Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Mississippi Medical Center, Jackson, MS, USA.
G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA.
Rev Endocr Metab Disord. 2017 Mar;18(1):49-66. doi: 10.1007/s11154-017-9420-5.
The population of elderly individuals is increasing worldwide. With aging, various hormonal and kidney changes occur, both affecting water homeostasis. Aging is a risk factor for chronic kidney disease (CKD) and many features of CKD are reproduced in the aging kidney. Dehydration and hyperosmolarity can be triggered by diminished thirst perception in this population. Elderly with dementia are especially susceptible to abnormalities of their electrolyte and body water homeostasis and should be (re-)assessed for polypharmacy. Hypo- and hypernatremia can be life threatening and should be diagnosed and treated promptly, following current practice guidelines. In severe cases of acute symptomatic hyponatremia, a rapid bolus of 100 to 150 ml of intravenous 3% hypertonic saline is appropriate to avert catastrophic outcomes; for asymptomatic hyponatremia, a very gradual correction is preferred. In summary, the body sodium (Na+) balance is regulated by a complex interplay of environmental and individual factors. In this review, we attempt to provide an overview on this topic, including dehydration, hyponatremia, hypernatremia, age-related kidney changes, water and sodium balance, and age-related changes in the vasopressin and renin-angiotensin-aldosterone system.
全球老年人口正在增加。随着年龄的增长，各种激素和肾脏变化都会发生，这两者都会影响水的动态平衡。衰老会增加慢性肾脏病（CKD）的风险，而 CKD 的许多特征在衰老的肾脏中重现。由于该人群的口渴感知减弱，可能会引发脱水和高渗状态。患有痴呆症的老年人特别容易出现电解质和身体水动态平衡异常，应（重新）评估其药物使用情况。低钠血症和高钠血症可能危及生命，应根据现行实践指南迅速诊断和治疗。在急性症状性低钠血症的严重情况下，适当给予 100 至 150 毫升静脉注射 3%高渗盐水可避免灾难性结局；对于无症状性低钠血症，建议缓慢纠正。总之，机体钠（Na+）平衡受环境和个体因素的复杂相互作用调节。在这篇综述中，我们试图概述这个话题，包括脱水、低钠血症、高钠血症、与年龄相关的肾脏变化、水和钠平衡以及与年龄相关的血管加压素和肾素-血管紧张素-醛固酮系统变化。
