Introduction: Severe hyponatraemia is a medical emergency and can be life-threatening. It requires prompt assessment, investigation and treatment which can be a challenge as it presents to multiple departments. We therefore looked to undertake a review of severe hyponatraemia cases in our 1000-bedded acute trust with the aim of determining most appropriate care.
Aims and methods: Retrospective notes review of all patients with Na ≤110 mmol/l between 1/1/14 and 30/4/14 were reviewed to determine treatments and outcomes.
Results: 13 patients were identified (from ~18 200 admissions). 11/13 had symptomatic hyponatraemia; in 12/13 the hyponatraemia was a presenting feature. Assessment 8/13 had a complete drug history, 5/13 had fluid status documented. 3/13 had a complete set of hyponatraemia investigations. 4/13 were diagnosed as SIADH, with a range of diagnoses for others. Management 0/13 patients were referred to Endocrinology at diagnosis, 5/13 being reviewed later in admission. 6/13 had ITU review, with 3 admissions. Treatments 3/13 patients had a Na rise of >12 mmol/l in first 24 h. Outcomes 4/13 died during admission, rising to 6/13 at 12 months. 6/9 patients had a recurrence of hyponatraemia and 3/9 were readmitted within 3 months of discharge.
Discussion: Results confirm severe hyponatraemia carries a high risk of mortality (46% at 12 months). Those patients surviving to discharge had a high risk of recurrence and readmission. Low rates of effective investigations/assessment/escalation across diverse departments highlight the importance of dissemination of recently published national and international guidelines to all hospital specialties and not just Endocrinology where we know that assessment and management processes are much more robust. The expertise and educational role of Endocrinologists in the management process needs to be encouraged and the investigational pathway highlighted through Biochemistry flagging of the index Na result.