Endocrine Abstracts

Aims: To assess the prevalence, investigations and management of hyponatraemia in hospital inpatients (previously deemed inadequate) over a 2-week period (1–15 May 2013) and compare with data collected in 2011, following the introduction of updated clinical guidelines in our trust.

Methods: Hospital notes and electronic records of all patients with a sodium level of <130 mmol/l were analysed.

Results: 43/255 (17%) patients had sodium <130 mmol/l. Complete data was available in 35/43 (78%) – 24 males, 11 females, average age 69 years, mean sodium 128 mmol/l, 7 (3%) had sodium <125 mmol/l.

Hydration status was mentioned at diagnosis in 21 (60%) patients: 13 (37%) were euvolaemic, 5 (14%) hypovolaemic and 3 (9%) hypervolaemic. Further investigations were only requested in 5 (14%) patients. No patients were diagnosed with SIADH, but from the results, 2 (6%) patients had findings consistent with SIADH.

5 (14%) patients were put on fluid restriction, 13 (37%) received i.v. fluids, 6 (17%) of patients had diuretics withheld. Demeclocycline was not prescribed in any case. 11 (13%) required i.v. antibiotics and 3 (9%) were admitted to ITU. Endocrinology review was not requested in any case.

4 (11%) patients died and 16 (46%) were discharged with a sodium <130 mmol/l. The average length of hospital stay was 14.5 days (range 1–61 days).

Compared to the previous audit, hyponatraemia was mentioned in the diagnosis in fewer cases (14 vs 26%), as was hydration status (60 vs 67%). However, investigations for SIADH were requested in twice as many (14 vs 7%) and more patients had active management (fluid restriction and withholding of diuretics).

Conclusion: Investigation of hyponatraemia has improved following introduction of new local guidelines, although management is still suboptimal. Endocrinologists continue to be underutilised. Our plan is to disseminate hyponatremia guidelines more widely and incorporate hyponatremia management within the core teaching programme of junior doctors.