What treatment can be given for an 83-year-old patient with hyponatremia (low sodium levels) and weakness, who is experiencing generalized pruritus (itchiness) without an underlying skin condition?

From the Guidelines

For an 83-year-old patient with hyponatremia, weakness, and generalized pruritus without skin disease, the most appropriate initial treatment for pruritus would be topical emollients and nonsedative antihistamines, given the potential risks of sedative antihistamines in the elderly, as suggested by 1. The patient's hyponatremia should be managed concurrently through fluid restriction and addressing underlying causes, with gradual sodium correction to prevent osmotic demyelination syndrome. Key considerations for managing pruritus in this context include:

• Topical emollients like CeraVe or Eucerin applied 2-3 times daily to help with dry skin, which is a common cause of pruritus in the elderly, as noted in 1.
• Oral antihistamines such as cetirizine 10mg daily, which is preferred over sedative antihistamines like diphenhydramine due to its safer side effect profile in elderly patients, as indicated by 1.
• Monitoring for and managing potential underlying causes of pruritus, including but not limited to, malignancy, neuropathy, or drug-induced pruritus, as discussed in 1 and 1.
• Regular sodium checks and kidney function tests are crucial, as hyponatremia can cause neurological symptoms, including pruritus, and its correction needs to be carefully managed, as generally recommended in clinical practice.
• Given the patient's age and potential for polypharmacy, it's essential to consider the side effect profile of any medication, including antihistamines, and to prefer options with the least risk of adverse effects, such as nonsedative antihistamines, as suggested by 1.

From the Research

Treatment Options for Generalized Pruritus

• For an 83-year-old patient with hyponatremia and weakness experiencing generalized pruritus without an underlying skin condition, treatment options can be considered based on the available evidence 2, 3, 4.
• The patient's symptoms of generalized itchiness without skin lesions can be addressed with antipruritic treatments, as suggested by studies on drug-induced itch management 2 and pruritus treatment 3, 4.
• Oral antihistamines, such as diphenhydramine, can provide nonspecific relief for patients with intractable pruritus 3.
• However, for opioid-induced pruritus, nalbuphine has been shown to be effective in reducing the incidence and severity of pruritus without affecting analgesia 5, 6.

Considerations for the Patient's Condition

• Given the patient's age and medical condition, it is essential to consider the potential side effects and interactions of any medication prescribed for pruritus.
• The patient's hyponatremia and weakness should be taken into account when selecting a treatment option, as some medications may exacerbate these conditions.
• Benadryl (diphenhydramine) may be considered for short-term relief of pruritus, but its effectiveness and potential side effects should be carefully evaluated in the context of the patient's overall health status 3, 5.

Potential Orders for the Patient

• Based on the available evidence, potential orders for the patient could include:

• Diphenhydramine (Benadryl) for short-term relief of pruritus, as suggested by studies on pruritus treatment 3.
• Alternatively, nalbuphine could be considered if the patient's pruritus is suspected to be opioid-induced, given its efficacy in reducing pruritus without affecting analgesia 5, 6.

• However, any medication orders should be carefully evaluated and individualized to the patient's specific needs and medical condition.