Low Sodium Levels Causes In The Elderly – Hyponatremia is an electrolyte disorder associated with low serum sodium levels that may cause neuropsychiatric symptoms. In psychiatric patients, hyponatremia is most often caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) caused by psychotropic drugs, including antidepressants and antipsychotics.

Hyponatremia is defined as a serum sodium ([Na+]) concentration of less than 136 mEq/L (1 mEq/L = 1 mmol/L). This indicates an excess of water relative to sodium in the extracellular fluid (ECF) compartment. The normal range for serum sodium may be 135 to 145 mEq/L.

Low Sodium Levels Causes In The Elderly

Why is hyponatremia important in psychiatry? Hyponatremia is often underdiagnosed and undertreated in both general medical and psychiatric patients.

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Hyponatremia may cause neuropsychiatric symptoms. Acute onset hyponatremia may cause delirium and acute behavioral changes that may be confused with symptoms of a psychiatric disorder. Other causes of hyponatremia, such as SIADH, may resemble psychiatric disorders or adverse effects of psychotropic medications, and the diagnosis of SIADH may be delayed in psychiatric patients.

Early signs and symptoms of hyponatremia include nausea, vomiting, anorexia, confusion, headache, fatigue, weakness, irritability, lethargy, disorientation and muscle cramps.

There are many etiologies of hyponatremia. Correct treatment and management of hyponatremia depends on determining the etiology of hyponatremia. For example, a distinction must be made between iatrogenic hyponatremia (usually caused by the use of thiazide diuretics, carbamazepine, antidepressants, or antipsychotics), idiopathic hyponatremia, or other etiologies (such as hypothyroidism or alcoholism). In general, most hyponatremia in the psychiatric population is associated with physiologically abnormal (but not necessarily elevated) levels of arginine vasopressin (AVP), leading to water retention and serum hypotonicity.

See also: Jacob, S., & Spinier, S. A. (2006). Hyponatremia associated with selective serotonin reuptake inhibitors in the elderly. Annals of Pharmacotherapy, 40(9), 1618-1622.

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Many psychotropic drugs can cause SIADH by stimulating the release of vasopressin or increasing its effects on the renal tubules. It is also believed that psychotropic drugs may also cause stimulation of central serotonin receptors. SIADH is a known side effect of antidepressants, especially in the elderly.

Severe hyponatremia due to SIADH may cause cerebral edema and/or seizures. Treatment for SIAD consists of: (1) fluid restriction (first-line), (2) salt tablets, (3) diuretics, (4) ADH antagonists, and/or (5) slow correction of hyponatremia with hypertonic saline to avoid osmotic demyelination syndrome ( central pontine myelinolysis).

Psychogenic polydipsia (PPD) (also known as primary polydipsia) is excessive and intentional water consumption, commonly occurring in patients with severe mental illness and/or developmental disabilities. Psychogenic polydipsia may cause hyponatremia and is associated with minor disturbances in water excretion.

The syndrome of psychosis, intermittent hyponatremia and polydipsia (PIP syndrome) is a triad of symptoms observed in psychiatric patients, especially in patients with schizophrenia and/or psychosis.

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The basic etiology of polydipsia (compulsive water drinking) remains unclear. Hypotheses include impairment of central thirst regulation or drug therapy, which may result in altered thirst perception.

Typically, the symptoms of this syndrome are subclinical and patients are asymptomatic. However, in severe cases, mortality may occur when polydipsia causes severe water intoxication.

Excessive consumption of beer (low in dissolved solids) and exclusion of other fluids may result in severe hyponatremia, known as “beer mania.”

The incidence of hyponatremia caused by SSRIs varies greatly, ranging from 0.5% to 32%. In most cases, hyponatremia occurs within the first 2 to 4 weeks of starting treatment. Hyponatremia usually resolves within 2 weeks of discontinuation of the SSRI, and the incidence returns to population baseline levels by 3 months.

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Antipsychotics are thought to increase AVP release despite normal plasma osmolality, resulting in the syndrome of inappropriate antidiuretic hormone secretion (SIADH) causing hyponatremia.

It is important to distinguish between psychotropic drug-induced SIADH and psychogenic polydipsia. SIADH should be a diagnosis of exclusion. To distinguish SIADH from psychogenic polydipsia, it is important to measure serum sodium, osmolality, and urine osmolality.

Siegel, A. J. (2008). Hyponatremia in psychiatric patients: an update on assessment and management. Harvard review of psychiatry, 16(1), 13-24.

Soiza, R. L., & Talbot, H. S. (2011). Management of hyponatremia in the elderly: old threats and new opportunities. Therapeutic Advances in Drug Safety, 2(1), 9-17.

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Liu, B. A., Mittmann, N., Knowles, S. R., & Shear, N. H. (1996). Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports. CMAJ: Journal of the Canadian Medical Association, 155(5), 519.

