International Urology and Nephrology

, Volume 41, Issue 3, pp 733–737 | Cite as

Hyponatremia associated with large-bone fracture in elderly patients

  • Harminder S. Sandhu
  • Emmanuelle Gilles
  • Maria V. DeVita
  • Georgia Panagopoulos
  • Michael F. Michelis
Nephrology - Original Paper

Abstract

Hyponatremia has been shown to be associated with gait disturbances, decreased mentation, and falls. The study objective was to determine the incidence of hyponatremia in patients who experienced a substantial skeletal fracture (hip/pelvis/femur). During an 18-month period from March 2007 to August 2008 serum sodium levels were evaluated in 364 cases of bone fracture in patients aged 65 years or older and in 364 nonfracture patients aged 65 years and older seen in an urban emergency room setting. The incidence of hyponatremia in patients with fractures was more than double that of nonfracture patients (9.1% and 4.1%, respectively; P = 0.007). The degree of hyponatremia was noted to be mild to moderate. Mean serum sodium of the entire fracture group was 131 ± 2 mEq/L. In the fracture group the patients were 75.3% female, while females comprised 66.2% of the nonfracture group (P = 0.02). Of fracture patients with hyponatremia, 24.2% were taking antidepressants [3/4 of which were selective serotonin receptor inhibitors (SSRIs)], while none were taking these medications in the nonfracture group. Attention regarding careful follow-up of serum sodium levels in elderly patients seems appropriate.

Keywords

Hyponatremia SSRI use Large-bone fracture 

References

  1. 1.
    Miller M (2006) Hyponatremia and arginine vasopressin dysregulation: mechanisms, clinical consequences, and management. J Am Geriatr Soc 54:345–353. doi:10.1111/j.1532-5415.2005.00609.x PubMedCrossRefGoogle Scholar
  2. 2.
    Zhou XJ, Saxena R, Liu Z et al (2008) Renal senescence in 2008: progress and challenges. Int Urol Nephrol 40:823–839. doi:10.1007/s11255-008-9405-0 PubMedCrossRefGoogle Scholar
  3. 3.
    Verbalis JG, Berl T (2008) Disorders of water balance. In: Brenner BM (ed) Brenner & Rector’s The Kidney, 8th edn. Saunders Elsevier, Philadelphia, pp 459–504Google Scholar
  4. 4.
    Renneboog B, Musch W, Vandemergel X et al (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119:71.e1–71.e8CrossRefGoogle Scholar
  5. 5.
    Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370. doi:10.1046/j.1532-5415.2003.51110.x PubMedCrossRefGoogle Scholar
  6. 6.
    Kugler JP, Hustead T (2000) Hyponatremia and hypernatremia in the elderly. Am Fam Physician 61:3623–3630PubMedGoogle Scholar
  7. 7.
    Pagano M, Gauvreau K (1993) Principles of biostatistics. Duxbury Press, Belmont, CAGoogle Scholar
  8. 8.
    Verbalis JG, Goldsmith SR, Greenberg A et al (2007) Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med 120(11A):S1–S21. doi:10.1016/j.amjmed.2007.09.001 PubMedCrossRefGoogle Scholar
  9. 9.
    Sterns RH, Cappuccio JD, Silver SM et al (1994) Neurologic sequelae after treatment of severe hyponatremia: a multicenter prespective. J Am Soc Nephrol 4:1522–1530PubMedGoogle Scholar
  10. 10.
    Schrier RW, Gross P, Gheorghiade M et al (2006) Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med 355(20):2099–2112. doi:10.1056/NEJMoa065181 PubMedCrossRefGoogle Scholar
  11. 11.
    Morley JE (2007) Falls and fractures. J Am Med Dir Assoc 8(5):276–278. doi:10.1016/j.jamda.2007.04.008 PubMedCrossRefGoogle Scholar
  12. 12.
    Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87(3):398–403. doi:10.2105/AJPH.87.3.398 PubMedCrossRefGoogle Scholar
  13. 13.
    Lee C-T, Guo H-R, Chen J-B (2000) Hyponatremia in the emergency department. Am J Emerg Med 18:264–268. doi:10.1016/S0735-6757(00)90118-9 PubMedCrossRefGoogle Scholar
  14. 14.
    Kengne FG, Andres C, Sattar L et al (2008) Mild hyponatremia and risk of fracture in the ambulatory elderly. Q J Med 101:583–588Google Scholar
  15. 15.
    Arieff AI, Ayus JC (2001) Hip fractures associated with symptomatic hyponatremia. J Am Soc Nephrol 12:133Google Scholar
  16. 16.
    Fabian TJ, Amico JA, Kroboth PD et al (2004) Paroxetine-induced hyponatremia in older adults. A 12 week prospective study. Arch Intern Med 164:327–332. doi:10.1001/archinte.164.3.327 PubMedCrossRefGoogle Scholar
  17. 17.
    Roxanas M (2003) Mirtazapine-induced hyponatremia. Med J Aust 179(8):453–454PubMedGoogle Scholar
  18. 18.
    Ensrud KE, Blackwell T, Mangione CM et al (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163:949–957. doi:10.1001/archinte.163.8.949 PubMedCrossRefGoogle Scholar
  19. 19.
    Jacob S, Spinler SA (2006) Hyponatremia associated with selective serotonin-reuptake inhibitors in older patients. Ann Pharmacother 40(9):1618–1622PubMedCrossRefGoogle Scholar
  20. 20.
    Draper B, Berman K (2008) Tolerability of selective serotonin reuptake inhibitors. Drugs Aging 25(6):501–519. doi:10.2165/00002512-200825060-00004 PubMedCrossRefGoogle Scholar
  21. 21.
    Metzger BL, DeVita MV, Michelis MF (2008) Observations regarding the use of the aquaretic agent conivaptan for treatment of hyponatremia. Int Urol Nephrol 40:725–730. doi:10.1007/s11255-008-9353-8 PubMedCrossRefGoogle Scholar
  22. 22.
    Gheorghiade M, Konstam M, Burnett JC et al (2007) Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure. The EVEREST clinical status trials. JAMA 297(12):1332–1343. doi:10.1001/jama.297.12.1332 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2009

Authors and Affiliations

  • Harminder S. Sandhu
    • 1
  • Emmanuelle Gilles
    • 1
  • Maria V. DeVita
    • 1
  • Georgia Panagopoulos
    • 2
  • Michael F. Michelis
    • 1
  1. 1.Division of NephrologyLenox Hill HospitalNew YorkUSA
  2. 2.Department of ResearchLenox Hill HospitalNew YorkUSA

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