Diagnosis and management of hyponatraemia in the older patient

Internal Medicine Journal
Michael WoodwardDuncan J Topliss

Abstract

Hyponatraemia (serum sodium concentration below 135 mmol/L) is the most common electrolyte disturbance and occurs commonly in older people. The causes can be complex to diagnose and treat and many published guidelines do not focus on the issues in an older patient group. Here, we are principally concerned with diagnosis and management of euvolaemic and hypervolaemic hyponatraemia in hospitalised patients over 70 years old. We also aim to increase awareness of hyponatraemia in residential aged care facilities and the community. Hyponatraemia can have many causes; in older people, chronic hyponatraemia can often be the result of medications used to treat chronic disease, particularly thiazide or thiazide-like drugs (such as indapamide) or drugs acting on the central nervous system. Where a reversible trigger (such as drug-induced hyponatraemia) can be identified, hyponatraemia may be treated relatively simply. Chronic hyponatraemia due to an irreversible cause will require ongoing treatment. Fluid restriction can be an effective therapy in dilutional hyponatraemia, although poor compliance and the burdensome nature of the restrictions are important considerations. Tolvaptan is an oral vasopressin receptor antagonist that can incr...Continue Reading

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Citations

Jun 28, 2019·Clinical Pharmacology and Therapeutics·Elena RamírezJesús Frías
Aug 5, 2020·BMC Pharmacology & Toxicology·Ivan VelatViktor Čulić
Nov 6, 2018·Internal Medicine Journal·Leanne O'NeilJeffrey W Stephens
Mar 3, 2021·Zeitschrift für Gerontologie und Geriatrie·Johannes KleybolteBjörn Hegner
Jul 25, 2021·Journal of Clinical Medicine·Petros IoannouTheodosios D Filippatos

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