Abstract
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.
Highlights
Hyponatremia is the commonest electrolyte imbalance encountered in clinical practice [1]
This review examines some of the recent insights into the special implications of hyponatremia in the older patient, paying particular attention to the potential for even mild, chronic hyponatremia to result in subtle symptoms such as cognitive impairment, bone demineralization, falls and fractures [6,7,8]
Prevalence of hyponatremia is known to increase in frail patient groups, elderly patients where hyponatremia is observed in almost half of acute geriatric admissions [9,10]
Summary
Hyponatremia is the commonest electrolyte imbalance encountered in clinical practice [1]. It is associated with multiple poor clinical outcomes including increased mortality [2], increased length of hospital stay [3,4] and institutionalization [4]. Hyponatremia occurs due to disruption of sodium and water homeostasis, normally maintained by complex multi-system physiological mechanisms [5]. It represents an excess of water relative to sodium, though both sodium and total body water may be increased, normal or diminished. The unique challenges of accurate diagnosis and treatment of the underlying causes in the older patient are highlighted
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