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.
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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
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
Verbalis JG, Berl T (2008) Disorders of water balance. In: Brenner BM (ed) Brenner & Rector’s The Kidney, 8th edn. Saunders Elsevier, Philadelphia, pp 459–504
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.e8
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
Kugler JP, Hustead T (2000) Hyponatremia and hypernatremia in the elderly. Am Fam Physician 61:3623–3630
Pagano M, Gauvreau K (1993) Principles of biostatistics. Duxbury Press, Belmont, CA
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
Sterns RH, Cappuccio JD, Silver SM et al (1994) Neurologic sequelae after treatment of severe hyponatremia: a multicenter prespective. J Am Soc Nephrol 4:1522–1530
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
Morley JE (2007) Falls and fractures. J Am Med Dir Assoc 8(5):276–278. doi:10.1016/j.jamda.2007.04.008
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
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
Kengne FG, Andres C, Sattar L et al (2008) Mild hyponatremia and risk of fracture in the ambulatory elderly. Q J Med 101:583–588
Arieff AI, Ayus JC (2001) Hip fractures associated with symptomatic hyponatremia. J Am Soc Nephrol 12:133
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
Roxanas M (2003) Mirtazapine-induced hyponatremia. Med J Aust 179(8):453–454
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
Jacob S, Spinler SA (2006) Hyponatremia associated with selective serotonin-reuptake inhibitors in older patients. Ann Pharmacother 40(9):1618–1622
Draper B, Berman K (2008) Tolerability of selective serotonin reuptake inhibitors. Drugs Aging 25(6):501–519. doi:10.2165/00002512-200825060-00004
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
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
The authors wish to gratefully acknowledge Mr. Michael F. Dougherty, MS, RN, CEN and Mr. John Lisa who developed the electronic search instrument that identified the patients reported in this study.
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Sandhu, H.S., Gilles, E., DeVita, M.V. et al. Hyponatremia associated with large-bone fracture in elderly patients. Int Urol Nephrol 41, 733–737 (2009). https://doi.org/10.1007/s11255-009-9585-2
- SSRI use
- Large-bone fracture