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Yaşli Popülasyonda Hiponatremiye Yaklaşim

Yıl 2024, Cilt: 19 Sayı: 2, 85 - 90, 22.07.2024
https://doi.org/10.17517/ksutfd.1206810

Öz

Hiponatremi hem hastanede yatan hastalarda hem de normal popülasyonda en sık görülen elektrolit bozukluğudur. Hiponatremi prevalansı popülasyonda yaklaşık %8'dir ve yaşla birlikte önemli ölçüde artar. Yaşlı hastalarda hiponatremi gelişiminde sıklıkla birden fazla faktör rol oynar. Yaşlıların hiponatremi geliştirme eğilimi, esas olarak yaşlanma ve hiponatremi ile ilişkili ilaçlara ve hastalıklara sık maruz kalma ile ilişkili bozulmuş su atılım kapasitesine bağlanır. Akut semptomatik hiponatremide, serum sodyum seviyelerini akut olarak artırmak ve ciddi nörolojik semptomları önlemek için yaygın olarak hipertonik salin solüsyonu kullanılır. Kronik hiponatremide, serum sodyum konsantrasyonunun düzeltme hızı 10 mEq/L/24 saat ile ve daha güvenli bir şekilde 6-8 mEq/L/24 saat ile sınırlandırılmalıdır. Yaşlı popülasyonda hiponatreminin hem değerlendirilmesi hem de tedavisi zor olduğundan çok dikkatli bir değerlendirme gereklidir.

