Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions.
Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community. Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0-137.1 mmol/l) was lower than in the 586 not prescribed diuretics (137.1-137.9 mmol/l). The difference was small but statistically significant (95% CI difference = 0.3-1.6 mmol/l; P less than 0.01). Hyponatraemia (serum sodium less than 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others. There was a significant positive correlation between the serum potassium and the log [serum urea] (r = 0.26, P less than 0.001) and a weak negative correlation existed between sodium and potassium (r = -0.14; P less than 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive.(ABSTRACT TRUNCATED AT 250 WORDS)
Byatt
C M
CM
Department of Geriatric Medicine, St George's Hospital Medical School, London.
Millard
P H
PH
Levin
G E
GE
D000367:Age Factors; D000368:Aged; D000584:Amiloride / Q000009:adverse effects; D004232:Diuretics / Q000009:adverse effects*; D004338:Drug Combinations; D011307:Drug Prescriptions; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects; D007008:Hypokalemia / Q000139:chemically induced*; D007010:Hyponatremia / Q000139:chemically induced*; D009026:Mortality; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D014508:Urea / Q000097:blood
D004232:Diuretics; D004338:Drug Combinations; D006852:Hydrochlorothiazide; C010247:amiloride, hydrochlorothiazide drug combination; D000584:Amiloride; D014508:Urea; D012964:Sodium; D011188:Potassium