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. 2025 Feb;58(1):40-45.
doi: 10.1007/s00391-024-02342-z. Epub 2024 Aug 14.

Hyponatremia in geriatric patients

Marija Djukic  1   2 , Jeannine Grewe  1 , Olga Kunz  3 , Oliver Gross  4 , Roland Nau  5   6
Affiliations

Hyponatremia in geriatric patients

Marija Djukic et al. Z Gerontol Geriatr. 2025 Feb.

Abstract
in English, German

Hyponatremia is the most frequent electrolyte imbalance in geriatric medicine. Causes of hyponatremia were retrospectively analyzed in all in-patients treated in 2016 (N = 2267, 1564 women, 703 men, mean age ± standard deviation 81.9 ± 7.6 years). Any form of hyponatremia on admission, during the stay or on discharge was noted in 308 patients (13.6%, 231 women, 77 men; mean age ± standard deviation 83.1 ± 7.3 years, p = 0.009 vs. age of all patients). Women had a higher probability of developing hyponatremia compared to men (p = 0.019), 131 patients were hypovolemic, and dyspnea as an indicator of hypervolemia was noted in 71 patients.Only 12 patients suffering from hyponatremia (3.9%) did not receive any of the potentially sodium-lowering drugs assessed (diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, antidepressants, neuroleptics, nonsteroidal antirheumatics, carbamazepine, oxcarbazepine). The median number of drugs per patient potentially lowering the plasma sodium level was 3 and the maximum number was 7.Hypovolemic hyponatremia and the syndrome of inadequate antidiuretic hormone secretion were the most important causes of hyponatremia. Adverse drug effects were the main origins of both conditions. In patients with hyponatremia the drug load influencing plasma sodium level should be minimized, thiazide diuretics should be avoided and older individuals should receive a diet with sufficient salt content.

Die Hyponatriämie ist die häufigste Elektrolytstörung in der geriatrischen Medizin. Mögliche Ursachen der Hyponatriämie wurden retrospektiv bei allen stationären Patienten im Jahr 2016 evaluiert (N = 2267 [1564 Frauen, 703 Männer], Alter 81,9 ± 7,6 Jahre [Mittelwert ± Standardabweichung]). Irgendeine Form der Hyponatriämie bei Krankenhausaufnahme, während des Aufenthalts oder bei Entlassung wurde bei 308 Patienten (13,6 % [231 Frauen, 77 Männer; Durchschnittsalter ± Standardabweichung 83,1 ± 7,3; p = 0,009 im Vergleich zum Alter aller Patienten]) festgestellt. Die Wahrscheinlichkeit, eine Hyponatriämie zu entwickeln, lag bei Frauen höher als bei Männern (p = 0,019). 131 Patienten waren hypovolämisch, und bei 71 Patienten war eine Dyspnoe als Hinweis für eine Hypervolämie dokumentiert. Nur 12 Patienten mit einer Hyponatriämie (3,9 %) erhielten keines der ausgewerteten, potenziell die Plasma-Natrium-Konzentration senkenden Medikamente (Diuretika, Angiotensin-Converting-Enzyme-Inhibitoren, Angiotensin-II-Rezeptor-Antagonisten, Antidepressiva, Neuroleptika, nichtsteroidale Antirheumatika, Carbamazepin, Oxcarbazepin). Im Median lag die Zahl der potenziell den Plasma-Natrium-Spiegel senkenden Medikamente pro Patient bei 3, die höchste Zahl war 7. Hypovolämische Hyponatriämie und das Syndrom der inadäquaten ADH-Sekretion waren die wichtigsten Ursachen einer Hyponatriämie. Beide Zustände wurden am häufigsten durch unerwünschte Medikamentenwirkungen ausgelöst. Patienten mit Hyponatriämie sollten möglichst wenige Medikamente erhalten, die den Plasma-Natrium-Spiegel senken können. Thiaziddiuretika sollten vollständig vermieden werden, und ältere Personen sollten mit der Nahrung ausreichend Salz zu sich nehmen.

Keywords: Angiotensin-converting enzyme inhibitors; Angiotensin II receptor antagonists; Antidepressants; Diuretics; Neuroleptics; Nonsteroidal antirheumatic drugs.

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Conflict of interest statement

Declarations. Conflict of interest: M. Djukic, J. Grewe, O. Kunz, O. Gross and R. Nau declare that they have no competing interests. Ethical standards: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University Medicine Göttingen, Germany (approval code: 4/11/11, approval date: 17 July 2017). Patient consent was waived because this was a retrospective study with fully pseudonymized data serving as quality control measure for the diagnostic and therapeutic procedures in the Department of Geriatrics, Protestant Hospital Göttingen-Weende, 37075 Göttingen, Germany

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