Proje Numarası

-

Kaynakça

  • Ioannou P, Panagiotakis S, Tsagkaraki E, Tsioutis C, Fragkiadakis K, Gikas A, et al. Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study. J Clin Med. 2021;10:10(14):3059.
  • Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med. 2013;126(3):256–263.
  • Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med .2006;119:0-35.
  • Woodward M, Gonski P, Grossmann M, Obeid J, Scholes R, Topliss DJ. Diagnosis and management of hyponatremia in the older patient. Intern Med J. 2018; 48(Suppl 1): 5-12.
  • Miller M. Hyponatremia: age-related risk factors and therapy decisions. Geriatrics. 1998 ;53(7):32-3.
  • Frenkel WN, van den Born BJ, van Munster BC, Korevaar JC, Levi M, de Rooij SE. The association between serum sodium levels at the time of admission and mortality and morbidity in acutely admitted elderly patients: a prospective cohort study. J Am Geriatr Soc. 2010;58(11):2227–2228.
  • Zhang X, Li XY. Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med. 2020;11(4):685-692.
  • Zheng Y, Zheng FP, Li H. The prevalence and causes of hyponatremia in hospitalized patients. 2020 1;59(1):29-34.
  • Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169-172.
  • Siregar P. The risk of hyponatremia in the elderly compared with younger in the hospital inpatient and outpatient. Acta Med Indones. 2011;43:158-161.
  • Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging. 2017;12:1957-1965.
  • Rosner MH. Severe hyponatremia associated with the combined use of thiazide diuretics and selective serotonin reuptake inhibitors. Am J Med Sci. 2004:327(2):109-11.
  • Falhammar H, Skov J, Calissendorff J, Nathanson D, Lindh JD, Mannheimer B. Associations Between Antihypertensive Medications and Severe Hyponatremia: A Swedish Population-Based Case-Control Study. J Clin Endocrinol Metab. 2020 Oct 1;105(10):e3696–705. doi: 10.1210/clinem/dgaa194. Erratum in: J Clin Endocrinol Metab. 2020 Oct 1;105(10): PMID: 32285124; PMCID: PMC7451505.
  • De Picker L, Van Den Eede F, Dumont G, Moorkens G, Sabbe BG. Antidepressants and the risk of hyponatremia: a class-by-class review of literature. Psychosomatics. 2014 Nov-Dec;55(6):536-47.
  • Viramontes TS, Truong H, Linnebur SA. Antidepressant-induced hyponatremia in older adults. Consult Pharma. 2016;31(3):139–150.
  • Berghuis B, Hulst J, Sonsma A, McCormack M, de Haan GJ, Sander JW, et al. Symptomatology of carbamazepine- and oxcarbazepine-induced hyponatremia in people with epilepsy. Epilepsia. 2021 Mar;62(3):778-784.
  • Nagler EV, Vanmassenhove J, van der Veer SN, Nistor I, Van Biesen W, Webster AC, et al. Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Med. 2014 Dec 11;12:1.
  • Kounatidis D, Liakopoulou C, Brozou V, Dimopoulou G, Vallianou N. Chronic idiopathic hyponatremia in an elderly patient due to inappropriate antidiuretic hormone secretion (SIADH) syndrome. Hippokratia. 2019 Jan-Mar;23(1):42-44.
  • Anpalahan M. Chronic idiopathic hyponatremia in older people due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) possibly related to aging. J Am Geriatr Soc. 2001;49(6):788–792.
  • Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P. Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci. 2008;1(1):42–50.
  • Ishikawa Se, Saito T, Fukagawa A, Higashiyama M, Nakamura T, Kusaka I, et al. Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metab. 2001 Apr;86(4):1665-71. doi: 10.1210/jcem.86.4.7426. PMID: 11297601.
  • Shapiro DS, Sonnenblick M, Galperin I, Melkonyan L, Munter G. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Intern Med J. 2010;40(8):574–580.
  • Liamis G, Milionis HJ, Elisaf M. Endocrine disorders: causes of hyponatremia not to neglect. Ann Med. 2011 ;43(3):179-87. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med. 2014;40(3):320-31.
  • Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 ;126(10 Suppl 1):S1-42.
  • Thaler SM, Teitelbaum I, Berl T. “Beer potomania” in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998;31(6):1028–1031.
  • Kim GH. Pseudohyponatremia: does it matter in current clinical practice? Electrolyte Blood Press. 2006;4(2):77-82.
  • Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-42
  • Dineen R, Thompson CJ, Sherlock M. Hyponatraemia - presentations and management. Clin Med (Lond). 2017;17(3):263-269.
  • Gankam Kengne F, Decaux G. Hyponatremia and the Brain. Kidney Int Rep. 2017 Sep 1;3(1):24-35.
  • Hix JK, Silver S, Sterns RH. Diuretic-associated hyponatremia. Semin Nephrol. 2011 Nov;31(6):553-66. doi: 10.1016/j.semnephrol.2011.09.010. PMID: 22099512.
  • Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol. 2003;148(6):609-17.
  • Grinspoon SK, Biller BM. Clinical review 62: laboratory assessment of adrenal insuffi ciency. J Clin Endocrinol Metab. 1994;79:923- 31.
  • Hockings GI, Nye EJ, Grice JE, Jackson RV. Short synacthen test versus insulin stress test for the assessment of the hypothalamo-pituitary axis: controversy revisited again. Clin Endocrinol (Oxf). 1997;46:775- 6.
  • Karaca Z, Grossman A, Kelestimur F. Investigation of the Hypothalamo-pituitary-adrenal (HPA) axis: a contemporary synthesis. Rev Endocr Metab Disord. 2021 Jun;22(2):179-204.
  • Liamis G, Filippatos TD, Liontos A, Elisaf MS. Management of endocrine disease: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol. 2017;176(1):R15-R20.
  • Devdhar M, Ousman YH, Burman KD. Hypothyroidism. Endocrinol Metab Clin North Am. 2007;36:595- 615
  • Warner MH, Holding S, Kilpatrick ES. The effect of newly diagnosed hypothyroidism on serum sodium concentrations: a retrospective study. Clin Endocrinol (Oxf). 2006;64: 598 – 9.
  • Hato T, Ng R. Diagnostic value of urine sodium concentration in hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion versus hypovolemia. Hawaii Med J. 2010;69(11):264-267.
  • Milionis HJ, Liamis GL, Elisaf MS. The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ. 2002;166(8):1056-1062.
  • Soiza RL, Talbot HS. Management of hyponatraemia in older people: old threats and new opportunities. Ther Adv Drug Saf. 2011 ;2(1):9-17.
  • Schrier RW, Bansal S. Diagnosis and management of hyponatremia in acute illness. Curr Opin Crit Care. 2008;14(6):627-634.
  • Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol. 2017;28(5):1340-1349.
  • Sterns RH. Treatment of Severe Hyponatremia. Clin J Am Soc Nephrol. 2018;13(4):641-649.

