| Section 1 Analysis of the prevalence of hyponatremia in the elderlyObjective: Analysis the prevalence of hyponatremia in hospitalized elderly patients and risk factors for hyponatremia in the elderly.Methods: A total of 4051 elderly patients aged 65-102 were admitted to the Department of Geriatrics,Yuncheng Central Hospital from October 2013 to May 2017,among them,2982 were male and 1069 were female.Records of all patients history,age,gender,combined disease,laboratory tests,treatment,hospital stay,prognostic information and other information.All patients were routinely tested for blood electrolytes(blood sodium,potassium,calcium,magnesium,phosphorus),blood urea nitrogen,serum creatinine,blood uric acid,blood glucose,triglycerides,cholesterol,low density lipoprotein,serum proteins.For patients with hyponatremia(serum sodium<135mmol/L)found during hospitalization,simultaneous detection of blood and urine osmolality,24-hour urinary sodium,24-hour urinary potassium,blood PH,B-type brain natriuretic peptide,creatine kinase,tumor markers,thyroid function,blood aldosterone,blood cortisol,ACTH,ECG and so on.Related biochemical indicators determined by the Swiss Roche cobas8000-c701 automatic biochemical analyzer,for hyperlipidemia or hyperlipoproteinemia in patients with direct ISE method,we used blood gas analyzer direct ISE test.Blood gas analyzer determined by Denmark Dan ABL-90 blood gas analyzer.Correction of serum sodium with a correction formula for patients with a blood glucose>5.5 mmol/L: Serum sodium(corrected)= blood sodium(measured)+ 2.4x [blood glucose(mmol/L)-5.5(mmol/L)]/ 5.5(mmol/L).Urine routine measurement by the Japanese He Simei Kang uf1000 automatic urine sediment analyzer,hematuria osmotic pressure measured by Shanghai Wei Cheng BS-88 freezing point osmometer.Results: The prevalence of hyponatremia was 30.63%(1241/4051)in elderly patients over 65 years old,Men(33.07%)were higher than women(23.85%)(P <0.05).The prevalence of mild hyponatremia was 12.84%,moderate hyponatremia was 11.60% and severe hyponatremia was 6.20%.1.The prevalence of elderly hyponatremia increases with age.The highest prevalence of hyponatremia was 54.37% in patients over 90 years old,which were higher than those in patients aged 85-90(33.17%),(75.85%)and(65-75).The prevalence of hyponatremia in the(85-90)year-old group was 33.17%,higher than those in the(65-75)year-old group(22.78%)(P <0.05);2.The prevalence of elderly hyponatremia in different basic diseases were as follows: diabetes(43.76%),acute gastroenteritis(39.52%),coronary heart disease(31.38%),cerebral infarction(27.88%),pneumonia(27.10% 25.20%),hypertension(24.11%),fracture(22.22%)and malignant tumor(8.77%);3.The lower the level of serum sodium,the longer the average length of stay.The average duration of hospitalization for severe hyponatremia was(19.31 ± 10.94)days,higher than mild(10.57 ± 5.68)days and moderate(12.72 ± 7.04)hyponatremia patients,moderate hyponatremia patients were higher than those of mild hyponatremia(P <0.05);4.There were 4 independent risk factors for elderly hyponatremia: combined with diabetes(OR=17.87,P<0.05),gender(OR=9.38,P<0.05),age(OR=4.05,P<0.05),hypertension(OR=0.01,P<0.05).Conclusions: 1.The prevalence of senile hyponatremia as high as 30.63%,men than women,with age increased prevalence of hyponatremia increased;2.The prevalence of hyponatremia in different basic diseases were as follows: diabetes,acute gastroenteritis,coronary heart disease,cerebral infarction,pneumonia,dementia,essential hypertension,fractures,malignant tumor;3.Elderly hyponatremia,with reduced serum sodium levels,the average length of stay increased;4.Gender,age,diabetes mellitus,and hypertension are independent risk factors for elderly hyponatremia.Section 2 Analysis of the causes of elderly hyponatremia Objective:Analysis the causes of elderly hyponatremia.Methods: A total of 4051 elderly patients aged 65-102 were