title: Management of hyponatraemia in older people: old threats and new opportunities.
abstract: Hyponatraemia is the commonest electrolyte abnormality seen in clinical practice, and is especially prevalent in frail, older people. However, the serious implications of hyponatraemia in this age group are seldom recognized by clinicians. Hyponatraemia is associated with osteoporosis, impaired balance, falls, hip fractures and cognitive dysfunction. Even mild, apparently asymptomatic hyponatraemia is associated with prolonged stays in hospital, institutionalization and increased risk of death. Emerging evidence of the potential benefits of improved treatment of hyponatraemia is slowly generating renewed clinical interest in this area. The development of specific vasopressin-2 receptor antagonists (vaptans) has the potential to revolutionize the management of hyponatraemia, in particular for the syndrome of inappropriate antidiuretic hormone. However, challenges remain for the attending physician. Diagnosing the cause or causes of hyponatraemia in older people is difficult, and incorrect diagnosis can lead to treatment that worsens the electrolyte imbalance. Established treatments are often poorly tolerated and patient outcomes remain poor, and the role of vaptans in the treatment of older people is unclear. This review summarizes the existing evidence base and highlights areas of controversy. It includes practical guidance for overcoming some common pitfalls in the management of the elderly patient with hyponatraemia.
authors.affiliation: Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, UK.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Soiza
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
authors.forename: Hannah S C
authors.initials: HS
authors.lastname: Talbot
keywords: arginine vasopressin; elderly; hyponatraemia; syndrome of inappropriate antidiuretic hormone; tolvaptan; vasopressin receptor antagonist
references.citation: QJM. 2006 Aug;99(8):505-11
references.pmid: 16861720
references.citation: Semin Nephrol. 2009 May;29(3):282-99
references.pmid: 19523575
references.citation: Age Ageing. 2002 Mar;31(2):151-2
references.pmid: 11937482
references.citation: J Bone Miner Res. 2010 Mar;25(3):554-63
references.pmid: 19751154
references.citation: Medicine (Baltimore). 1976 Mar;55(2):121-9
references.pmid: 1256311
references.citation: Anaesthesia. 2008 Jan;63(1):92-5
references.pmid: 18086078
references.citation: Ann Pharmacother. 2007 May;41(5):840-50
references.pmid: 17405824
references.citation: Am J Cardiol. 2006 Apr 1;97(7):1064-7
references.pmid: 16563917
references.citation: Am J Physiol Endocrinol Metab. 2004 Nov;287(5):E1019-23
references.pmid: 15213060
references.citation: Ann Intern Med. 1973 Jun;78(6):870-5
references.pmid: 4197370
references.citation: NDT Plus. 2009 Nov;2(Suppl_3):iii12-iii19
references.pmid: 19881932
references.citation: J Am Soc Nephrol. 1994 Feb;4(8):1522-30
references.pmid: 8025225
references.citation: Clin Nephrol. 2006 Apr;65(4):248-55
references.pmid: 16629223
references.citation: Intern Med. 2008;47(10):885-91
references.pmid: 18480571
references.citation: J Am Geriatr Soc. 1995 Dec;43(12):1410-3
references.pmid: 7490395
references.citation: Am J Med. 2006 Jul;119(7 Suppl 1):S30-5
references.pmid: 16843082
references.citation: N Engl J Med. 2006 Nov 16;355(20):2099-112
references.pmid: 17105757
references.citation: Clin Endocrinol (Oxf). 2006 Aug;65(2):246-9
references.pmid: 16886968
references.citation: N Engl J Med. 2000 May 25;342(21):1581-9
references.pmid: 10824078
references.citation: Eur J Endocrinol. 2010 Jun;162 Suppl 1:S13-8
references.pmid: 20164215
references.citation: Intern Med J. 2010 Aug;40(8):574-80
references.pmid: 20298512
references.citation: J Am Geriatr Soc. 2006 Feb;54(2):345-53
references.pmid: 16460390
references.citation: J Am Geriatr Soc. 2006 Sep;54(9):1473; author reply 1473-4
references.pmid: 16970667
references.citation: J Am Soc Nephrol. 2010 Apr;21(4):705-12
references.pmid: 20185637
references.citation: Postgrad Med J. 2006 Mar;82(965):216-9
references.pmid: 16517805
references.citation: Eur J Endocrinol. 2010 Jun;162 Suppl 1:S5-12
references.pmid: 20164214
references.citation: Intern Med J. 2011 Mar;41(3):295; author reply 296
references.pmid: 21426472
references.citation: J Clin Endocrinol Metab. 1997 Apr;82(4):1054-7
references.pmid: 9100572
references.citation: Hepatology. 2003 Jan;37(1):182-91
references.pmid: 12500203
references.citation: Arch Gerontol Geriatr. 2007 Nov-Dec;45(3):253-8
references.pmid: 17244514
references.citation: J Natl Med Assoc. 2003 May;95(5):335-43
references.pmid: 12793790
references.citation: QJM. 2011 Jan;104(1):35-9
references.pmid: 20823196
references.citation: Am J Med. 2009 Sep;122(9):857-65
references.pmid: 19699382
references.citation: Ann Intern Med. 1978 May;88(5):607-9
references.pmid: 646242
references.citation: Am J Med. 2006 Jan;119(1):71.e1-8
references.pmid: 16431193
references.citation: Hypertension. 1992 Jun;19(6 Pt 1):508-19
references.pmid: 1592445
references.citation: Kidney Int Suppl. 1998 Feb;64:S6-11
references.pmid: 9475480
references.citation: Crit Care Med. 2005 Jan;33(1):196-202; discussion 257-8
references.pmid: 15644669
references.citation: Tidsskr Nor Laegeforen. 2001 Mar 20;121(8):921-3
references.pmid: 11332379
references.citation: J Clin Endocrinol Metab. 2006 Jun;91(6):2145-52
references.pmid: 16522696
references.citation: Eur J Endocrinol. 2010 Jun;162 Suppl 1:S1-3
references.pmid: 20406740
references.citation: Q J Med. 1988 Jul;68(255):553-8
references.pmid: 3252306
references.citation: Lancet. 1998 Jul 18;352(9123):220-8
references.pmid: 9683227
references.citation: QJM. 2008 Jul;101(7):583-8
references.pmid: 18477645
references.citation: Am J Med. 2001 May;110(7):582-4
references.pmid: 11343672
references.citation: JAMA. 2007 Mar 28;297(12):1319-31
references.pmid: 17384437
references.citation: Metab Brain Dis. 2010 Mar;25(1):91-6
references.pmid: 20221678
references.citation: Br J Sports Med. 2006 Mar;40(3):255-9
references.pmid: 16505084
references.citation: Osteoporos Int. 2010 Jun;21(6):891-902
references.pmid: 19924496
references.citation: Proc Natl Acad Sci U S A. 2008 Mar 4;105(9):3634-9
references.pmid: 18296634
references.citation: Adv Exp Med Biol. 1998;449:251-76
references.pmid: 10026814
references.citation: J Cardiovasc Pharmacol. 2007 Aug;50(2):213-22
references.pmid: 17703139
references.citation: Am J Med. 2007 Nov;120(11 Suppl 1):S1-21
references.pmid: 17981159
references.citation: Clin J Am Soc Nephrol. 2006 Nov;1(6):1154-60
references.pmid: 17699341
references.citation: Clin Nephrol. 1996 Sep;46(3):149-69
references.pmid: 8879850