Introduction: Hyponatremia is a prevalent electrolyte disorder in hospitalized patients, especially among the elderly due to aging, comorbidities, and polypharmacy. Early recognition is crucial for reducing morbidity and mortality. However, there is limited Indian data on clinical spectrum and treatment strategies. AIM: The study aims to compare clinical features in elderly patients with adult patients and hyponatremia outcomes in hospitalized patients, and correlate these findings with treatment outcomes. Materials and Methods: The study, conducted at KLE Hospital, Belgaum, involved 75 elderly patients with hyponatremia, aged 60 and above, admitted to medical wards and MICU. Patients were divided into three groups based on volume status and severity. Statistical analyses included chi-square tests and descriptive statistics. Results: A study of 75 patients, 50 geriatric and 25 adult, found distinct differences in clinical presentation and etiological factors. Geriatric patients had milder hyponatremia, while adults experienced more moderate and severe hyponatremia. Geriatric patients exhibited gastrointestinal symptoms. Discussion: The study compares adult and geriatric populations' clinical profiles of hyponatremia, finding geriatric patients have more gastrointestinal symptoms, confusion, and seizures, and suggesting aging and male gender may protect against hyponatremia-induced seizures. Conclusion: The study reveals differences in hyponatremia clinical presentation and etiology between geriatric and adult populations. Geriatric patients show more common symptoms like nausea, confusion, and seizures, with drug-induced hyponatremia being the leading cause. Geriatric patients have milder forms and longer hospital stays. Tailored management strategies are crucial for optimal patient outcomes.