Abnormalities of water metabolism in the elderly

Hypernatremia is a frequent problem at the extremes of age, but particularly so in elderly individuals. Changes in the physiological responses to water deprivation with increasing age may be of particular interest in understanding the pathogenesis of hypernatremia in the elderly. When comparing healthy elderly men to younger controls, there are differences in the response to water deprivation. In older men, there are deficits in both the intensity and threshold of the thirst response. The ability to concentrate the urine also declines with age. There is both a decline in glomerular filtration rate and an increased incidence of renal disease with advancing age, which may contribute to impaired ability to conserve water. Because of a decrease in the percent total body water with age, equal volumes of fluid loss in young and old individuals may represent more severe dehydration in the elderly. Hyponatremia is seen in all age groups, but there are important differences in the elderly. When compared with postmenopausal women, menstruant (of childbearing age) women are over 25 times more likely to suffer permanent brain damage as a complication of hyponatremic encephalopathy. Furthermore, menstruant women suffer seizures or respiratory arrest at far higher levels of plasma sodium (110 to 130 mmol/L) than occurs in postmenopausal women (95 to 123 mmol/L).