Endocrine Abstracts

Introduction: Hyponatraemia is commonly encountered in clinical practice in the context of multiple pathology and marked morbidity. A study was conducted to examine the quality of clinical assessment, care offered and frequency of specialist opinion sought in hospital in-patients with severe hyponatraemia (<120 mmol/l).

Audit standards included assessment of fluid status, measurement of ‘baseline investigations’ (urinary sodium and paired osmolalities) and identification of an underlying cause. A total of 96 patients with Na <120 mmol/l were admitted during 2006. Case notes were available for analysis in 79 cases.

Results: The mean presenting sodium was 118 mmol/l and the average patient age was 73 years. Initial fluid status was not documented in 57% and ‘baseline’ investigations were not checked in 70%. A total of 39% had neither urinary sodium nor fluid balance documented.

Fifty cases were treated with potentially contributory medication −21 of these were withheld. The management of patients with diuretic treatment varied to include fluid restriction and normal saline infusion.

In 9/79 cases, an inappropriate rate of correction was identified. In 6/79 cases, sodium levels fell with treatment. In total, 40% were seen by an endocrinologist (3 suggested adrenal, 1 pituitary case)

Fluid restriction was instituted in 43%. Only 6/34 cases had documented criteria for SIADH; 7/34 had assessment of fluid balance.

In 11% of cases, a discharge plan was made. There was a 30% mortality identified.

Conclusion: This audit suggests that hyponatraemia appears to be sub optimally managed in a large number of cases. Fluid status is assessed and diagnosis proposed in <50%. A Specialist input is sought in only a small minority of complicated cases.