Seasonal variations of hyponatremia in the emergency department: Age-related changes

Giordano, Mauro; Ciarambino, Tiziana; Castellino, Pietro; Malatino, Lorenzo; Cataliotti, Alessandro; Rinaldi, Luca; Paolisso, Giuseppe; Adinolfi, Luigi Elio

doi:10.1016/j.ajem.2017.01.018

Cited by 44 publications

(42 citation statements)

References 12 publications

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“…The prevalence of hyponatremia observed in emergency departments varies between studies. The 5.7% prevalence of hyponatremia in the adult group observed in our study was close to the previous report [ 7 , 9 ]. Similarly, the 0.3% prevalence of severe hyponatremia in the adult group observed in our study was also close to the previous report [ 10 ].…”

Section: Discussionsupporting

confidence: 92%

“…Similarly, the 0.3% prevalence of severe hyponatremia in the adult group observed in our study was also close to the previous report [ 10 ]. On the other hand, the 17.0% prevalence of hyponatremia in the elderly group was higher than the previous report [ 7 ].…”

Section: Discussioncontrasting

confidence: 81%

“…Hyponatremia is one of the most commonly encountered electrolyte disorders in the emergency departments [ 1 , 2 ]. Hyponatremia is known for its high morbidity and mortality and age is a strong independent risk factor of hyponatremia [ 3 – 7 ]. Only a few studies have investigated the impact of age on the seasonal prevalence of hyponatremia in patients admitted to emergency departments [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hyponatremia is known for its high morbidity and mortality and age is a strong independent risk factor of hyponatremia [ 3 – 7 ]. Only a few studies have investigated the impact of age on the seasonal prevalence of hyponatremia in patients admitted to emergency departments [ 7 , 8 ]. Considering the aging population in Japan, the increased susceptibility of the elderly to develop hyponatremia is particularly important.…”

Section: Introductionmentioning

confidence: 99%

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Seasonal prevalence of hyponatremia in the emergency department: impact of age

et al. 2018

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BackgroundHyponatremia is one of the most commonly encountered electrolyte disorders in emergency department (ED). Seasonal fluctuations of the prevalence of hyponatremia has been reported. We investigated the impact of age on the seasonal prevalence of hyponatremia in the emergency department in Japan.MethodsTotal of 8377 patients presented to the ED between January 2015 and December 2016 were reviewed. The adult group aged between 18 and 64 years old consisted of 3656 patients and the elderly group aged over 65 years consisted of 4721 patients. Information collected included age, sex, serum sodium, and serum creatinine. Hyponatremia was defined as a serum sodium leve1 < 135 mEq/L and severe hyponatremia was defined as a serum sodium level < 125 mEq/L.ResultsPrevalence of hyponatremia was significantly higher in the elderly group than in the adult group (17.0% vs. 5.7%, p < 0.001). Similarly, the prevalence of severe hyponatremia was significantly higher in the elderly group than in the adult group (1.9% vs. 0.3%, p < 0.001). Prevalence of hyponatremia and severe hyponatremia was significantly higher in the elderly group than in the adult group in all seasons. In the elderly group, there was a significant correlation between weather high temperature during summer and prevalence of hyponatremia (r = 0.510, p = 0.011).ConclusionThere was a major impact of age on the seasonal prevalence of hyponatremia and severe hyponatremia. Strategies to prevent hyponatremia and severe hyponatremia should be taken especially in the elderly patients during summer.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Seasonal prevalence of hyponatremia in the emergency department: impact of age

et al. 2018

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“… 27 , 28 It should also be mentioned that hyponatremia follows a seasonal variation (higher incidence during the summer) because of more frequent impairment of renal function, increased salt losses, diminished salt intake and increased water ingestion. 29 …”

