Clinical value of hypernatremia in elderly patients

OBJECTIVE: Hypernatremia in young adults is a rare condition, sometimes occ urring after gastrointestinal diseases, osmotic diuresis or diabetes insipi dus. The clinical characteristics and prognosis of hypernatremia in geriatr ic patients would be different Each case must be examined separately. PATIENTS AND METHODS: We conducted a prospective uncontrolled study among p atients over 70 with sodium levels equal to or greater than 150 mmol/l (at admission or during the hospitalization). RESULTS: Hypernatremia was found in 77 patients. Mean age was 84.1+/-6.7 ye ars. The mean peak serum sodium level was 157.3+/-7.4 mmol (two-thirds rang ed from 150 to 160). Hypernatremia onset was produced by a wide range of sy mptoms: 48% had a febrile illness, 470% were on diuretics 15% had had a str oke, but only 9% were suffering from diarrhea or vomiting. Most of the pati ents had disabling chronic illnesses (62% loss of two or more ADL of Katz), severe dementia (84% level = 6 on the Reisberg global deterioration scale) . In spite of fluid replacement and follow-up treatment, outcome was poor: 62% of the patients died within three months. CONCLUSION: Besides digestive and renal losses, hypernatremia in elderly pa tients is increased by fluid supply disorders consecutive to hypodipsis con tracted at the same time as disability and dementia. Hypodispis is a sign o f poor prognosis. Prevention must be undertaken early, emphasizing the impo rtance of identifying dehydration early among elderly people with chronic d isabling illnesses.