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Hyponatremia is the most common type of electrolyte imbalance, and is often found in older adults. [11] [12] It occurs in about 20% of those admitted to hospital and 10% of people during or after an endurance sporting event. [3] [5] Among those in hospital, hyponatremia is associated with an increased risk of death. [5]
The low GFR causes a lowered rate of osmole excretion, and an increase in the amount of water reabsorbed; thus, hyponatremia occurs when the amount of water intake exceeds the renal water excretion capacity. [2] Medications, such as thiazides and antidepressants, may exacerbate symptoms of hyponatremia. [2]
In severe or acute hypoosmolar hyponatremia, swelling of brain cells causes various neurological abnormalities, which in severe or acute cases can result in convulsions, coma, and death. The symptoms of chronic syndrome of inappropriate antidiuresis are more vague, and may include cognitive impairment , gait abnormalities , or osteoporosis .
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, [1] are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings.
[14] [3] Dilutional hyponatremia can happen in diabetics as high glucose levels pull water into the blood stream causing the sodium concentration to be lower. [14] [3] Diagnosis of the cause of hyponatremia relies on three factors: volume status, plasma osmolality, urine sodium levels and urine osmolality. [14] [3]
Loop diuretics usually have a ceiling effect whereby doses greater than a certain maximum amount will not increase the clinical effect of the drug. Also, there is a threshold minimum concentration of loop diuretics that needs to be achieved at the thick ascending limb to enable the onset of abrupt diuresis.
Class Ib drugs tend to be more specific for voltage gated Na channels than Ia. Lidocaine in particular is highly frequency dependent, in that it has more activity with increasing heart rates. This is because lidocaine selectively blocks Na channels in their open and inactive states and has little binding capability in the resting state.
Non-psychogenic – another non-psychological cause, including idiopathic (unknown cause) The terms primary polydipsia and psychogenic polydipsia are sometimes incorrectly used interchangeably – to be considered psychogenic, the patient needs to have some other psychiatric symptoms, such as delusions involving fluid intake or other unusual ...