Clinical Manifestations of Elderly Patients Admitted Because of Severe Hyponatremia

Korean Journal of Nephrology 2010;29(1):23-30.

You Jeong Oh, M.D., Ji Sun Han, M.D., Do Kyong Kim, M.D., Seuk Hee Chung, M.D.Sang Ock Kim, M.D., Chien Ter Hsing, M.D., Ji Young Mok, M.D.Won Suk An, M.D., Seong Eun Kim, M.D. and Ki Hyun Kim, M.D.

Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

원저 : 심한 저나트륨혈증으로 내원한 노인 환자의 임상 양상

오유정, 한지선, 김도경, 정석희, 김상옥, 형건덕, 목지영, 안원석, 김성은, 김기현

동아대학교 의과대학 내과학교실

Abstract

Purpose : Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room. Methods : We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age >60 years, Na <125 mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia. Results : Mean serum sodium concentration was 111.4±6.9 mEq/L and urine sodium concentration was 68.7±43.8 mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125 mEq/L of serum sodium level was 336.5±160.6 mEq/L. Conclusion : The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.

Key Words: Hyponatremia, Aged, Diuretics, Neurologic manifestation