Approach to Hyponatremia in the Elderly Population

Yıl 2024, Cilt: 19 Sayı: 2, 85 - 90, 22.07.2024
https://doi.org/10.17517/ksutfd.1206810

Öz

Hyponatremia is the most common electrolyte disorder in both hospitalized patients and the normal population. The prevalence of hyponatremia is approximately 8% in the population and increases significantly with age. In older patients, more than one factor often plays a role in the development of hyponatremia. The tendency of the elderly to develop hyponatremia is mainly attributed to impaired water excretion capacity associated with aging and frequent exposure to drugs and diseases associated with hyponatremia. In acute symptomatic hyponatremia, hypertonic saline solution is commonly used to acutely increase serum sodium levels and prevent severe neurological symptoms. In chronic hyponatremia, the rate of correction of serum sodium concentration should be limited to 10 mEq/L/24 h and more safely to 6–8 mEq/L/24 h. Since both the evaluation and treatment of hyponatremia are difficult in the older population, very careful evaluation is required.

Destekleyen Kurum

YOK

Proje Numarası

-

Teşekkür

-

Kaynakça

  • Ioannou P, Panagiotakis S, Tsagkaraki E, Tsioutis C, Fragkiadakis K, Gikas A, et al. Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study. J Clin Med. 2021;10:10(14):3059.
  • Liamis G, Rodenburg EM, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Electrolyte disorders in community subjects: prevalence and risk factors. Am J Med. 2013;126(3):256–263.
  • Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med .2006;119:0-35.
  • Woodward M, Gonski P, Grossmann M, Obeid J, Scholes R, Topliss DJ. Diagnosis and management of hyponatremia in the older patient. Intern Med J. 2018; 48(Suppl 1): 5-12.
  • Miller M. Hyponatremia: age-related risk factors and therapy decisions. Geriatrics. 1998 ;53(7):32-3.
  • Frenkel WN, van den Born BJ, van Munster BC, Korevaar JC, Levi M, de Rooij SE. The association between serum sodium levels at the time of admission and mortality and morbidity in acutely admitted elderly patients: a prospective cohort study. J Am Geriatr Soc. 2010;58(11):2227–2228.
  • Zhang X, Li XY. Prevalence of hyponatremia among older inpatients in a general hospital. Eur Geriatr Med. 2020;11(4):685-692.
  • Zheng Y, Zheng FP, Li H. The prevalence and causes of hyponatremia in hospitalized patients. 2020 1;59(1):29-34.
  • Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169-172.
  • Siregar P. The risk of hyponatremia in the elderly compared with younger in the hospital inpatient and outpatient. Acta Med Indones. 2011;43:158-161.
  • Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging. 2017;12:1957-1965.
  • Rosner MH. Severe hyponatremia associated with the combined use of thiazide diuretics and selective serotonin reuptake inhibitors. Am J Med Sci. 2004:327(2):109-11.
  • Falhammar H, Skov J, Calissendorff J, Nathanson D, Lindh JD, Mannheimer B. Associations Between Antihypertensive Medications and Severe Hyponatremia: A Swedish Population-Based Case-Control Study. J Clin Endocrinol Metab. 2020 Oct 1;105(10):e3696–705. doi: 10.1210/clinem/dgaa194. Erratum in: J Clin Endocrinol Metab. 2020 Oct 1;105(10): PMID: 32285124; PMCID: PMC7451505.
  • De Picker L, Van Den Eede F, Dumont G, Moorkens G, Sabbe BG. Antidepressants and the risk of hyponatremia: a class-by-class review of literature. Psychosomatics. 2014 Nov-Dec;55(6):536-47.
  • Viramontes TS, Truong H, Linnebur SA. Antidepressant-induced hyponatremia in older adults. Consult Pharma. 2016;31(3):139–150.
  • Berghuis B, Hulst J, Sonsma A, McCormack M, de Haan GJ, Sander JW, et al. Symptomatology of carbamazepine- and oxcarbazepine-induced hyponatremia in people with epilepsy. Epilepsia. 2021 Mar;62(3):778-784.
  • Nagler EV, Vanmassenhove J, van der Veer SN, Nistor I, Van Biesen W, Webster AC, et al. Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements. BMC Med. 2014 Dec 11;12:1.
  • Kounatidis D, Liakopoulou C, Brozou V, Dimopoulou G, Vallianou N. Chronic idiopathic hyponatremia in an elderly patient due to inappropriate antidiuretic hormone secretion (SIADH) syndrome. Hippokratia. 2019 Jan-Mar;23(1):42-44.
