title: An elderly patient with chronic hyponatremia.
abstract: Hyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this Attending Rounds, an illustrative patient with hyponatremia is presented. The reasons for the increased incidence and prevalence of hyponatremia in the elderly are discussed, with emphasis on the effects of aging on urinary dilution, the frequently multifactorial nature of hyponatremia in this population, and the absence of a definite cause for inappropriate and persistent vasopressin release in many such patients. The rationale for treating the hyponatremia, even when apparently asymptomatic, is discussed, with attention to cognitive function, gait, and bone structure disturbances that increase the risk for fractures. The various available treatment approaches, including water restriction, demeclocycline, loop diuretics with NaCl supplementation, urea, and vasopressin antagonists are summarized, with emphasis on the efficacy and limitations of each of these therapies.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA. Tomas.berl@ucdenver.edu
authors.forename: Tomas
authors.initials: T
authors.lastname: Berl
mesh_terms: D000367:Age Factors; D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003707:Demeclocycline / Q000627:therapeutic use; D004326:Drinking; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D014508:Urea / Q000627:therapeutic use; D014554:Urination; D014882:Water-Electrolyte Balance
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D015415:Biomarkers; D006727:Hormone Antagonists; D049994:Sodium Potassium Chloride Symporter Inhibitors; D012965:Sodium Chloride; D003707:Demeclocycline; D014508:Urea; D012964:Sodium