Hyponatremia in the Elderly: Challenges and Solutions

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2017 Nov 29

PMID 29180859

Citations 69

Authors

Theodosios D Filippatos

Andromachi Makri

Moses S Elisaf

George Liamis

Affiliations

Soon will be listed here.

Abstract

Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia and also because of other mechanisms such as the "tea and toast" syndrome. The aim of this review is to present certain challenges in the evaluation and treatment of hyponatremia in the elderly population and provide practical solutions. Hyponatremia in elderly subjects is mainly caused by drugs (more frequently thiazides and antidepressants), the syndrome of inappropriate antidiuretic hormone secretion (SIAD) or endocrinopathies; however, hyponatremia is multifactorial in a significant proportion of patients. Special attention is needed in the elderly population to exclude endocrinopathies as a cause of hyponatremia before establishing the diagnosis of SIAD, which then requires a stepped diagnostic approach to reveal its underlying cause. The treatment of hyponatremia depends on the type of hyponatremia. Special attention is also needed to correct serum sodium levels at the appropriate rate, especially in chronic hyponatremia, in order to avoid the osmotic demyelination syndrome. In conclusion, both the evaluation and the treatment of hyponatremia pose many challenges in the elderly population.

Citing Articles

Evaluation of hyponatremia among older adults exposed to selective serotonin reuptake inhibitors and thiazide diuretics.

Matsuura T, Tawfik A, Ben-Umeh K, Hansten P, Malone D Pharmacotherapy. 2025; 45(3):169-176.

PMID: 40035448 PMC: 11905335. DOI: 10.1002/phar.70004.

Associations of serum sodium, potassium and chloride levels with the all-cause and cardiovascular diseases mortality among patients with depression.

Zeng Q, Jia S, Li Y, She F, Zhang P PLoS One. 2025; 20(2):e0314636.

PMID: 39937768 PMC: 11819521. DOI: 10.1371/journal.pone.0314636.

Pathophysiology, symptoms, outcomes, and evaluation of hyponatremia: comprehension and best clinical practice.

Sumi H, Tominaga N, Fujita Y, Verbalis J Clin Exp Nephrol. 2025; 29(2):134-148.

PMID: 39847311 PMC: 11828805. DOI: 10.1007/s10157-025-02624-9.

Polypharmacy or potentially inappropriate medications among older adults with COVID-19 in a secondary hospital in China and their association with mortality.

Mao M, Du S, Xu Y, Li Q, Luo R, Zhou Q Sci Rep. 2025; 15(1):166.

PMID: 39747995 PMC: 11696121. DOI: 10.1038/s41598-024-84064-1.

Serum sodium levels and geriatric syndromes: an overlooked association.

Yoshimura Y Eur Geriatr Med. 2024; 16(1):359-361.

PMID: 39704785 DOI: 10.1007/s41999-024-01076-w.

References

Hoorn E, Rivadeneira F, van Meurs J, Ziere G, Stricker B, Hofman A . Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res. 2011; 26(8):1822-8. DOI: 10.1002/jbmr.380. View

Frenkel W, van den Born B, van Munster B, Korevaar J, Levi M, de Rooij S . The association between serum sodium levels at time of admission and mortality and morbidity in acutely admitted elderly patients: a prospective cohort study. J Am Geriatr Soc. 2010; 58(11):2227-8. DOI: 10.1111/j.1532-5415.2010.03104.x. View

Maesaka J, Batuman V, Yudd M, Salem M, Sved A, Venkatesan J . Hyponatremia and hypouricemia: differentiation from SIADH. Clin Nephrol. 1990; 33(4):174-8. View

Sterns R . Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med. 2015; 372(1):55-65. DOI: 10.1056/NEJMra1404489. View

Lohr J . Osmotic demyelination syndrome following correction of hyponatremia: association with hypokalemia. Am J Med. 1994; 96(5):408-13. DOI: 10.1016/0002-9343(94)90166-x. View

Liamis G, Filippatos T, Elisaf M . Electrolyte disorders associated with the use of anticancer drugs. Eur J Pharmacol. 2016; 777:78-87. DOI: 10.1016/j.ejphar.2016.02.064. View

Liamis G, Filippatos T, Liontos A, Elisaf M . Serum osmolal gap in clinical practice: usefulness and limitations. Postgrad Med. 2017; 129(4):456-459. DOI: 10.1080/00325481.2017.1308210. View

Greenblatt H, Greenblatt D . Antidepressant-Associated Hyponatremia in the Elderly. J Clin Psychopharmacol. 2016; 36(6):545-549. DOI: 10.1097/JCP.0000000000000608. View

Viramontes T, Truong H, Linnebur S . Antidepressant-Induced Hyponatremia in Older Adults. Consult Pharm. 2016; 31(3):139-50. DOI: 10.4140/TCP.n.2016.139. View

10.

Liamis G, Milionis H, Elisaf M . Hyponatremia in patients with infectious diseases. J Infect. 2011; 63(5):327-35. DOI: 10.1016/j.jinf.2011.07.013. View

11.

Lindner G, Pfortmuller C, Leichtle A, Fiedler G, Exadaktylos A . Age-related variety in electrolyte levels and prevalence of dysnatremias and dyskalemias in patients presenting to the emergency department. Gerontology. 2014; 60(5):420-3. DOI: 10.1159/000360134. View

12.

Hawkins R . Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003; 337(1-2):169-72. DOI: 10.1016/j.cccn.2003.08.001. View

13.

Mannesse C, Vondeling A, van Marum R, van Solinge W, Egberts T, Jansen P . Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review. Ageing Res Rev. 2012; 12(1):165-73. DOI: 10.1016/j.arr.2012.04.006. View

14.

Liamis G, Filippatos T, Elisaf M . Treatment of hyponatremia: the role of lixivaptan. Expert Rev Clin Pharmacol. 2014; 7(4):431-41. DOI: 10.1586/17512433.2014.911085. View

15.

Sardar G, Eilbert W . Severe hyponatremia associated with thiazide diuretic use. J Emerg Med. 2014; 48(3):305-9. DOI: 10.1016/j.jemermed.2014.09.054. View

16.

Harbeck B, Lindner U, Haas C . Low-dose tolvaptan for the treatment of hyponatremia in the syndrome of inappropriate ADH secretion (SIADH). Endocrine. 2016; 53(3):872-3. DOI: 10.1007/s12020-016-0912-y. View

17.

Kogiso T, Tokushige K, Hashimoto E, Ikarashi Y, Kodama K, Taniai M . Safety and efficacy of long-term tolvaptan therapy for decompensated liver cirrhosis. Hepatol Res. 2015; 46(3):E194-200. DOI: 10.1111/hepr.12547. View

18.

Snell D, Bartley C . Osmotic demyelination syndrome following rapid correction of hyponatraemia. Anaesthesia. 2007; 63(1):92-5. DOI: 10.1111/j.1365-2044.2007.05341.x. View

19.

Filippatos T, Liamis G, Christopoulou F, Elisaf M . Ten common pitfalls in the evaluation of patients with hyponatremia. Eur J Intern Med. 2015; 29:22-5. DOI: 10.1016/j.ejim.2015.11.022. View

20.

Lu X, Wang X . Hyponatremia induced by antiepileptic drugs in patients with epilepsy. Expert Opin Drug Saf. 2016; 16(1):77-87. DOI: 10.1080/14740338.2017.1248399. View