  • Anpalahan M. Chronic idiopathic hyponatremia in older people due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) possibly related to aging. J Am Geriatr Soc. 2001;49(6):788–792.
  • Foppiani L, Ruelle A, Bandelloni R, Quilici P, Del Monte P. Hypopituitarism in the elderly: multifaceted clinical and biochemical presentation. Curr Aging Sci. 2008;1(1):42–50.
  • Ishikawa Se, Saito T, Fukagawa A, Higashiyama M, Nakamura T, Kusaka I, et al. Close association of urinary excretion of aquaporin-2 with appropriate and inappropriate arginine vasopressin-dependent antidiuresis in hyponatremia in elderly subjects. J Clin Endocrinol Metab. 2001 Apr;86(4):1665-71. doi: 10.1210/jcem.86.4.7426. PMID: 11297601.
  • Shapiro DS, Sonnenblick M, Galperin I, Melkonyan L, Munter G. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Intern Med J. 2010;40(8):574–580.
  • Liamis G, Milionis HJ, Elisaf M. Endocrine disorders: causes of hyponatremia not to neglect. Ann Med. 2011 ;43(3):179-87. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med. 2014;40(3):320-31.
  • Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 ;126(10 Suppl 1):S1-42.
  • Thaler SM, Teitelbaum I, Berl T. “Beer potomania” in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998;31(6):1028–1031.
  • Kim GH. Pseudohyponatremia: does it matter in current clinical practice? Electrolyte Blood Press. 2006;4(2):77-82.
  • Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-42
  • Dineen R, Thompson CJ, Sherlock M. Hyponatraemia - presentations and management. Clin Med (Lond). 2017;17(3):263-269.
  • Gankam Kengne F, Decaux G. Hyponatremia and the Brain. Kidney Int Rep. 2017 Sep 1;3(1):24-35.
  • Hix JK, Silver S, Sterns RH. Diuretic-associated hyponatremia. Semin Nephrol. 2011 Nov;31(6):553-66. doi: 10.1016/j.semnephrol.2011.09.010. PMID: 22099512.
  • Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol. 2003;148(6):609-17.
  • Grinspoon SK, Biller BM. Clinical review 62: laboratory assessment of adrenal insuffi ciency. J Clin Endocrinol Metab. 1994;79:923- 31.
  • Hockings GI, Nye EJ, Grice JE, Jackson RV. Short synacthen test versus insulin stress test for the assessment of the hypothalamo-pituitary axis: controversy revisited again. Clin Endocrinol (Oxf). 1997;46:775- 6.
  • Karaca Z, Grossman A, Kelestimur F. Investigation of the Hypothalamo-pituitary-adrenal (HPA) axis: a contemporary synthesis. Rev Endocr Metab Disord. 2021 Jun;22(2):179-204.
  • Liamis G, Filippatos TD, Liontos A, Elisaf MS. Management of endocrine disease: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment. Eur J Endocrinol. 2017;176(1):R15-R20.
  • Devdhar M, Ousman YH, Burman KD. Hypothyroidism. Endocrinol Metab Clin North Am. 2007;36:595- 615
  • Warner MH, Holding S, Kilpatrick ES. The effect of newly diagnosed hypothyroidism on serum sodium concentrations: a retrospective study. Clin Endocrinol (Oxf). 2006;64: 598 – 9.
  • Hato T, Ng R. Diagnostic value of urine sodium concentration in hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion versus hypovolemia. Hawaii Med J. 2010;69(11):264-267.
  • Milionis HJ, Liamis GL, Elisaf MS. The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ. 2002;166(8):1056-1062.
  • Soiza RL, Talbot HS. Management of hyponatraemia in older people: old threats and new opportunities. Ther Adv Drug Saf. 2011 ;2(1):9-17.
  • Schrier RW, Bansal S. Diagnosis and management of hyponatremia in acute illness. Curr Opin Crit Care. 2008;14(6):627-634.
  • Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol. 2017;28(5):1340-1349.
  • Sterns RH. Treatment of Severe Hyponatremia. Clin J Am Soc Nephrol. 2018;13(4):641-649.
Toplam 43 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Dilek Tüzün 0000-0002-6693-4928

Proje Numarası -
Erken Görünüm Tarihi 11 Temmuz 2024
Yayımlanma Tarihi 22 Temmuz 2024
Gönderilme Tarihi 18 Kasım 2022
Kabul Tarihi 13 Kasım 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 19 Sayı: 2

Kaynak Göster

AMA Tüzün D. Approach to Hyponatremia in the Elderly Population. KSÜ Tıp Fak Der. Temmuz 2024;19(2):85-90. doi:10.17517/ksutfd.1206810