Summary
Electrolyte abnormalities in the elderly are common and it is most important to establish if drug treatment is the cause, as this is so easily remediable. The vast majority of electrolyte disturbances will settle with treatment of the underlying condition. Great attention must be paid to fluid balance to establish if the patient is receiving too little, which could induce hypernatraemia, or too much, particularly after surgery, which may induce hyponatraemia. Electrolyte levels should be checked ideally before and certainly after the prescription of diuretics. In the elderly it is important that the electrolyte levels be checked if the patient exhibits any vague symptoms, particularly if they are taking a diuretic. Care must be taken in replacing potassium as in most cases this is unnecessary and may have a significant morbidity.
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References
Adams KRH, Al-Hamouz S, Edmund E, Tallis RC, Vellodi C, et al. Inappropriate prescribing in the elderly. Journal of the Royal College of Physicians, London 21: 1 39–41, 1987
Adams KRH, Vargas E, Lye M. Electrolyte abnormalities and diuretics in the elderly. Journal of Clinical Experimental Gerontology 10(3 and 4): 171–180, 1988/1989
Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. American Journal of Medicine 42: 790–806, 1967
Covey CM, Arieff AI. Disorders of sodium and water metabolism and their effects on the central nervous system. In Brenner BM & Stein JH (Eds) Contemporary issues in nephrology, pp. 212–214, Churchill Livingstone, New York, 1978
Demanet JC, et al. Coma due to water intoxication in beer drinkers. Lancet 2: 1115–1117, 1971
Discala VA, Kinney MJ. Effects of myxoedema on renal diluting and concentrating mechanism. American Journal of Medicine 50: 325–335, 1971
Drury PL, Besser GM. In Hall R & Besser M (Eds) Fundamentals of clinical endocrinology, 4th ed., pp. 153–184, Churchill Livingstone, 1989
Ettinger PO, Regan TJ, Oldewartel HA. Hyperkalaemia, cardiac conduction and the EKG: a review. American Heart Journal 88: 360–371, 1974
Flear CTG. Hyponatraemia. Lancet 2: 164–166, 1974
Flear CTG, Gill GV, Burn J. Hyponatraemia: mechanisms and management. Lancet 2: 26–31, 1981
Flear CTG, Singh CM. Hyponatraemia and sick cells. British Journal of Anaesthesia 45: 976–994, 1973
Fraser CG, Cummings ST, Wilkinson SP, Neville RG, Knox JDE, et al. Biological variability of 26 clinical chemistry anolytes in elderly people. Clinical Chemistry 35: 783–786, 1989
Gehi MM, Rosenthal RH, Fizette NB, et al. Psychiatric manifestations of hyponatraemia. Psychosomatics 22: 739–743, 1981
Goldberg M, Handler JS. Hyponatraemia and renal wasting of sodium in patients with mild function of the central nervous system. New England Journal of Medicine 263: 1037–1043, 1960
Greenblatt DJ, Duhme DW, Allen MD, Kock-Weser J. Clinical toxicity of frusemide in hospitalized patients: a report from the Boston Collaborative Drug Surveillance Program. American Heart Journal 94(1): 6–13, 1977
Hawks AM. In Gowenlock A et al. (Eds) Varley’s practical clinical biochemistry, 6th ed., pp. 550–600, Heineman, New York, 1988
Hodgkinson HM. Biochemical diagnosis of the elderly, pp. 40–52, Chapman and Hollow, 1977
Joynt RJ, Feibel JH, Sladek CM. Anti diuretic hormone levels in stroke patients. Annals of Urology 9: 182–184, 1981
Judge TG. Hypokalaemia in the elderly. Gerontologia Clinica 10: 102–107, 1968
Kliger AS, Hayslett JP. Disorders of potassium balance. In Brenner BM & Stein JH (Eds) Acid-base potassium homeostasis, pp. 168–204, Churchill Livingstone, London, 1978
Lawson DH. Adverse reactions to potassium chloride. Quarterly Journal of Medicine 43: 433, 1974
Lawson DH, Henry DA, Lowe JM, Gray JMB, Morgan HG. Severe hypolcalcaemia in hospitalised patients. Archives of Internal Medicine 139: 978–980, 1979
Lowe J, Gray J, Henry DA, Lawson DH. Adverse reactions to frusemide in hospital inpatients. British Medical Journal 2: 360, 1979
Mitchell DM, Kennedy GE. Hyponatraemia and its management. Hospital Update, pp. 755–771, September 1979
Moran WH, Miltonberger FW, Shuayb WA, Zimmerman B. The relationship of anti diuretic hormone secretion to surgical stress. Surgery 56: 99–108, 1964
Morgan DB, Davidson C. Hypokalaemia and diuretics: an analysis of publications. British Medical Journal 1: 905, 1980
Nawar T, Genest J. Non-hormonal drugs for the treatment of diabetes insipidus. Canadian Medical Association Journal 107: 1225, 1972
Owen JA, Campbell DG. A comparison of plasma electrolyte and urea values in healthy persons and in hospital patients. Clinica Chimica Acta 22: 611–618, 1968
Polanska AI, Baron DN. Hyponatraemia associated with hydrochlorothiazide treatment. British Medical Journal 1: 175, 1978
Richardson T. In Gowenlock AH et al. (Eds) Varley’s practical clinical biochemistry, 6th ed. pp. 1007–1011, Heineman Medical Books, London, 1988
Robinson AG. Disorders of antidiuretic hormone secretion. In Ney RL (Ed.) Clinics in endocrinology and metabolism, pp. 55–88, 1985
Schwartz WB, Relman AS. Effects of electrolyte disorders on renal structure and function. New England Journal of Medicine 276: 383–389, 1967
Simpson FO. Sodium intake, body sodium and sodium excretion. Lancet 2: 25, 1988
Sobel KG, McTart GM. Drug use and accidental falls in an intermediate care facility. Drug Intelligence and Clinical Pharmacy 17: 539–542, 1983
Stormont JM, Westerhouse C. The genesis of hyponatraemia in association with marked overhydration and water intoxication. Circulation 24: 191–203, 1961
Thomas AJ, Hodgkinson HM. Which diuretics cause hypomagnesaemia? A study of elderly in-patients. Journal of Experimental Gerontology 3: 269–283, 1981
Verbalis JG, Robinson AG. Neurophysin and vasopressin: newer concepts of secretion and regulation. In Imura I (Ed.) The pituitary, Comprehensive Endocrinology Series, pp. 307–340, Raven Press, New York, 1984
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Adams, K.R.H., Martin, J.A. Electrolyte Disorders in the Elderly. Drugs & Aging 1, 254–265 (1991). https://doi.org/10.2165/00002512-199101040-00002
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DOI: https://doi.org/10.2165/00002512-199101040-00002