admitted to the Department of Geriatrics,Yuncheng Central Hospital from October 2013 to May 2017.Records of all patients history,age,gender,combined disease,laboratory tests,treatment,hospital stay,prognostic information and other information.All patients were routinely tested for blood electrolytes(blood sodium,potassium,calcium,magnesium,phosphorus),blood urea nitrogen,serum creatinine,blood uric acid,blood glucose,triglycerides,cholesterol,low density lipoprotein,serum proteins.For patients with hyponatremia(serum sodium<135mmol/L)found during hospitalization,simultaneous detection of blood and urine osmolality,24-hour urinary sodium,24-hour urinary potassium,blood PH,B-type brain natriuretic peptide,creatine kinase.Tumor markers,thyroid function,blood aldosterone,blood cortisol,ACTH,ECG and so on.Results: The causes of elderly hyponatremia are varied.1.This study excluded 3 cases of pseudo-hyponatremia,the incidence was 0.24%(3/1241),two cases of acute pancreatitis caused by hyperlipidemia,a case of Sheehan syndrome led to hypothyroidism,followed by hyperlipidemia.Three cases of hyperosmolar pseudohypnoeaemia,caused by hyperglycemia,the incidence was 0.24%(3/1241);2.The causes of hyponatremia were as follows: drug-induced hyponatremia(33.92%),loss of non-renal sodium loss(32.88%),caused by inadequate intake(23.53%),heart failure(5.48%),acute and chronic renal failure(2.26%),SIADH(0.56%),adrenal insufficiency(0.40%),nephrotic syndrome(0.40%),hypothyroidism(0.24%),CSW(0.16%),liver cirrhosis(0.16%);3.The common drugs that cause elderly hyponatremia were as follows: furosemide(33.73%),hydrochlorothiazide(22.09%),indapamide(18.05%),spironolactone(16.15%),torsemide(5.94%),methotrexate(3.56%),carbamazepine(0.48%);4.There were 12 independent risk factors for drug-induced elderly hyponatremia : coronary heart disease(OR=104.68,P<0.05),diabetes(OR=59.43,P<0.05),malignant tumor(OR=33.61,P<0.05),serum sodium level(OR=1.30,P<0.05),blood urea nitrogen(OR=1.11,P<0.05),CRP(OR=1.05,P<0.05),serum creatinine(OR=1.05,P<0.05),blood glucose(OR=1.06,P<0.05),ESR(OR=0.98,P<0.05),pneumonia(OR=0.25,P<0.05),acute gastroenteritis(OR=0.18,P<0.05),dementia(OR=0.09,P<0.05).Conclusions: 1.The study excluded 3 cases of pseudohyponatremia and 3 cases of hyperosmolar pseudohyponatremia,the incidence both were 0.24%;2.The causes of elderly hyponatremia are varied,the first one is drug-induced hyponatremia,the second one is non-renal sodium loss;the third one is inadequate intake;the fourth one is hyponatremia related to effective circulating blood volume reduction,of which the most common cause is heart failure,in addition Acute and chronic renal failure,SIADH,hypothyroidism,adrenal insufficiency,CSW in patients with senile hyponatremia still occur,should cause our attention;3.The common drugs that cause elderly hyponatremia were as follows: furosemide,hydrochlorothiazide,indapamide,spironolactone,torsemide,methotrexate,carbamazepine.coronary heart disease,diabete,malignant tumor,serum sodium level,blood urea nitrogen,CRP,serum creatinine,blood glucose,ESR,pneumonia,acute gastroenteritis,dementia are independent risk factors for drug-induced elderly hyponatremia.Section 3 Analysis of risk factors for poor prognosis of elderly hyponatremiaObjective: To investigate the incidence and risk factors of hospitalized patients with senile hyponatremia who were transferred to intensive care unit or died.Methods: A total of 1241 elderly patients with hyponatremia aged 65-102 who were hospitalized in Department of Geriatrics,Yuncheng Central Hospital from October 2013 to May 2017 were collected.Among them,86(6.93%,86/1241)patients were transferred to intensive care unit,54 males and 32 females;11 patients(0.9%,11/1241)died during hospitalization,8 males and 3 females.Records of all patients history,age,gender,combined disease,laboratory tests,treatment,hospital stay,prognostic information and other information.All