Filling the Gap – Improving Awareness and Practice in Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in the Older Patient: A European Consensus View

Abstract

Introduction: Causes of hyponatraemia in older patients are multivariate and in the case of SIADH may often be drug induced. Diagnostic and treatment algorithms are unclear for this important age group.

Methods: The author group identified 6 broad themes for consensus and formulated 42 separate consensus statements within these 6 themes. Statements were then circulated to geriatricians, general practitioners and other doctors to test agreement at the European level.

Results: 64 responses were evaluated from around Europe. Agreement was achieved in 86% of the statements following amendment and redistribution of 6 of the statements. The survey and its feedback prompted the development of 13 recommendations related to the diagnosis and treatment of hyponatraemia including SIADH.

Conclusion: The series of 13 recommendations developed here is intended to increase clarity for clinicians managing older patients with hyponatraemia and SIADH. Surprisingly, despite the lack of clear guidelines or recommendations for this age group consensus levels for the author-based statements were high among the respondents.

Key words

hyponatraemia - SIADH - older patients - geriatric pharmacotherapy - algorithms

• References

• 1 NICE Clinical Knowledge Summary. Hyponatraemia. NICE 2011 http://cks.nice.org.uk/hyponatraemia#!topicsummary last viewed 1^st April 2015
• 2 Mohan S, Gu S, Parikh A et al. Prevalence of hyponatraemia and association with mortality: Results from NHANES. Am J Med 2013; 126: 1127-1137.e1
• 3 Rhoney DH. Cost issues in hyponatraemia. Hosp Pharm 2011; 46 (Suppl. 02) S30-S38
• 4 Reynolds RM, Seckl JR. 2005; Hyponatraemia for the clinical endocrinologist. Clinical Endocrinology 2005; 63: 366-374
• 5 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: 192-197
• 6 Asadollahi K, Beeching N, Gill G. Hyponatraemia as a risk factor for hospital mortality. QJM 2006; 99: 877-880
• 7 Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis 2008; 52: 144-153
• 8 Sorensen JB, Andersen MK, Hansen HH. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. Journal of Internal Medicine 1995; 238: 97-100
• 9 Miller M, Morley JE, Rubenstein LZ. Hyponatremia in a nursing home population. Journal of The American Geriatrics Society 1995; 43: 1410-1413
• 10 Babar S. SIADH Associated with ciprofloxacin. The annals of pharmacotherapy (Sage Publishing) 2013; 47: 1359-1363 DOI: 10.1177/1060028013502457.. ISSN 1060-0280. PMID 24259701. Retrieved November 18, 2013
• 11 Corrada MM, Brookmeyer R, Paganini-Hill A et al. Dementia incidence continues to increase with age in the oldest old: the 90+ study. Ann Neurol 2010; 67: 114-121 DOI: 10.1002/ana.21915.
• 12 Woodruff K. Preventing polypharmacy in older adults. Am Nurs Today 2010; 5: 10
• 13 Nigro N, Winzeler B, Suter-Widmer I et al. Symptoms and characteristics of individuals with profound hyponatraemia: a prospective multicentre observational study. J Am Geriatr Soc 2015; 63: 470-475 DOI: 10.1111/jgs.13325.. Epub 2015 Mar 4
• 14 Spasovski G, Vanholder R, Allolio B et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014; 29 (Suppl. 02) i1-i39
• 15 Berl T. Vasopressin Antagonists. N Engl J Med 2015; 372: 2207-2216
• 16 Schrier RW. Does ‘asymptomatic hyponatremia’ exist? Nature reviews. Nephrology 2010; 6: 185 http://www.medscape.com/viewarticle/732131_1 accessed 1^st April 2015-04-01
• 17 Gill G, Huda B, Boyd A et al. Characteristics and mortality of severe hyponatraemia – a hospital-based study. Clinical Endocrinology 2006; 65: 246-249
• 18 Siegler EL, Tamres D, Berlin JA et al. Risk factors for the development of hyponatremia in psychiatric inpatients. Arch Intern Med 1995; 155: 953-957
• 19 Ranta R, Wooten GF. Hyponatraemia due to an Additive Effect of Carmamazepine and Thiazide Diuretics. Epilepsia 2004; 45: 879
• 20 American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012; 60: 616-631
• 21 Kuhn-Thiel A, Weiss C, Wehling M. Consensus validation of the FORTA (Fit fOR The Aged) list: A clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 2014; 31: 131-140 Open access, URL http://link.springer.com/article/10.1007%2Fs40266-013-0146-0
• 22 Norman D, Olaf H. An Experimental Application of the Delphi Method to the use of experts. Management Science 1963; 9: 458-467
• 23 Wehling M. Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc 59: 376-377 2011;
• 24 Verbalis JG, Goldsmith SR, Greenberg A et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013; 126 (Suppl. 01) S1-S42
• 25 Forbes MB, Owen JA, Raymond-Barker P et al. Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine, and saliva markers. J Am Med Dir Assoc 2015; 16: 221-228