Clinical Profile of Euvolemic Hyponatremia and its Outcome in Elderly Hospitalized Patients

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Abstract (English)

Background: Euvolemic hyponatremia is a common electrolyte imbalance observed in hospitalized elderly patients. It is often associated with conditions like Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), medications, and chronic illnesses. Given the complexities of its diagnosis and management, understanding the clinical profile of elderly patients with euvolemic hyponatremia is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, underlying etiologies, and outcomes of euvolemic hyponatremia in a sample of 50 elderly hospitalized patients. Methodology: A prospective observational study was conducted in a tertiary care hospital over six months. Fifty elderly patients (aged ≥ 60 years) with confirmed euvolemic hyponatremia (serum sodium < 135 mEq/L, normal total body water) were included. Patients with hypervolemic or hypovolemic hyponatremia were excluded. Detailed medical histories, including medication use, comorbidities, and clinical presentations, were recorded. Laboratory parameters, including serum sodium, osmolality, and urine sodium, were analysed. Data was statistically analyzed to identify significant trends and correlations. Results: The current study observed a male predominance (62%) among elderly patients with euvolemic hyponatremia. A significant proportion of patients presented with severe (42%) and moderate (40%) hyponatremia, which aligns with similar studies reporting delayed diagnosis due to masked symptoms in the elderly. SIADH was identified as the leading cause (48%), often linked to medications and comorbidities. Lethargy (56%) and postural dizziness (36%) were the most common symptoms, with severe cases exhibiting CNS complications like confusion and seizures. Severe hyponatremia significantly increased the risk of mortality (20%, p=0.01), emphasizing the need for early intervention. Discussion: This study highlights that euvolemic hyponatremia in elderly hospitalized patients is predominantly linked to SIADH and medication use. The clinical presentation is often nonspecific, emphasizing the importance of careful evaluation to prevent misdiagnosis. Timely intervention with fluid restriction and management of the underlying cause can lead to favourable outcomes, although comorbid conditions continue to pose significant challenges. Further research is needed to explore preventive strategies and optimize treatment protocols in this vulnerable population. Conclusion: Euvolemic hyponatremia in the elderly is a multifaceted condition with diverse etiologies and presentations. Early identification and targeted therapy are essential to minimize hospital stays and complications.