patients were routinely tested for blood electrolytes(blood sodium,potassium,calcium,magnesium,phosphorus),blood urea nitrogen,serum creatinine,blood uric acid,blood glucose,triglycerides,cholesterol,low density lipoprotein,serum proteins,For patients with hyponatremia(serum sodium<135mmol/L)found during hospitalization,simultaneous detection of blood and urine osmolality,24-hour urinary sodium,24-hour urinary potassium,blood PH,B-type brain natriuretic peptide,creatine kinase,tumor markers,thyroid function,blood aldosterone,blood cortisol,ACTH,ECG and so on.Results:1.The rates of elderly hyponatremia to ICU(6.93%)were higher than those in normal sodium group(1.64%)(P <0.05),there was no significant difference in mortality between hyponatremia group(0.89%)and normal sodium group(0.43%)(P> 0.05)),but we can see an increasing trend.Multivariate logistic regression analysis showed that:(1)There are 7 independent risk factors for the elderly hyponatremia admitted to ICU: heart failure(OR=20.67,P<0.05),>85 years(OR=14.02,P<0.05),serum sodium< 125mmol/L(OR=12.37,P<0.05),pneumonia(OR=6.71,P<0.05),acute gastroenteritis(OR=3.56,P=0.04),serum sodium(125-130)mmol/L(OR=2.55,P<0.05),inadequate intake(OR=0.14,P<0.05).(2)There are 3 independent risk factors for death in elderly hyponatremia: acute and chronic renal failure(OR=17.20,P=0.01),serum sodium level(OR=1.53,P <0.05),age(OR=0.78,P<0.05).2.The rates of severe hyponatremia into the ICU and mortality were significantly higher(P <0.05),elderly hyponatremia into the ICU treatment rate and mortality increased with the reduction of serum sodium levels.Multivariate logistic regression analysis showed that:There are 5 independent risk factors for severe hyponatremia in elderly hyponatremia: CRP(OR=1.47,P<0.05),CCI(OR=1.35,P<0.05),serum creatinine(OR=1.25,P<0.05),blood urea nitrogen(OR=1.18,P<0.05),erythrocyte sedimentation rate(OR=0.97,P=0.03).3.The rates of admitted to ICU and mortality in patients with hyponatremia over 85 years old were significantly higher(P <0.05).The rates of admitted to ICU and mortality of elderly hyponatremia increased with age.Multivariate logistic regression analysis showed that:(1)There are 3 independent risk factors for elderly hyponatremia admitted to the ICU: acute gastroenteritis(OR=25.10,P=0.04),serum sodium(OR=1.82,P<0.05),drug-induced hyponatremia(OR=0.14,P=0.02).(2)There were 3 independent risk factors for death of elderly hyponatremia over 85 years old: SIADH(OR=84.73,P=0.03),gender(OR=61.47,P=0.03),serum sodium level(OR=47.69,P=0.01).Conclusions:1.The rate of elderly hyponatremia transferred to the intensive care unit was higher than the normal serum sodium group;there was no statistical difference of the mortality between elderly hyponatremia and the normal serum sodium group.Heart failure,>85 years,serum sodium<130mmol/L,pneumonia,acute gastroenteritis,serum sodium level,inadequate intake are the independent risk factors for elderly hyponatremia into the ICU;acute and chronic renal failure,serum sodium level,age are the independent risk factors for death in elderly hyponatremia;2.The rates of severe hyponatremia into the ICU and mortality were significantly higher,elderly hyponatremia into the ICU treatment rate and mortality increased with the reduction of serum sodium levels.CRP,CCI,serum creatinine,blood urea nitrogen,erythrocyte sedimentation rate in elderly hyponatremia were independent risk factors for severe hyponatremia.3.The rates of admitted to ICU and mortality in patients with hyponatremia over 85 years old were significantly higher,the rate of admitted to ICU and mortality of elderly hyponatremia increased with age.Combined acute gastroenteritis,serum sodium,drug-induced hyponatremia were independent risk factors for 85-year-old elderly hyponatremia admitted to the ICU.SIADH,gender,serum sodium level were independent risk factors for death in elderly hyponatremia over 85-year-old. |
