ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2011) 25 P49

Hyponatraemia: the view from primary care

Anh Tran1,2, Steve Hyer1, Padmini Manghat3, Marta Lapsley3 & Andrew Rodin1


1Endocrine Department, St Helier Hospital, Carshalton, Surrey, UK; 2Shadbolt Park House Surgery, Worcester Park, Surrey, UK; 3Chemical Pathology Department, Epsom General Hospital, Epsom, Surrey, UK.


Introduction: Hyponatraemia is not uncommon in primary care and its management can be complex. It is vital that initial assessment is carried out properly as mismanagement can have serious consequences.

Aim: To investigate general practitioners’ views and perceptions on the management of hyponatraemia encountered in primary care.

Method: Local general practitioners were surveyed with a questionnaire via email and at local postgraduate meetings. Questions were themed around the following areas i) the management of hyponatraemia ii), confidence in managing hyponatraemia, iii) experience managing hyponatraemia including long-term complications and iv) training needs.

Results: A total of 65 general practitioners returned completed questionnaires.

The median (range) suggested serum sodium concentration (mmol/l) for arranging further investigations was 130 (118–135), for routine referral to secondary care was 125 (105–130), and urgent referral 120 (100–128).

When asked about the importance of a serum sodium of 125–130, 63% of respondents replied ‘moderately’ important, 25% very important and 12% little importance. When asked what further tests would be considered at this level of hyponatraemia, the majority (65%) would repeat serum electrolytes. Only 9% mentioned urinary sodium and paired plasma/urine osmolarity.

The commonest cause of hyponatraemia that respondents had encountered was drug-related (78%).

Most respondents felt they had not received sufficient training (85%) and lacked confidence in the initial assessment of hyponatraemia (64%). Those qualified >20 years felt less confident and were less likely to suggest further tests as recommended by specialists.

77% of respondents would like a management protocol or algorithm and 60% were keen to attend a local educational event on hyponatraemia.

Conclusion: In our area, many general practitioners lack confidence in the management of hyponatraemia and practice varies widely. There is a large unmet educational need in this area and future studies will look at how best this can be addressed.

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