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Elektrolytveränderungen im Alter mit Fokus auf Hyponatriämie

Electrolyte disturbances in geriatric patients with focus on hyponatremia

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Zusammenfassung

Aufgrund von vielfältigen altersphysiologischen und auch krankheitsbedingten Veränderungen sind geriatrische Patienten prädisponiert für Störungen des Elektrolyt- und Wasserhaushalts, insbesondere für das Auftreten einer Hyponatriämie. Bereits eine milde chronische Hyponatriämie kann zu kognitiven Einschränkungen und Gangunsicherheit führen und ist mit erhöhten Raten an Stürzen und Frakturen assoziiert. Zusätzlich legen experimentelle und epidemiologische Daten nahe, dass die Hyponatriämie die Knochenresorption begünstigen kann und daher das Risiko für Osteoporose steigert. Hypernatriämie verursacht häufig nur unspezifische Symptome, ist jedoch mit einer deutlich erhöhten Mortalität assoziiert. Hypomagnesiämie kann Sarkopenie und Osteoporose begünstigen. Da Elektrolytstörungen bei geriatrischen Patienten eine hohe Prävalenz aufweisen und zu geriatrischen Syndromen beitragen können, sollte der Ausschluss relevanter Elektrolytveränderungen bei allen geriatrischen Patienten erfolgen, insbesondere nach Umstellung der Medikation.

Abstract

Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia. Hypernatremia often only results in unspecific symptoms but the condition is associated with a clearly increased mortality. As electrolyte disturbances have a high prevalence in the geriatric population and can contribute to geriatric syndromes and frailty, relevant electrolyte alterations should be excluded in all geriatric patients, in particular after a change in medication schedules.

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Literatur

  1. Adeleye O, Faulkner M, Adeola T, ShuTangyie G (2002) Hypernatremia in the elderly. J Natl Med Assoc 94:701–705

    PubMed Central  Google Scholar 

  2. Adrogué HJ, Madias NE (2000) Hypernatremia. N Engl J Med 342:1493–1499. doi:10.1056/NEJM200005183422006

    Article  Google Scholar 

  3. Barbagallo M, Belvedere M, Dominguez LJ (2009) Magnesium homeostasis and aging. Magnes Res 22:235–246. doi:10.1684/mrh.2009.0187

    CAS  Google Scholar 

  4. Corona G, Giuliani C, Parenti G et al (2016) The economic burden of hyponatremia: Systematic review and meta-analysis. Am J Med. doi:10.1016/j.amjmed.2016.03.007

    Google Scholar 

  5. Coudray C, Feillet-Coudray C, Rambeau M et al (2005) Stable isotopes in studies of intestinal absorption, exchangeable pools and mineral status: The example of magnesium. J Trace Elem Med Biol 19:97–103. doi:10.1016/j.jtemb.2005.07.002

    Article  CAS  Google Scholar 

  6. Coudray C, Feillet-Coudray C, Rambeau M et al (2006) The effect of aging on intestinal absorption and status of calcium, magnesium, zinc, and copper in rats: A stable isotope study. J Trace Elem Med Biol 20:73–81. doi:10.1016/j.jtemb.2005.10.007

    Article  CAS  Google Scholar 

  7. Dominguez LJ, Barbagallo M, Lauretani F et al (2006) Magnesium and muscle performance in older persons: The InCHIANTI study. Am J Clin Nutr 84:419–426

    CAS  PubMed Central  Google Scholar 

  8. Gosch M, Joosten-Gstrein B, Heppner H‑J, Lechleitner M (2012) Hyponatremia in geriatric inhospital patients: Effects on results of a comprehensive geriatric assessment. Gerontology 58:430–440. doi:10.1159/000339100

    Article  CAS  Google Scholar 

  9. Haskew-Layton RE, Rudkouskaya A, Jin Y et al (2008) Two distinct modes of hypoosmotic medium-induced release of excitatory amino acids and taurine in the rat brain in vivo. PLoS ONE 3:e3543. doi:10.1371/journal.pone.0003543

    Article  PubMed Central  Google Scholar 

  10. Hoorn EJ, Rivadeneira F, van Meurs JBJ et al (2011) Mild hyponatremia as a risk factor for fractures: The Rotterdam Study. J Bone Miner Res 26:1822–1828. doi:10.1002/jbmr.380

    Article  CAS  Google Scholar 

  11. Hyzinski-García MC, Vincent MY, Haskew-Layton RE et al (2011) Hypo-osmotic swelling modifies glutamate-glutamine cycle in the cerebral cortex and in astrocyte cultures. J Neurochem 118:140–152. doi:10.1111/j.1471-4159.2011.07289.x

    Article  PubMed Central  Google Scholar 

  12. Kinsella S, Moran S, Sullivan MO et al (2010) Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol 5:275–280. doi:10.2215/CJN.06120809

