Endocrine Abstracts

Introduction: Hyponatremia is common in hospitalised patients and can be due to a number of aetiologies. Investigations and management are often quite varied.

Aims: To find out the prevalence, aetiology, investigations and management of hyponatremia in our hospitalised patients over a 2 week period (1 May and 15 May 2011).

Methods: Case notes and electronic data assessment of all patients admitted with sodium level <130 mmol/l.

Results: One hundred and seventy patients had hyponatremia (hospital range 136–143 mmol/l). Complete data was available in 27/46 patients (15 males, 12 females, average age 65 years) with sodium <one hundred and thirty mmol/l. Mean sodium was 127 mmol/l. 6 (4%) had sodium < 125 mmol/l. Hyponatremia was mentioned as a diagnosis in 7(26%) and SIADH specifically in only 2 (7%). Hydration status recorded were as follows: euvolemic–seven (26%), hypovolemic–five (18%), hypervolemic–six (22%), not mentioned–nine (33%). Only 2 patients had proper investigations for SIADH. Speciality ward allocation were Acute Medicine - 8, Cardiology - 3, Gastroenterology - 2, Endocrinology - 2, Care of Elderly - 1, Respiratory - 1, Orthopaedics - 3, Surgery (various) - 3, Obstetrics - 2, Gynaecology oncology - 1. Working diagnosis on admission were reported as: Hypovolemia - 6 (22%), Hypervolemia - 1, SIADH (cancer lung and ovary) - 2, Sepsis - 7 (26%). 6 (22%) patients received fluid restriction, IV fluid - 1, Demeclocycline - 1, diuretics withheld - 1, IV antibiotics - 3, ITU admission - 3. 5 (18%) patients died and 8 (30%) were discharged with Sodium level < 130 mmol/l. Average Length of stay was 15.6 days (range 1–51 days).

Conclusions: Hyponatremia is poorly understood & recorded, frequently overlooked and inadequately investigated and managed in hospitalised patients. A variety of specialities deal with hyponatremia. Endocrinologists are rarely consulted to investigate and rule out SIADH - which can often be challenging. Plan is to increase awareness among clinical staff and develop pathways to enable correct investigations and management and re-audit the whole process.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.