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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Drug-Induced Electrolyte Disturbances in Older Adults Presenting to the Emergency Department: Mechanisms, Recognition and Prevention

  • Alexandru Cristian Brici1,2
  • Maria Octavia Murariu1,3
  • Alexia Manole4
  • Raul Patrascu5
  • Vera Ciocan6
  • Dorin Novacescu7
  • Talida Georgiana Cut8
  • Alina Petrica9,10
  • Felicia Manole11
  • Flavia Zara7
  • Cristina Stefania Dumitru7
  • Marius Liviu Moise12
12 affiliations
  1. 1Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  2. 2Emergency Unit, County Emergency Hospital Resita, 320154 Resita, Romania
  3. 3ENT Department, County Emergency Hospital Resita, 320154 Resita, Romania
  4. 4Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
  5. 5Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  6. 6Department VIII, Discipline of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  7. 7Department II of Microscopic Morphology, Discipline of Histology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  8. 8Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  9. 9Centre for Artificial Intelligence and Big Data in Emergency Medicine and Clinical Research, Department of Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
  10. 10Department of Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
  11. 11ENT Department, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
  12. 12Radiology Department, Emerald Medical Center, Corneliu Coposu Boulevard 14, 300552 Timisoara, Romania
Open at sourceDOICite

Abstract

Many older adults attending the emergency department (ED) take medications that interfere with water and electrolyte balance. This narrative review, based on a structured PubMed/MEDLINE search covering January 2016 to September 2026, summarizes evidence on drug-associated disorders of sodium, potassium, magnesium and calcium in older ED patients. Thiazides, antidepressants, antiepileptic drugs, antipsychotics, proton pump inhibitors and desmopressin are associated with hyponatremia; with thiazides, the risk peaks in the first weeks of treatment and is highest in women aged 80 years or older. Lithium can cause nephrogenic diabetes insipidus, which may persist after discontinuation and cause hypernatremia when water intake is inadequate. Renin–angiotensin–aldosterone system inhibitors, mineralocorticoid receptor antagonists, trimethoprim and non-steroidal anti-inflammatory drugs predispose to hyperkalemia, particularly in chronic kidney disease; diuretics and proton pump inhibitors are associated with hypokalemia and hypomagnesemia; and denosumab can cause severe hypocalcemia in advanced kidney disease. Most of this evidence is observational, and drugs usually act together with comorbidities, acute illness and other medications. We propose a severity-based ED algorithm integrating medication history, laboratory, electrocardiographic and volume assessment (including point-of-care ultrasound) to guide stabilization, drug adjustment, safe correction and disposition. ED-based medication safety programs reduce inappropriate prescribing, but their effect on electrolyte-related outcomes remains unproven.

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Cite

BibTeXRIS
BibTeX
@article{brici2026druginduced,
  title = {{Drug-Induced Electrolyte Disturbances in Older Adults Presenting to the Emergency Department: Mechanisms, Recognition and Prevention}},
  author = {Alexandru Cristian Brici and Maria Octavia Murariu and Alexia Manole and Raul Patrascu and Vera Ciocan and Dorin Novacescu and Talida Georgiana Cut and Alina Petrica and Felicia Manole and Flavia Zara and Cristina Stefania Dumitru and Marius Liviu Moise},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218719},
  url = {https://www.mdpi.com/2077-0383/15/21/8719},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Drug-Induced Electrolyte Disturbances in Older Adults Presenting to the Emergency Department: Mechanisms, Recognition and Prevention
AU  - Alexandru Cristian Brici
AU  - Maria Octavia Murariu
AU  - Alexia Manole
AU  - Raul Patrascu
AU  - Vera Ciocan
AU  - Dorin Novacescu
AU  - Talida Georgiana Cut
AU  - Alina Petrica
AU  - Felicia Manole
AU  - Flavia Zara
AU  - Cristina Stefania Dumitru
AU  - Marius Liviu Moise
PY  - 2026
DA  - 2026/11/08
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218719
UR  - https://www.mdpi.com/2077-0383/15/21/8719
AB  - Many older adults attending the emergency department (ED) take medications that interfere with water and electrolyte balance. This narrative review, based on a structured PubMed/MEDLINE search covering January 2016 to September 2026, summarizes evidence on drug-associated disorders of sodium, potassium, magnesium and calcium in older ED patients. Thiazides, antidepressants, antiepileptic drugs, antipsychotics, proton pump inhibitors and desmopressin are associated with hyponatremia; with thiazides, the risk peaks in the first weeks of treatment and is highest in women aged 80 years or older. Lithium can cause nephrogenic diabetes insipidus, which may persist after discontinuation and cause hypernatremia when water intake is inadequate. Renin–angiotensin–aldosterone system inhibitors, mineralocorticoid receptor antagonists, trimethoprim and non-steroidal anti-inflammatory drugs predispose to hyperkalemia, particularly in chronic kidney disease; diuretics and proton pump inhibitors are associated with hypokalemia and hypomagnesemia; and denosumab can cause severe hypocalcemia in advanced kidney disease. Most of this evidence is observational, and drugs usually act together with comorbidities, acute illness and other medications. We propose a severity-based ED algorithm integrating medication history, laboratory, electrocardiographic and volume assessment (including point-of-care ultrasound) to guide stabilization, drug adjustment, safe correction and disposition. ED-based medication safety programs reduce inappropriate prescribing, but their effect on electrolyte-related outcomes remains unproven.
SN  - 2077-0383
ER  -