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Title: Diagnosis and management of hyponatraemia in the older patient.
Austin Authors: Woodward, Michael M ;Gonski, Peter;Grossmann, Mathis ;Obeid, John;Scholes, Ron;Topliss, Duncan J
Affiliation: Aged Care Services, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
Southcare (Aged and Extended Care) Sutherland Hospital, Sydney, New South Wales, Australia
Specialist Services Medical Group, Sydney, New South Wales, Australia
Epworth Healthcare, Melbourne, Victoria, Australia
Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Victoria, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Issue Date: Jan-2018
Publication information: Internal Medicine Journal 2018; 48 Suppl 1: 5-12
Abstract: Hyponatraemia (serum sodium concentration below 135 mmol/L) is the most common electrolyte disturbance and occurs commonly in older people. The causes can be complex to diagnose and treat and many published guidelines do not focus on the issues in an older patient group. Here, we are principally concerned with diagnosis and management of euvolaemic and hypervolaemic hyponatraemia in hospitalised patients over 70 years old. We also aim to increase awareness of hyponatraemia in residential aged care facilities and the community. Hyponatraemia can have many causes; in older people, chronic hyponatraemia can often be the result of medications used to treat chronic disease, particularly thiazide or thiazide-like drugs (such as indapamide) or drugs acting on the central nervous system. Where a reversible trigger (such as drug-induced hyponatraemia) can be identified, hyponatraemia may be treated relatively simply. Chronic hyponatraemia due to an irreversible cause will require ongoing treatment. Fluid restriction can be an effective therapy in dilutional hyponatraemia, although poor compliance and the burdensome nature of the restrictions are important considerations. Tolvaptan is an oral vasopressin receptor antagonist that can increase serum sodium concentrations by increasing electrolyte-free water excretion. Tolvaptan use is supported by clinical trial evidence in patients with hypervolaemic or euvolaemic hyponatraemia below 125 mmol/L. Clinical trial evidence also supports its use after a trial of fluid restriction in patients with symptomatic hyponatraemia above 125 mmol/L. The use of tolvaptan is affected by regulatory restriction of chronic therapy due to safety concern and the non-subsidised cost of treatment.
DOI: 10.1111/imj.13682
ORCID: 0000-0001-8261-3457
Journal: Internal Medicine Journal
PubMed URL: 29318728
Type: Journal Article
Subjects: aged
frail elderly
Appears in Collections:Journal articles

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