Endocrine Abstracts

Introduction/objective: Elderly patients have a higher prevalence of hypernatremia. Previous studies suggested that impaired ADH secretion contributes to development of hypernatremia in the elderly. Copeptin is the C terminal part of the ADH precursor and is more stable in plasma than ADH. The aim of this study was to detect demographic and clinical characteristics of the elderly hypernatremic patient hospitalized in the internal medicine ward, and to increase the understanding of the role of ADH secretion in the pathogenesis of hypernatremia.

Design: Case–control study.

Setting: Internal Medicine ward in a University affiliated hospital.

Participants: /33 hypernatremic patients (admission sodium>150 meq/l, age>70) compared to 34 normonatremic patients.

Measurements: Demographic, functional and clinical data (APACHE II score) were collected at admission. Serum copeptin levels were obtained 48 hours from admission. Mortality and change in the functional status were followed up to 30 days after discharge.

Results

Patients with hypernatremia presented with significantly lower baseline functional and cognitive states and higher APACHE II score (21.3±8.6 vs 15.4±6.7, P< 0.01). Dementia was present in 97% of the hypernatremic patients compared to 46% of the control group (P<0.001). Mortality within 30 days of discharge was higher in the hypernatremic group (58% vs 32%, P<0.05). Higher Copeptin levels were found in the hypernatremic group compared to the normonatremic group (100.2±60.6 pmol/l v. 66.5±57.2 pmol/l, P<0.05). High levels of Copeptin were associated with higher in hospital (P<0.05) and 30 days mortality (P<0.01). Sodium levels were found to correlate with Copeptin levels; yet, an even stronger correlation was demonstrated between Copeptin levels and Apache II score (r=0.52, P<0.001).

Conclusions: Hypernatremia in the elderly at admission is associated with a high rate of mortality. Copeptin is appropriately secreted by the elderly patient with dementia and seems to be a good single disease severity marker.

Disclosure: Mirski fund.