Severe Diuretic-Induced Hyponatremia in the Elderly

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Abstract
• Eight elderly patients with severe diuretic-induced hyponatremia (mean serum sodium level [±SD], 110±2 mEq/L [110±2 mmol/L]) and overt neurological manifestations were treated with 3% sodium chloride. Within 28.8±6 hours of treatment, the serum sodium level was corrected to 132±5.6 mEq/L (132±5.6 mmol/L), indicating a correction rate of 0.78 ± 0.26 mEq/L/h (0.78 ± 0.26 mmol/L/h). Seven of the eight patients recovered from the neurological insult and were discharged from the hospital. One patient died of an unrelated illness. Severe diuretic-induced hyponatremia seems to be predisposed by age, sex, and body weight. Patients with this entity are usually old, female, and underweight. Associated conditions (eg, intractable diarrhea, tube feeding, hypoglycemic drugs, polydipsia, and cerebrovascular accidents) may play a role in the pathogenesis of the syndrome. (Arch Intern Med 1986;146:1355-1357)