Objective: Hyponatraemia is one of the major problems in geriatric inpatients. However, in nonhospitalised elderly, the preponderance of hyponatraemia and the importance of the effect of drug intake on serum sodium concentrations are little known. This study investigated the prevalence of hyponatraemia in very old nonhospitalised people, controlling for factors that may induce hyponatraemia (especially drug use).
Methods: Data on serum sodium concentration, health and drug use were retrieved for 185 persons aged 92 to 93 years (the 1905 cohort) and 147 persons aged 100 years (the centenarian cohort) participating in two major population-based studies of elderly people in Denmark. Data were analysed by comparing median serum sodium concentrations between users and nonusers of various drugs after controlling for the influence of age, sex, cancer, heart failure, hypothyroidism, renal failure and smoking. Furthermore, the preponderance of drug use in the patients with clinically relevant hyponatraemia was compared with that in persons with normal serum sodium concentrations.
Results: Median serum sodium concentration was 140 mmol/L for the centenarians and 141 mmol/L for the 1905 cohort. In total, 19 persons had hyponatraemia (serum sodium concentration ≤134 mmol/L). There was no association between median serum sodium concentration and any of the above-mentioned diseases, or sex or smoking. Of the drugs generally known to cause hyponatraemia, only omeprazole and oral antidiabetic agents were associated with significantly lower median serum sodium concentrations (difference 3 mmol/L). Use of thiazide diuretics was significantly more common than expected in persons with hyponatraemia compared with persons with a normal serum sodium concentration (7 of 19 vs 46 of 270 individuals). Furthermore, the results suggested that digoxin and lactulose might be associated with a lowered median serum sodium concentration.
Conclusion: This study demonstrates that severe hyponatraemia was rarely seen in a population-based sample of very old persons and that drugs have only a limited influence on serum sodium concentration. The only drug class associated with clinically relevant hyponatraemia was thiazide diuretics, which were used by significantly more persons with hyponatraemia. Furthermore, this study suggests that digoxin and lactulose use is associated with lower serum sodium concentrations in the elderly.
Digoxin Omeprazole Lactulose Thiazide Diuretic Anatomical Therapeutic Chemical
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Supported by the US National Institute on Aging research grant NIA-PO1-AG08761, the Danish National Research Foundation and a centre grant from the Danish Medical Research Council no. 9501767.
The study complies with the current laws in Denmark.
The authors have no conflicts of interest directly relevant to the contents of this manuscript.
Owen JA, Campell DG. A comparison of plasma electrolyte and urea values in healthy persons and in hospital patients. Clin Chem Acta 1968; 22: 611–8CrossRefGoogle Scholar
Isselbacher KJ, Braunwald E, Wilson JD, et al., editors. Harrison’s principles of internal medicine, 13th ed. New York: McGraw Hill, 1994Google Scholar
Spigset O, Hedenmalm K. Hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs. Drug Saf 1995; 12: 209–25PubMedCrossRefGoogle Scholar
Allon M, Allen HM, Deck LV, et al. Role of cigarette use in hyponatremia in schizophrenic patients. Am J Psychiatry 1990; 147: 1075–7PubMedGoogle Scholar
Caird F, Andrews GR, Kennedy RD. Effect on posture on blood pressure in the elderly. Br Heart J 1973; 35: 527–30PubMedCrossRefGoogle Scholar
Miller M, Hecker MS, Friedlander DA, et al. Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriatr Soc 1996; 44: 404–8PubMedGoogle Scholar
Sørensen IJ, Matzen LE. Serum electrolytes and medicamental treatment in a geriatric department. Ugeskr Læger 1993; 155: 3921–2PubMedGoogle Scholar
Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967; 42: 790–806PubMedCrossRefGoogle Scholar
Nybo H, Gaist D, Jeune B, et al. The Danish 1905 cohort: a genetic-epidemiological nationwide survey. J Aging Health 2001; 13(1): 32–46PubMedCrossRefGoogle Scholar
Andersen-Ranberg K, Jeune B, Hoeier-Madsen M, et al. Thyroid function, morphology and prevalence of thyroid disease in a population-based study of Danish centenarians. J Am Geriatr Soc 1999; 47: 1238–43PubMedGoogle Scholar
WHO Collaborating Centre for Drug Statistics Methodology. The anatomical therapeutic chemical (ATC) classification and DDD assignment. Oslo: World Health Organisation, 1998: 12–29Google Scholar
Gaist D, Søgerrensen HT, Hallas J. The Danish prescription registries. Dan Med Bull 1997; 44: 445–8PubMedGoogle Scholar
Bjerrum L, Rosholm JU, Hallas J, et al. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol 1997; 53: 7–11PubMedCrossRefGoogle Scholar
Gentric AT. Severe hyponatremia associated with ramipril therapy in an old woman [letter]. J Am Geriatr Soc 1995; 43: 1448–9Google Scholar
Oster JR, Materson BJ. Renal and electrolyte complications on congestive heart failure and effects of therapy with angiotensin-converting enzyme inhibitors. Arch Intern Med 1992; 152: 704–10PubMedCrossRefGoogle Scholar
Bouman WP, Pinner G, Johyponatremiason H. Incidence of selective serotonin reuptake inhibitors (SSRI) induced hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion in the elderly. Int J Geriatr Psychiatry 1998; 13: 12–5PubMedCrossRefGoogle Scholar
Mercado R, Michelis MF. Severe sodium depletion syndrome during lithium carbonate therapy. Arch Intern Med 1977; 137: 1731–3PubMedCrossRefGoogle Scholar
Amelsvoort TV, Bakshi R, Devaux CB, et al. Hyponatremia associated with carbamazepine and oxacarbazepine therapy: a review. Epilepsia 1994; 35: 181–8PubMedCrossRefGoogle Scholar
Hensen J, Haenelt M, Gross P, et al. Water retention after oral chlorpropamide is associated with an increase in renal papillary arginine vasopressin receptors. Eur J Endocrinol 1995; 132: 459–64PubMedCrossRefGoogle Scholar
Shiba S, Sugiura K, Ebata A, et al. Hyponatremia with consciousness disturbance caused by omeprazole administration. Dig Dis Sci 1996; 41: 1615–7PubMedCrossRefGoogle Scholar