Cheng, J.C., Zikos, D., Skopicki, H.A., Peterson, D.R., and Fisher, K.A. (1990). Long-term neurological outcomes in psychogenic water drinkers with severe symptomatic hyponatremia: the effect of rapid correction. American Journal of Medicine, 88(6), 561-566.

Vieweg, W. V. R., David, J. J., Rowe, W. T., Peach, M. J., Veldhuis, J. D., Kaiser, D. L., & Spradlin, W. W. (1985). Psychogenic polydipsia and water intoxication – concepts that failed. Biological Psychiatry, 20(12), 1308-1320.

Goldman, M. B., Luchins, D. J., & Robertson, G. L. (1988). Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia. New England Journal of Medicine, 318(7), 397-403.

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Lydakis, C., Apostolakis, S., Thalassinos, E., Stamataki, K., Saridaki, K., & Basta, M. (2005). PIP syndrome: a potentially dangerous symptom of a mental disorder. International Journal of Clinical Practice, 59(5), 612-613.

Kujubu, D. A., and Khosraviani, A. (2015). Beer potomania – an unusual cause of hyponatremia. Permanent Journal, 19(3), 74.

Leth-Møller, K. B., Hansen, A. H., Torstensson, M., Andersen, S. E., Ødum, L., Gislasson, G., … and Holm, E. A. (2016). Antidepressants and the risk of hyponatremia: a Danish population-based register-based study. BMJ Open, 6(5).

Jacob, S., & Spinier, S. A. (2006). Hyponatremia associated with selective serotonin reuptake inhibitors in the elderly. Annals of Pharmacotherapy, 40(9), 1618-1622.

What Causes Low Sodium? Hyponatremia, Explained

Kenes, M. T., Hamblin, S. E., Tumuluri, S. S., & Guillamondegui, O. D. (2016). Inappropriate antidiuretic hormone syndrome in a patient receiving high-dose haloperidol and quetiapine therapy. The Journal of neuropsychiatry and Clinical Neurosciences, 28(2), e29-e30. Hyponatremia means low levels of sodium in the blood. This is the opposite of a condition called hypernatremia, in which sodium levels are very high. Both conditions often occur while patients are in hospital. This is especially true if they are receiving fluids intravenously, have a medical condition such as kidney or heart disease, or are in intensive care.

Studies have shown that hyponatremia develops in 15–30 percent of all patients during their hospital stay. (1) Hyponatremia and associated electrolyte imbalances may develop during exercise or in extreme heat, when symptoms of dehydration are more common. When hyponatremia is mild and sometimes even moderate, it is usually asymptomatic. This means that there are no noticeable symptoms that the patient is aware of. However, when it is more severe, symptoms of hyponatremia usually include headaches, nausea, and in some cases even seizures or coma.

Treatment of hyponatremia usually involves regulating fluid levels in the body. In other words, salt intake and excretion compared to water must be balanced. Ways to prevent hyponatremia from developing or reversing the condition once it has occurred include:

Hyponatremia is a type of electrolyte imbalance characterized by abnormally low levels of sodium in the blood. Sodium (salt) often gets a bad rap because too much of it affects blood pressure and contributes to fluid retention/edema. However, it is actually an essential electrolyte. All electrolytes perform important functions throughout the body. This is because of the way they carry an electrical charge when dissolved in body fluids, including blood. (2) Some of the roles sodium plays include:

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Your doctor will adjust your fluid intake to correct the imbalance, depending on whether you have hyponatremia (too little salt in the blood) or hypernatremia (too much salt). To prevent electrolyte imbalances, you can monitor your water intake, diet and medications. Normally, the body obtains sodium from the diet and loses an appropriate amount in urine or sweat. So, unless you have kidney problems, you should be able to balance your sodium and water levels naturally by making a few healthy changes.

The problem with too little sodium and too much water is that it causes cells to swell. Depending on the extent of the swelling and fluid retention, hyponatremia can be very serious – even fatal in severe cases.

Hyponatremia happens when sodium levels in the body become too dilute; too much water in the blood in relation to sodium. The symptoms and complications of hyponatremia are caused by water-induced swelling of cells, which causes fluid retention. It may even lead to serious neurological disorders and fluid retention in the brain (cerebral edema).

Hyponatremia is divided into several categories/types, depending on the effect on blood volume and total fluid levels. In other words, it is classified depending on the cause.):

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When a patient sees a doctor for symptoms of hyponatremia or is already in the hospital after the disease has developed, the health care provider will usually look for any signs of electrolyte imbalance by taking several measurements:

Once your doctor diagnoses you with hyponatremia, he or she may decide to restore your fluid levels to normal by administering fluids or medications intravenously. This will depend on the type of hyponatremia you suffer from and its effect on your total blood volume. The goal of fluids and medications is to increase sodium levels/low water retention.

Typical treatment for hypovolemic hyponatremia involves administering saline solutions to raise sodium levels. If the water level in your blood is too high (euvolemia

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