Monnerat Sophie, Christ-Crain Mirjam, Refardt Julie
Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland.
Nat Rev Endocrinol. 2025 Jun 17. doi: 10.1038/s41574-025-01138-4.
Hyponatraemia is the most common electrolyte disorder in both inpatient and outpatient settings and mostly affects older adults, in whom intrinsic factors (such as chronic heart, liver or kidney diseases and malignancies) and extrinsic factors (such as polypharmacy and malnutrition) favouring hyponatraemia are highly prevalent. Importantly, its occurrence is expected to increase exponentially with global warming. Chronic hyponatraemia is associated with an increased risk of falling, osteoporosis and fractures, attention deficits, and even mortality. In the past two decades, a growing number of studies have suggested that correcting hyponatraemia improves clinical outcomes, outlining hyponatraemia management as a part of promoting healthy ageing. In addition, SGLT2 inhibitors and protein supplementation have been shown to be efficacious in treating hyponatraemia, both of which represent attractive and holistic treatment options in older adults. However, despite hyponatraemia being encountered in all medical specialties, its clinical burden is often overlooked, partly due to low awareness but also to low confidence in applying diagnostic and therapeutic algorithms. In this Review, we aim to depict the consequences of hyponatraemia, characterize the most common aetiologies in older individuals, and finally detail the diagnostic pathway as well as the benefits and limitations of the available treatment options.
低钠血症是住院和门诊环境中最常见的电解质紊乱，主要影响老年人，在这些老年人中，导致低钠血症的内在因素（如慢性心脏、肝脏或肾脏疾病以及恶性肿瘤）和外在因素（如多种药物联用和营养不良）非常普遍。重要的是，随着全球变暖，其发生率预计将呈指数级增长。慢性低钠血症与跌倒、骨质疏松和骨折、注意力缺陷甚至死亡风险增加有关。在过去二十年中，越来越多的研究表明，纠正低钠血症可改善临床结局，将低钠血症管理作为促进健康老龄化的一部分。此外，已证明钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和补充蛋白质在治疗低钠血症方面有效，这两者都是老年人有吸引力的整体治疗选择。然而，尽管所有医学专科都会遇到低钠血症，但其临床负担往往被忽视，部分原因是认识不足，也因为应用诊断和治疗算法的信心不足。在本综述中，我们旨在描述低钠血症的后果，表征老年人中最常见的病因，最后详细介绍诊断途径以及现有治疗选择的益处和局限性。
