Yaşlılarda Hiponatremiyle İlişkili Faktörler

Yıl 2019, Cilt: 2 Sayı: 3, 90 - 94, 31.12.2019

Suleyman Emre Kocyıgıt , Ali Ekrem Aydın

Öz

Amaç: Hiponatremi yaşlı hastalarda en sık görülen
elektrolit bozukluğudur, kötü prognoz ve mortalite artışı ile ilişkilidir. Bu
çalışmanın amacı, yaşlı erişkinlerde hiponatremi ile ilişkili komorbid
hastalıkları ve ilaçları incelemektir.

Gereç ve Yöntemler: Bu retrospektif, kesitsel bir çalışmada geriatri
kliniğine başvuran 240 yaşlı hasta (yatarak ve ayakta tedavi gören hasta)
değerlendirdi. Tüm katılımcıların demografik özellikleri, komorbiditeleri,
ilaçları ve laboratuvar bulguları değerlendirildi. Hiponatremi, sodyum düzeyi
<135 mmol / L olarak tanımlandı.

Bulgular:
Çalışmada hiponatremi
prevalansı % 22.1 idi  ve ortalama yaş
75.27 ± 7.28 olarak saptandı. 
Hiponatremi grubunda hipertansiyon (HT), diabetes mellitus (DM), konjestif
kalp yetmezliği (KKY), aterosklerotik kalp hastalığı (ASKH) sıklığı daha
yüksekti (p<0.05). Diüretik, antidepresan ve antipsikotik ilaç kullanım
sıklığı hiponatremi grubunda daha fazla olarak tespit edildi (p< 0.05).

Sonuç: Bazı komorbiditeler ile diüretik, antidepresan
ve antipsikotik gibi yaşlılarda sık reçete edilen ilaç gruplarının hiponatremi
ile ilişkili olabileceği gösterilmiştir. Bu açıdan geriatri pratiğinde
hastaları değerlendirmek önemlidir.

Anahtar Kelimeler

hiponatremi, yaşlılık, diüretik, komorbidite

The Factors Associated Hyponatremia in Older Adults

Öz

Aim: Hyponatremia is the most common electrolyte
disturbance in older adults and is associated with poor prognosis and increased
mortality. The aim of this study was to investigate comorbid diseases and drugs
associated with hyponatremia in older adults.

Material and Methods: In this
retrospective and cross-sectional study, 240 elderly patients (inpatients and
outpatients) admitted to the geriatrics clinic were evaluated. Demographic
characteristics, comorbidities, drugs and laboratory findings of all participants
were evaluated. Hyponatremia was defined as sodium level <135 mmol / L.

Results: The prevalence of hyponatremia was 22.1%
and the mean age was 75.27 ± 7.28 years. The frequency of hypertension (HT),
diabetes mellitus (DM), congestive heart failure (CHF), and atherosclerotic
heart disease (ASHD) were higher in the hyponatremia group than normonatremia
group (p <0.05). The incidence of diuretics, anridepressant and
antipsychotic drugs usage was higher in hyponatremia group (p <0.05).

Conclusions: Several
comorbidities and frequently prescribed drug groups in older adults such as
diuretics, antidepressants and antipsychotic medicines may be associated with
hyponatremia. In this respect, it is necessary to evaluate patients in
geriatric practice in terms of comorbidities and drugs.

Anahtar Kelimeler

hyponatremia, old age, diuretic, comorbidity

Kaynakça

• 1. Cumming K, Hoyle GE, Hutchison JD, Soiza RL. Prevalence, incidence and etiology of hyponatremia in elderly patients with fragility fractures. PLoS One. 2014;9:e88272.
• 2. Soiza RL, Cumming K, Clarke JM, Wood KM, Myint PK. Hyponatremia: Special Considerations in Older Patients. J Clin Med. 2014;3:944-958.
• 3. Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: challenges and solutions. Clin Interv Aging. 2017;12:1957-1965.
• 4. Soiza RL, Hoyle GE, Chua M. Electrolyte and salt disturbances in older people: causes, management and implications. Rev Clin Gerontol. 2008;18:143-158.
• 5. Chua M, Hoyle GE, Soiza RL. Prognostic implications of hyponatremia in elderly hospitalized patients. Arch Gerontol Geriatr. 2007;45:253-258.
• 6. Hanotier P. Hyponatremia in the elderly: its role in frailty. Rev Med Brux. 2015;36:475-484.
• 7. Anpalahan M. Chronic idiopathic hyponatremia in older people due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) possibly related to aging. J Am Geriatr Soc. 2001;49:788-792.
• 8. Vu T, Wong R, Hamblin PS, Zajac J, Grossmann M. Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes. Hosp Pract (1995). 2009;37:128-136.
• 9. Soiza RL, Talbot HSC. Management of hyponatraemia in older people: old threats and new opportunities. Ther Adv drug Saf. 2011;2:9-17.
• 10. Frenkel WNJ, van den Born B-JH, van Munster BC, Korevaar JC, Levi M, de Rooij SE. 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;58:2227-2228.
• 11. Hoorn EJ, Rivadeneira F, van Meurs JBJ, et al. Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res. 2011;26:1822-1828.
• 12. Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169-172.
• 13. Mannesse CK, Vondeling AM, van Marum RJ, van Solinge WW, Egberts TCG, Jansen PAF. Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review. Ageing Res Rev. 2013;12:165-173.
• 14. Nelson JM, Robinson M V. Hyponatremia in older adults presenting to the emergency department. Int Emerg Nurs. 2012;20:251-254.
• 15. Lippi G, Meschi T, Picanza A, Nouvenne A, Borghi L, Cervellin G. The prevalence of hyponatremia increases with ageing in an Italian emergency department population. Eur Geriatr Med. 2015.
• 16. Shapiro DS, Sonnenblick M, Galperin I, Melkonyan L, Munter G. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Intern Med J. 2010;40:574-580.
• 17. Berl T. An elderly patient with chronic hyponatremia. Clin J Am Soc Nephrol. 2013;8:469-475.
• 18. Mazhar F, Pozzi M, Gentili M, et al. Association of Hyponatraemia and Antidepressant Drugs: A Pharmacovigilance-Pharmacodynamic Assessment Through an Analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) Database. CNS Drugs. 2019;33:581-592.
• 19. Lange-Asschenfeldt C, Kojda G, Cordes J, et al. Epidemiology, symptoms, and treatment characteristics of hyponatremic psychiatric inpatients. J Clin Psychopharmacol. 2013;33:799-805.
• 20. Liamis G, Filippatos TD, Elisaf MS. Thiazide-associated hyponatremia in the elderly: what the clinician needs to know. J Geriatr Cardiol. 2016;13:175-182.
• 21. Buon M, Gaillard C, Martin J, et al. Risk of proton pump inhibitor-induced mild hyponatremia in older adults. J Am Geriatr Soc. 2013;61:2052-2054.