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Hyponatremia in the elderly: challenges and solutions

Authors Filippatos TD, Makri A, Elisaf MS, Liamis G

Received 5 September 2017

Accepted for publication 12 October 2017

Published 14 November 2017 Volume 2017:12 Pages 1957—1965

DOI https://doi.org/10.2147/CIA.S138535

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

Theodosios D Filippatos, Andromachi Makri, Moses S Elisaf, George Liamis

Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece

Abstract: Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia and also because of other mechanisms such as the “tea and toast” syndrome. The aim of this review is to present certain challenges in the evaluation and treatment of hyponatremia in the elderly population and provide practical solutions. Hyponatremia in elderly subjects is mainly caused by drugs (more frequently thiazides and antidepressants), the syndrome of inappropriate antidiuretic hormone secretion (SIAD) or endocrinopathies; however, hyponatremia is multifactorial in a significant proportion of patients. Special attention is needed in the elderly population to exclude endocrinopathies as a cause of hyponatremia before establishing the diagnosis of SIAD, which then requires a stepped diagnostic approach to reveal its underlying cause. The treatment of hyponatremia depends on the type of hyponatremia. Special attention is also needed to correct serum sodium levels at the appropriate rate, especially in chronic hyponatremia, in order to avoid the osmotic demyelination syndrome. In conclusion, both the evaluation and the treatment of hyponatremia pose many challenges in the elderly population.

Keywords: sodium, prognosis, hypopituitarism, elderly, pituitary

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