. More than 10 percent of the participants had HN (serum Na+ level ≤ 137mEq/L). No significant difference has been observed between hyponatremic and nonhyponatremic individuals about their balance abilities; bone mineral density; incidence of falls and/or bone fracture during the previous 6 months; dependency in activities of daily living; and osteoporosis.
Conclusion. HN was not a prevalent problem in older adults who met the inclusion criteria of this research. No significant difference has been observed between HN and bone mineral density and falls in the elderly.
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Affiliation(s)
- Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , Iran
| | - Naghi Baghitabar
- Faculty of Medicine , Babol University of Medical Sciences , Babol , Iran
| | - Ali Mirzapour
- Faculty of Medicine , Babol University of Medical Sciences , Babol , Iran
| | - Farshid Oliaei
- Department of Internal Medicine , Babol University of Medical Sciences , Babol , Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , Iran
| | - Simin Mouodi
- Social Determinants of Health Research Center, Health Research Institute , Babol University of Medical Sciences , Babol , Iran
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17
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Fehlberg EA, Lucero RJ, Weaver MT, McDaniel AM, Chandler AM, Richey PA, Mion LC, Shorr RI. Associations between hyponatraemia, volume depletion and the risk of falls in US hospitalised patients: a case-control study. BMJ Open 2017; 7:e017045. [PMID: 28790043 PMCID: PMC5724091 DOI: 10.1136/bmjopen-2017-017045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We aimed to determine if abnormal laboratory values which may indicate volume depletion are associated with increased odds of experiencing a hospital-acquired fall. DESIGN Matched case-control study. SETTING Four hospitals located in the Southeast USA. PARTICIPANTS Data from 699 adult fallers and 1189 matched controls (non-fallers) were collected via chart review from 2005 to 2010. Controls were matched to cases by nursing unit, time of fall and length of stay. OUTCOME MEASURES The primary exposures included serum sodium, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio and haematocrit. Conditional logistic regression with m:n matching was used to determine adjusted and unadjusted ORs. RESULTS Serum sodium levels were strongly associated with falls. In models controlling for demographic and other fall risk factors, patients with serum sodium levels of 125 mEq/L or less were associated with increased odds of experiencing a fall as compared with those with serum sodium levels of greater than 134 mEq/L (adjusted OR (aOR)=5.08, 95% CI 1.43 to 18.08). Conversely, elevated BUN, creatinine and elevated BUN/creatinine ratios were not associated with increased odds of experiencing a fall (aOR=0.64, 95% CI 0.49 to 0.84; aOR=0.70, 95% CI 0.54 to 0.92 and aOR=0.77, 95% CI 0.58 to 1.04, respectively.) CONCLUSIONS: Laboratory indices that may indicate volume depletion appear to be unrelated to falls. However, hyponatraemia does appear to be a risk factor for falls, and those with serum sodium levels below 126 mEq/L are at especially high risk. It may be that other deficits associated with hyponatraemia, like altered mental status, are associated with risk of experiencing a hospital-acquired fall. These results indicate that abnormal laboratory values, like low sodium, can be useful for identifying hospitalised patients at risk of falling. Therefore, further investigation into abnormal laboratory values as predictors of hospital-acquired falls is warranted.
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Affiliation(s)
- Elizabeth A Fehlberg
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
- Division of Research on Healthcare Value, Equity, and the Lifespan, RTI International, Research Triangle Park, NC, USA
| | - Robert J Lucero
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
- Center for Innovation on Disability and Rehabilitation Research (CINDRR), Malcom Randall VAMC, Gainesville, Florida, USA
| | - Michael T Weaver
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Anna M McDaniel
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | | | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lorraine C Mion
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Ronald I Shorr
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
- Geriatric Research Education and Clinical Centers (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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18
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Abstract
Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.
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Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA.
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