Section: Pathogenetic Mechanisms Of Increased Susceptibility Of the Ementioning

confidence: 99%

Hyponatremia in the elderly: challenges and solutions

Filippatos¹,

Makri²,

Elisaf³

et al. 2017

CIA

142

111

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Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia and also because of other mechanisms such as the “tea and toast” syndrome. The aim of this review is to present certain challenges in the evaluation and treatment of hyponatremia in the elderly population and provide practical solutions. Hyponatremia in elderly subjects is mainly caused by drugs (more frequently thiazides and antidepressants), the syndrome of inappropriate antidiuretic hormone secretion (SIAD) or endocrinopathies; however, hyponatremia is multifactorial in a significant proportion of patients. Special attention is needed in the elderly population to exclude endocrinopathies as a cause of hyponatremia before establishing the diagnosis of SIAD, which then requires a stepped diagnostic approach to reveal its underlying cause. The treatment of hyponatremia depends on the type of hyponatremia. Special attention is also needed to correct serum sodium levels at the appropriate rate, especially in chronic hyponatremia, in order to avoid the osmotic demyelination syndrome. In conclusion, both the evaluation and the treatment of hyponatremia pose many challenges in the elderly population.

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Urban Heat and Burden of Hyponatremia

Prpic,

Hoffmann,

Bauer

et al. 2024

JAMA Netw Open

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ImportanceHyponatremia (sodium level &lt;135 mEq/L), the most prevalent electrolyte disorder in clinical practice, is associated with considerable clinical and economic burdens. Despite its recognized effect and indication of seasonal patterns, there is a research gap regarding heat-related hyponatremia. Addressing this issue is crucial, especially regarding projected increases in environmental temperature, particularly in urban areas.ObjectiveTo comprehensively analyze the association of heat in an urban setting with hyponatremia prevalence.Design, Setting, and ParticipantsThis cross-sectional study using retrospective time series analysis was conducted among all adult patients (age ≥18 years) presenting to the Charité–Universitätsmedizin Berlin between March 1, 2000, and August 31, 2023, with a blood sodium measurement.ExposureThe daily heat index, which accounts for both outdoor air temperature and relative humidity.Main Outcomes and MeasuresThe primary outcome measure was the daily number of hyponatremia cases, further categorized by severity. Differences in prevalence across age groups (adult patients, aged 18-65 years; and older patients, aged &gt;65 years) and sexes were also examined.ResultsA total of 7 135 688 sodium measurements from 2 028 537 hospital visits were analyzed. The mean (SD) age at admission was 57.8 (17.8) years, and 51.7% of patients were male. A clear seasonal pattern of heat-related hyponatremia was evident among older patients, especially for moderate (sodium level, 125-129 mEq/L) and severe hyponatremia (sodium level, &lt;125 mEq/L), where the cumulative risk over a lag period of 5 days reached a maximum relative risk (RR) of 1.26 (95% CI, 1.07-1.48) when the heat index reached 30 °C, compared with the temperature at which hyponatremia occurred least frequently. Older women were disproportionately more likely to experience hyponatremia compared with older men, with a cumulative RR of 1.10 (95% CI, 1.03-1.18) at a heat index of 26 °C. The highest RR was on lag day 0 for all subgroups (older patients: RR, 1.04 [95% CI, 1.00-1.08]; moderate and severe hyponatremia in older patients: RR, 1.05 [1.01-1.10]; and older women: RR, 1.07 [95% CI, 1.01-1.12]) and significantly increased when the heat index exceeded 15 °C (RR, 1.01 [95% CI, 1.00-1.02]).Conclusions and RelevanceThis cross-sectional study of patients with sodium measurements suggests that older people, especially women, were vulnerable to heat-related hyponatremia. Environmental heat was associated with an immediate exacerbation of hyponatremia. This finding highlights the importance of implementing prevention strategies to mitigate heat-related hyponatremia, as an increased burden in the future due to climate change is likely.

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Seasonal variations of hyponatremia in the emergency department: Age-related changes

Cited by 44 publications

References 12 publications

Seasonal prevalence of hyponatremia in the emergency department: impact of age

Seasonal prevalence of hyponatremia in the emergency department: impact of age

Hyponatremia in the elderly: challenges and solutions

Urban Heat and Burden of Hyponatremia

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