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Clinical Manifestations of Elderly Patients Admitted Because of Severe HyponatremiaPurpose : Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room.

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¿ÀÀ¯Á¤ ( Oh You-Jeong ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç

ÇÑÁö¼± ( Han Ji-Sun ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
±èµµ°æ ( Kim Do-Kyong ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
Á¤¼®Èñ ( Chung Seuk¡©Hee ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
±è»ó¿Á ( Kim Sang-Ock ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
Çü°Ç´ö ( Hsing Chien-Ter ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
¸ñÁö¿µ ( Mok Ji-Young ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
¾È¿ø¼® ( An Won-Suk ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç
±è¼ºÀº ( Kim Sung-Eun ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ½ÅÀå³»°úÇб³½Ç
±è±âÇö ( Kim Ki-Hyun ) - µ¿¾Æ´ëÇб³ Àǰú´ëÇÐ ³»°úÇб³½Ç

Abstract

¸ñ Àû:ÃÖ±Ù ³ëÀΠȯÀÚ¿¡¼­ ½ÉÇÑ Àú³ªÆ®·ýÇ÷ÁõÀÇ ¹ß»ýºóµµ°¡ Áõ°¡Çϰí ÀÖÀ¸³ª ÀÌ¿¡ ´ëÇÑ ¿¬±¸°¡ ¾ø´Â »óÅÂÀÌ´Ù. ÀúÀÚµéÀº ½ÉÇÑ Àú³ªÆ®·ýÇ÷ÁõÀ¸·Î ÀÀ±Þ½ÇÀ» ÅëÇØ ³»¿øÇÑ ³ëÀΠȯÀÚ¿¡¼­ Àú³ªÆ®·ýÇ÷ÁõÀÇ ¿øÀÎ ¹× ÀÓ»ó ¾ç»óÀ» ¾Ë¾Æº¸±â À§ÇØ º» ¿¬±¸¸¦ ½Ç½ÃÇÏ¿´´Ù.

¹æ ¹ý:2000³âºÎÅÍ 2007³â±îÁö ÀÀ±Þ½ÇÀ» ÅëÇØ ÀÔ¿øÇÑ È¯ÀÚ Áß 60¼¼ ÀÌ»óÀ̸鼭 Ç÷û ³ªÆ®·ý ³óµµ 125 mEq/L ÀÌÇÏÀΠȯÀÚ¸¦ ÈÄÇâÀûÀ¸·Î ºÐ¼®ÇÏ¿´´Ù. Àú³ªÆ®·ýÇ÷ÁõÀ» ÈçÈ÷ µ¿¹ÝÇÒ ¼öÀÖ´Â ½ÉÇÑ ¸¸¼º ÁúȯÀº ´ë»ó¿¡¼­ Á¦¿ÜÇÏ¿´°í Àǹ« ±â·ÏÀ» ¹ÙÅÁÀ¸·Î ¿øÀÎÀ» ºÐ¼®ÇÏ¿´´Ù. Áõ»ó ¹× ÀÌ´¢Á¦ º¹¿ë ¿©ºÎ, ¿ä Áß ³ªÆ®·ý ³óµµ, Àú³ªÆ®·ýÇ÷ÁõÀÇ ½ÉÇÑ Á¤µµ¿¡ µû¶ó ÀÓ»ó ¾ç»ó ¹× °Ë»ç°á°ú Â÷À̰¡ ÀÖ´ÂÁö ºÐ¼®ÇÏ¿´´Ù.

°á °ú:´ë»ó ȯÀÚ´Â 53¸íÀ̾ú°í, Æò±Õ Ç÷û ³ªÆ®·ý ³óµµ´Â111.4¡¾6.9 mEq/L, ¿ä Áß ³ªÆ®·ý ³óµµ´Â 68.7¡¾43.8 mEq/
L ¿´À¸¸ç, ¿¬·É¿¡ µû¸¥ Àú³ªÆ®·ýÇ÷Áõ Á¤µµÀÇ Â÷ÀÌ´Â ¾ø¾ú´Ù. ¿À½É ¹× ±¸Åä Áõ»óÀÌ 29¿¹ (54.7%), ½Å°æÇÐÀû ÀÌ»ó ¼Ò°ßÀ» º¸ÀÎ °æ¿ì°¡ 19¿¹ (35.8%) ¿´À¸¸ç, ½Å°æÇÐÀû ÀÌ»ó ¼Ò°ßÀ» º¸ÀÎ ±º¿¡¼­ Ç÷û ¹× ¼Òº¯ÀÇ Æò±Õ ³ªÆ®·ý ³óµµ°¡ ³·¾Ò´Ù. ÀǽɵǴ ¿øÀÎÀ¸·Î´Â ÀÌ´¢Á¦ »ç¿ëÀÌ 20¿¹ (37.7%), ¼ö¼úÀ» ½ÃÇàÇß´ø °æ¿ì°¡ 8¿¹ (15.1%) ¿´À¸¸ç 42¿¹ (79.2%)¿¡¼­ ½ÄÀ̼·Ãë°¡ °¨¼ÒµÇ¾î ÀÖ¾ú´Ù. ³ªÆ®·ý ¼öÄ¡°¡ 125 mEq/L·Î Áõ°¡ÇÒ ¶§±îÁö »ç¿ëÇÑ ¼ö¾×ÀÇ ³ªÆ®·ý Æò±Õ ³óµµ´Â 336.5¡¾160.6 mEq/L ¿´°í,Æò±Õ µµ´Þ ½Ã°£Àº 43.9¡¾25.4 ½Ã°£À̾ú´Ù.

°á ·Ð:60¼¼ ÀÌ»óÀÇ È¯ÀÚ¿¡¼­ ÀÌ´¢Á¦ »ç¿ë µî ¿ä Áß ³ªÆ®·ýÀÇ ¼Ò½ÇÀº ½ÉÇÑ Àú³ªÆ®·ýÇ÷ÁõÀÇ ÁÖ¿ä ¿øÀÎÀÌ µÉ ¼ö ÀÖ´Ù. µû¶ó¼­ ³ëÀΠȯÀÚ¿¡¼­ ÀÌ´¢Á¦¸¦ ó¹æÇÒ ¶§ ±× ÀûÀÀÁõÀ» ¼¼½ÉÇÏ°Ô °ËÅäÇØ¾ß Çϰí, ÀÏ´Ü Ã³¹æÇÑ °æ¿ì¿¡´Â Ç÷û ÀüÇØÁú¿¡ ´ëÇÑ ÃßÀûÀÌ ÇÊ¿äÇÏ´Ù.

Purpose:Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room.

Methods:We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age >60 years, Na <125 mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia.

Results:Mean serum sodium concentration was 111.4¡¾6.9 mEq/L and urine sodium concentration was 68.7¡¾43.8 mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125 mEq/L of serum sodium level was 336.5¡¾160.6 mEq/L.

Conclusion:The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.

Ű¿öµå

Hyponatremia;Aged; Diuretics;Neurologic manifestation
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