https://doi.org/10.4081/gc.2021.9911
Elderly with refractory chronic severe hyponatremia and anesthesia management dilemma: a case report with literature review
Submitted: 15 June 2021
Accepted: 8 November 2021
Published: 30 November 2021
Accepted: 8 November 2021
Abstract Views: 2146
PDF: 225
HTML: 1215
HTML: 1215
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.
Janicic N, Verbalis JG. Evaluation and management of hyperosmolality in hospitalized patients. Endocrinol Metab Clin North Am 2003;32:459-81.
DOI: https://doi.org/10.1016/S0889-8529(03)00004-5
Upadhyay A, Jaber BL, Madias NE. Epidemiology of hyponatremia. Semin Nephrol 2009;29:227-38.
DOI: https://doi.org/10.1016/j.semnephrol.2009.03.004
Xu J, Chen X, Wang X, et al. Preoperative hyponatremia and hypocalcemia predict poor prognosis in elderly gastric cancer patients. Cancer Manag Res 2019;11:8765-80.
DOI: https://doi.org/10.2147/CMAR.S211603
Reazaul Karim HM, Sahoo SK, Prakash A, et al. Abnormal routine preoperative test results and their perioperative anesthetic impact in patients aged 60 years and more: an observational study. Indian Anaesth Forum 2018;19:6-10.
DOI: https://doi.org/10.4103/TheIAForum.TheIAForum_41_17
Ramesh B, Pillai VS, Koshy RC, et al. Role of preoperative investigations in elderly patients undergoing oncosurgical procedures - A retrospective review audit. J Anaesthesiol Clin Pharmacol 2018;34:535-9.
DOI: https://doi.org/10.4103/joacp.JOACP_147_17
Lee KC, Lee IO. Preoperative laboratory testing in elderly patients. Curr Opin Anaesthesiol 2021;34:409-14.
DOI: https://doi.org/10.1097/ACO.0000000000001008
Verghese SC, Mahajan A, Uppal B. Chronic versus new-onset hyponatremia in geriatric patients undergoing orthopedic surgery. Int J App Basic Med Res 2019;9:37-43.
Mannesse CK, Vondeling AM, van Marum RJ, et al. prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review. Ageing Res Rev 2013;12:165-73.
DOI: https://doi.org/10.1016/j.arr.2012.04.006
Shapiro DS, Sonnenblick M, Galperin I, et al. Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome. Intern Med J 2010;40:574-80.
DOI: https://doi.org/10.1111/j.1445-5994.2010.02217.x
Maeda K, Kageyama S, Osafune T, et al. syndrome of inappropriate antidiuretic hormone secretion as a side effect of chemotherapy for testicular cancer: a case report. IJU Case Rep 2019;2:327-9.
DOI: https://doi.org/10.1002/iju5.12122
Berghmans T, Paesmans M, Body JJ. A prospective study on hyponatraemia in medical cancer patients: epidemiology, aetiology and differential diagnosis. Support Care Cancer 2000;8:192-7.
DOI: https://doi.org/10.1007/s005200050284
Jeppesen AN, Jensen HK, Donskov F, et al. hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma. Br J Cancer 2010;102:867-72.
DOI: https://doi.org/10.1038/sj.bjc.6605563
Caird FI, Andrews GR, Kennedy RD. Effect of posture on blood pressure in the elderly. Br Heart J 1973;35:527-30.
DOI: https://doi.org/10.1136/hrt.35.5.527
Kleinfeld M, Casimir M, Borra S. Hyponatremia as observed in achronic disease facility. J Am Geriatr Soc 1979;27:156-61.
DOI: https://doi.org/10.1111/j.1532-5415.1979.tb06439.x
Arieff AI, Llach F, Massry SG. Neurological manifestations of morbidity of hyponatremia: correlation with brain water and electrolytes. Medicine (Baltimore) 1976;55:121-9.
DOI: https://doi.org/10.1097/00005792-197603000-00002
Schrier RW. Does ‘asymptomatic hyponatremia’ exist? Nat Rev Nephrol 2010;6:185.
DOI: https://doi.org/10.1038/nrneph.2010.21
Renneboog B, Musch W, Vandemergel X, et al. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 2006;119:e71-8.
DOI: https://doi.org/10.1016/j.amjmed.2005.09.026
Renneboog B, Sattar L, Decaux G. Attention and postural balance are much more affected in older than in younger adults with mild or moderate chronic hyponatremia. Eur J Intern Med 2017;41:e25-6.
DOI: https://doi.org/10.1016/j.ejim.2017.02.008
Hoorn EJ, Liam is G, Zietse R, et al. hyponatremia and bone: an emerging relationship. Nat Rev Endocrinol 2011;8:33-9.
DOI: https://doi.org/10.1038/nrendo.2011.173
Sahay M, Sahay R. Hyponatremia: a practical approach. Indian J Endocrinol Metab 2014;18:760-71.
DOI: https://doi.org/10.4103/2230-8210.141320
Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29:i1-i39.
DOI: https://doi.org/10.1093/ndt/gfu040
Liam G, Filippatos TD, Elisaf MS. Treatment of hyponatremia: the role of lixivaptan. Expert Rev Clin Pharmacol 2014;7:431-41.
DOI: https://doi.org/10.1586/17512433.2014.911085
Takei M, Suzuki S, Sato A, et al. Five cases of severe hyponatremia in the elderly successfully treated with low doses of hydrocortisone. Geriatr Gerontol Int 2009;9:391-4.
DOI: https://doi.org/10.1111/j.1447-0594.2009.00553.x
How to Cite
Keshwani, M., Karim, H. M. R., Nagalikar, S., Kumar Biswal, D. ., & Dey, S. (2021). Elderly with refractory chronic severe hyponatremia and anesthesia management dilemma: a case report with literature review. Geriatric Care, 7(3). https://doi.org/10.4081/gc.2021.9911
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.