Hyponatremia: A Common Concern in the Elderly

• Hyponatremia is a term used to describe a below normal sodium level in the blood.
• The elderly population are at a higher risk for hypontremia.
• Seizures, coma, and death are possible in the advanced form of this condition.

When you think of sodium intake and nutrition, you assume sodium is bad for your health. While it’s true that too much sodium in the diet can cause health problems, it’s also true that consuming too little sodium can be an issue. 

 Hyponatremia is the medical term used to describe less than desired blood sodium levels and this condition is often seen in the elderly population. Hyponatremia is a serious condition that can be fatal if it’s not recognized quickly and treated quickly. It’s important that nurses remain vigilant and look  for the warning signs of this condition among the elderly.  

Why Is Sodium Intake Important in the Elderly Population 

 The body uses sodium to balance fluids in the blood and to maintain blood pressure. It also aids in nerve and muscle function. As we age, the systems involved in the regulation of fluid balance are compromised.

Fluid intake and thirst perception, kidney function and kidney disease, fluid overload, congestive heart failure, underactive thyroid or adrenal glands, and hormonal changes are all critical issues that increase the risk for the elderly patient developing hyponatremia.

The elderly population is more susceptible to hyponatremia because they are most often prescribed medications or have medical conditions that increase their risk of the disorder.

What Medications Are Common Contributors of Hyponatremia?

• Drugs that make you urinate more often (diuretics) 
• Certain antidepressants 
• Antiseizure medications 

What Are the Symptoms of Hyponatremia?  

The acronym “saltloss” can help you remember and identify hyponatremia symptoms easily. 

S-Seizures and Stupor 

A –Abdominal cramping, attitude changes (confusion) 

L- Lethargy 

T- Tendon reflexes diminished, trouble concentrating 

L- Loss of urine and appetite 

O-Orthostatic hypotension, overactive bowel sounds 

S-Shallow respirations 

S-Spasms of muscles 

Nursing Interventions

Remember, hyponatremia is a medical condition that can worsen quickly if prompt treatment is not administered. It usually requires a visit to the emergency department with hospitalization likely depending on the severity.  

Long-term care nurses should take these interventions in that case: 

• Ensure resident safety 
• Take vitals 
• Contact Provider and resident emergency contacts 
• Have staff member stay with resident while awaiting ambulance  
• Gather all necessary resident medical information and paperwork for transfer.  

Treatment Options

If Hyponatremia is severe, intravenous treatment to correct sodium blood levels and hospitalization are needed for close monitoring.  

• Treatments may also include: 
• Changing a medication that affects sodium levels 
• Treating underlying disease 
• Changing the amount of water intake 
• Changing the amount of sodium in the diet 
• Prescribing sodium supplements  

How Can Hyponatremia be Prevented in the Long-Term Care Resident?

• Fluid balance charts should be maintained regularly and accurately to detect hyponatremia and fluid overload. 
• Conditions of the adrenal glands should be treated as they play a significant role in hormone production. Hormones help regulation of sodium, potassium, and water in the body. 
• Healthcare staff should be aware of the residents on medications that increase their risk of developing hyponatremia. Healthcare staff education on what to do if a resident is exhibiting concerning behavior or symptoms. 

The Bottom Line

Hyponatremia is a serious medical condition that can present and escalate quickly. It may lead to death if further evaluation and treatment is not quickly provided. It is important for long-term care nurses to thoroughly examine each resident’s medical history and current medications being taken upon admission to the long-term care facility, so they are better equipped to respond to any emergencies that may arise.  

Supportive medical staff such as certified nursing assistants and certified medication aids should also be aware of the residents at higher risk for emergency intervention and these residents should be monitored more closely. Staff should also be educated on what to do if a situation arises. Witnessing an elderly resident having symptoms of hyponatremia can be scary, however, hyponatremia is a treatable medical condition with positive health outcomes for the elderly resident who is treated promptly.  

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