Abstract

Background: Hyponatremia is an important and common electrolyte abnormality that can be seen in isolation or as a complication of other medical illness. Sodium homeostasis is vital for the normal physiological function of the cells. Sever hyponatremia defined as serum sodium <115mEq/ L is associated with significant morbidity and mortality. Hyponatremia has been found to be a predictor of worsened outcomes in a variety of diseases including myocardial infarction, congestive cardiac failure, cirrhosis. This is probably because hyponatremia is more an indicator of severity of many underlying diseases, than an independent contributor to mortality.

Objectives: The present study aims in portraying the clinical profile of severe hyponatremia in patients above 65 years of age, getting admitted in the medical ward over a period of 1 year.

Materials and Methods: All patients who satisfied the inclusion criteria were included in the study. A detailed history, including drug history was taken. A thorough physical examination was carried out with special reference to volume status assessment. Blood samples were sent for assessment of complete hemogram, blood sugar, renal function tests, liver function tests, serum electrolytes and uric acid levels in all parients. If indicated, serum cortisol and thyroid function tests were done. urine spot sodium and urine osmolarity were also done in all patients. Patients were subjected to special investigations like, CT head, Lumbar Puncture, Ultrasound abdomen if required. Patients were studied after categorizing them according to the duration of hyponatremia as well as the volume status. Patients were treated according to their volume status and the underlying illness. They were monitored during their course of hospital stay for determining the outcome.

Observations: There were a total of 60 cases during the 1 year period who satisfied the inclusion criteria. 25 % were above 75 years of age. 60% of the cases were females. 80% of the cases were acute hyponatremia. 98% of patients had altered sensorium as the presenting complaint. Seizure in 37% and head ache in 35%. 48% cases were hypervolemic on admission. 8% of cases expired during the hospital admission.

Conclusions: Hyponatremia is a very common problem in clinical practice. Females are more commonly affected than males. Lower baseline sodium has a higher incidence of producing more neurologic complications. The older the patient is the lesser will be the efficacy of the salt conserving machinery.