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Review
. 2017 Nov 14:12:1957-1965.
doi: 10.2147/CIA.S138535. eCollection 2017.

Hyponatremia in the elderly: challenges and solutions

Theodosios D Filippatos  1 , Andromachi Makri  1 , Moses S Elisaf  1 , George Liamis  1
Affiliations
Review

Hyponatremia in the elderly: challenges and solutions

Theodosios D Filippatos et al. Clin Interv Aging. .

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: elderly; hypopituitarism; pituitary; prognosis; sodium.

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Conflict of interest statement

Disclosure This review was conducted independently. Professor Elisaf reports personal fees from Astra-Zeneca, grants and personal fees from MSD, personal fees from Pfizer, Abbott, Sanofi-Aventis, Boehringer Ingelheim, Eli-Lilly and GSK. The authors have given talks and attended conferences sponsored by various pharmaceutical companies, including Bristol-Myers Squibb, Pfizer, Lilly, Abbott, Amgen, AstraZeneca, Novartis, Vianex, Teva and MSD. The authors report no other conflicts of interest in this work.

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