Hyponatremia, defined as a serum sodium concentration below 135 mmol/l is acknowledged to be the most common electrolyte disturbance within hospital environment. Hyponatremia, specifically severe hyponatremia, is associated with an increase in morbidity and mortality.
Aim: Audit aim was to evaluate the diagnosis, investigation, and management of hyponatremia in our district general hospital. This is a retrospective audit using lab data and clinical notes.
Results: Across a time span of 2 months 31 patients with hyponatraemia were identified (nine men and 22 women). Mean patient age was 71.9 years. Bimodal distribution for both men (40s and 80s) and women (60s and 80s). Majority (66.7%) of patients were symptomatic. Also generally symptoms were related to severity of hyponatraemia except patients in their 60s were symptomatic regardless of severity. The mean initial plasma sodium concentration was 122.5 mmol/l. Among the essential investigations patients had: urine sodium (22.5%), plasma osmolality (22.5%), urine osmolality (22.5%), and paired samples (12.9%), TSH (45.1%), cortisol (22.5%), glucose (12.9%), and creatinine (100%). Only five patients had all investigations. Correct diagnosis was made only in half of the patients (48%). Of assessment a third had fluid status documented. Only 40% had appropriate fluid management. A quarter had drugs stopped appropriately. In severe hyponatraemia no single patient had daily sodium monitored and none of them had any pharmacological intervention for hyponatraemia.
Conclusions: This audit in our hospital highlighted that hyponatraemia is inadequately managed. Also essential investigations were not done and this has the potential for adverse consequences to the patient. We believe this malpractice is widespread across UK. We are planning to improve our practice through education and guideline but there is still scope for further improvement nationally.