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Clinical aspects of changes in water and sodium homeostasis in the elderly

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Abstract

The population of elderly individuals is increasing worldwide. With aging, various hormonal and kidney changes occur, both affecting water homeostasis. Aging is a risk factor for chronic kidney disease (CKD) and many features of CKD are reproduced in the aging kidney. Dehydration and hyperosmolarity can be triggered by diminished thirst perception in this population. Elderly with dementia are especially susceptible to abnormalities of their electrolyte and body water homeostasis and should be (re-)assessed for polypharmacy. Hypo- and hypernatremia can be life threatening and should be diagnosed and treated promptly, following current practice guidelines. In severe cases of acute symptomatic hyponatremia, a rapid bolus of 100 to 150 ml of intravenous 3% hypertonic saline is appropriate to avert catastrophic outcomes; for asymptomatic hyponatremia, a very gradual correction is preferred. In summary, the body sodium (Na+) balance is regulated by a complex interplay of environmental and individual factors. In this review, we attempt to provide an overview on this topic, including dehydration, hyponatremia, hypernatremia, age-related kidney changes, water and sodium balance, and age-related changes in the vasopressin and renin-angiotensin-aldosterone system.

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Mississippi Medical Center, Jackson, MS, USA

    Christian A. Koch

  2. G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA

    Christian A. Koch

  3. Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA

    Christian A. Koch

  4. FMC Extracorporeal Life Support Center, Fresenius Medical Care; Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

    Tibor Fulop

  5. Department of Medicine, Division of Nephrology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary

    Tibor Fulop

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CAK declares that he has no conflict of interest related to this work. TF declares that he is an employee of Fresenius Medical Care Hungary.

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Koch, C.A., Fulop, T. Clinical aspects of changes in water and sodium homeostasis in the elderly. Rev Endocr Metab Disord 18, 49–66 (2017). https://doi.org/10.1007/s11154-017-9420-5

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