Clinical presentation of hypernatremia in elderly patients: a case control study

Area of Science:

• Geriatric Medicine
• Internal Medicine
• Clinical Chemistry

Background:

• Hypernatremia is a common electrolyte imbalance in elderly patients, often associated with significant morbidity and mortality.
• Early identification of hypernatremia is crucial for timely intervention and improved patient outcomes.
• Traditional clinical signs of dehydration are not always reliable indicators in this population.

Purpose of the Study:

• To evaluate the early clinical signs of hypernatremia in elderly individuals.
• To determine the prognostic value of these clinical signs in predicting mortality.
• To identify reliable indicators for diagnosing hypernatremia in geriatric care settings.

Main Methods:

• A prospective, case-control study involving 150 elderly patients with hypernatremia and 300 matched controls.
• The study was conducted across seven short- and long-term geriatric care facilities.
• Clinical assessments of hydration status, including skin turgor and oral mucosa, were performed bedside. Consciousness status and vital signs were recorded.

Main Results:

• Patients with hypernatremia exhibited more frequent low blood pressure, tachycardia, dry oral mucosa, abnormal skin turgor, and altered consciousness compared to controls.
• Abnormal subclavicular and forearm skin turgor were present in over 60% of hypernatremic patients.
• Abnormal subclavicular skin turgor, dry oral mucosa, and altered consciousness were independently associated with hypernatremia and predicted 30-day mortality (OR=2.3).

Conclusions:

• Classical dehydration signs are inconsistently present in elderly patients with hypernatremia.
• Variations in consciousness are critical indicators that may signify severe hypernatremia and are associated with increased mortality.
• Geriatric care providers should prioritize assessment of consciousness status in elderly patients to detect hypernatremia.