    Article  CAS  PubMed Central  Google Scholar 

  13. Löwik MR, van Dokkum W, Kistemaker C et al (1993) Body composition, health status and urinary magnesium excretion among elderly people (Dutch Nutrition Surveillance System). Magnes Res 6:223–232

    Google Scholar 

  14. Luckey AE, Parsa CJ (2003) Fluid and electrolytes in the aged. Arch Surg 138:1055–1060 (Chic Ill 1960) doi:10.1001/archsurg.138.10.1055

    Article  Google Scholar 

  15. Mannesse CK, Vondeling AM, van Marum RJ et al (2013) Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: A systematic review. Ageing Res Rev 12:165–173. doi:10.1016/j.arr.2012.04.006

    Article  CAS  Google Scholar 

  16. McNair P, Christensen MS, Christiansen C et al (1982) Renal hypomagnesaemia in human diabetes mellitus: Its relation to glucose homeostasis. Eur J Clin Invest 12:81–85

    Article  CAS  Google Scholar 

  17. 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–e8. doi:10.1016/j.amjmed.2005.09.026

    Google Scholar 

  18. Rock E, Astier C, Lab C et al (1995) Dietary magnesium deficiency in rats enhances free radical production in skeletal muscle. J Nutr 125:1205–1210

    CAS  Google Scholar 

  19. Rude RK, Gruber HE (2004) Magnesium deficiency and osteoporosis: Animal and human observations. J Nutr Biochem 15:710–716. doi:10.1016/j.jnutbio.2004.08.001

    Article  CAS  Google Scholar 

  20. Schlanger LE, Bailey JL, Sands JM (2010) Electrolytes in the aging. Adv Chronic Kidney Dis 17:308–319. doi:10.1053/j.ackd.2010.03.008

    Article  PubMed Central  Google Scholar 

  21. Shah MK, Workeneh B, Taffet GE (2014) Hypernatremia in the geriatric population. Clin Interv Aging 9:1987–1992. doi:10.2147/CIA.S65214

    PubMed Central  Google Scholar 

  22. Snyder NA, Feigal DW, Arieff AI (1987) Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity. Ann Intern Med 107:309–319

    Article  CAS  Google Scholar 

  23. Soiza RL, Hoyle GE, Chua MP (2008) Electrolyte and salt disturbances in older people: Causes, management and implications. Rev Clin Gerontol 18:143–158. doi:10.1017/S0959259809002822

    Article  Google Scholar 

  24. Spasovski G, Vanholder R, Allolio B et al (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 29(Suppl 2):i1–i39. doi:10.1093/ndt/gfu040

    Article  Google Scholar 

  25. Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119:S30–S35. doi:10.1016/j.amjmed.2006.05.005

    Article  CAS  Google Scholar 

  26. Upala S, Sanguankeo A (2016) Association between hyponatremia, osteoporosis, and fracture: A systematic review and meta-analysis. J Clin Endocrinol Metab 101:1880–1886. doi:10.1210/jc.2015-4228

    Article  Google Scholar 

  27. Verbalis JG (2010) Brain volume regulation in response to changes in osmolality. Neuroscience 168:862–870. doi:10.1016/j.neuroscience.2010.03.042

    Article  CAS  Google Scholar 

  28. Verbalis JG, Ellison H, Hobart M et al (2016) Tolvaptan and neurocognitive function in mild to moderate chronic hyponatremia: A randomized trial (INSIGHT). Am J Kidney Dis 67(6):893–901. doi:10.1053/j.ajkd.2015.12.024

    Article  CAS  Google Scholar 

  29. Verbalis JG, Goldsmith SR, Greenberg A et al (2013) Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 126:S1–S42. doi:10.1016/j.amjmed.2013.07.006

    Article  Google Scholar 

  30. Wacker WE, Parisi AF (1968) Magnesium metabolism. N Engl J Med 278:658–663. doi:10.1056/NEJM196803212781205

    Article  CAS  Google Scholar 

  31. Wald R, Jaber BL, Price LL et al (2010) Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 170:294–302. doi:10.1001/archinternmed.2009.513

    Article  CAS  Google Scholar 

  32. Wester PO, Dyckner T (1981) Diuretic treatment and magnesium losses. Acta Med Scand Suppl 647:145–152

    Google Scholar 

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Authors and Affiliations

  1. Klinik II für Innere Medizin, Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Uniklinik Köln, Kerpenerstr. 62, 50937, Köln, Deutschland

    F. Grundmann

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F. Grundmann hat Reisekostenunterstützung sowie Beraterhonorar durch die Otsuka Pharma GmbH erhalten.

Dieser Beitrag beinhaltet keine von der Autorin durchgeführten Studien an Menschen oder Tieren.

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Grundmann, F. Elektrolytveränderungen im Alter mit Fokus auf Hyponatriämie. Z Gerontol Geriat 49, 477–482 (2016). https://doi.org/10.1007/s00391-016-1117-y

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