Introduction: Hyponatraemia is the commonest inpatient electrolyte disturbance, and its severity has been shown to correlate with in-patient mortality, length of stay, and use of hospital resources. Unfortunately, hyponatraemia goes frequently unrecognised. The purpose of this audit was to see how a tertiary health centre manages hyponatraemia and how patient journey is affected.
Goals: To identify hyponatraemic patients in a tertiary centre in a 2-week timeframe and through case note and electronic record scrutiny, record the aetiology and compare management to current best practice.
Methods: Two hundred and eighty-six hyponatraemic patients were identified within a 2-week window from a biochemistry database. The cohort was divided into two groups. The audit focussed on group 1, which comprised patients with serum sodium below 131 mmol/l (n=58). Group 2 included the remaining patients (n=228).
Results: Twenty percentage of the cohort had moderate/severe hyponatraemia (<131 mmol/l). Only 17% of group one patients were assigned an aetiology, the commonest being SIADH (7%). Urinary sodium, plasma osmolality, and urinary osmolality were measured in 8, 7, and 4 patients respectively. Group 1 patients remained in hospital for 29 days on average, with 37% being discharged hyponatraemic and 34% readmitted within 5 months.
Conclusions: In a tertiary centre, only a minority of patients with hyponatraemia were appropriately investigated and where SIADH was diagnosed, there was poor enforcement of fluid restriction, the only treatment option recorded. This audit has identified hyponatraemia as a poorly managed clinical entity, which is associated with increased hospital stay. Increased awareness amongst clinical staff accompanied by practical guidelines highlighting investigation and treatment are needed to enable correct management of this condition, especially at a time where newer treatment options are becoming available and greater importance is attached to length of hospital stay.