Introduction: Hyponatraemia is common and associated with significant morbidity and mortality. However, its often not recognised as a serious diagnosis and therefore inadequately investigated and poorly managed. An audit of the management of patients admitted to The Great Western Hospital (GWH) with hyponatraemia confirmed these problems. A hyponatraemia guideline was produced in order to improve diagnosis, investigation, and management of patients with hyponatraemia.
Methods: The guideline was piloted in the Acute Medical Unit at GWH. Following a teaching session and introductory period, a re-audit was performed. Data was collected retrospectively in patients with an admission sodium of ≤127 mmol/l, over a 1-month period. The aim was to identify whether introduction of a guideline improved diagnosis, investigation, and management of patients.
Results: Twenty patients were included; eight males and 12 females. The mean age was 64 years (range 2588 years). The mean sodium was 119 mmol/l; range 108127 mmol/l. Following the teaching session and introduction of the guideline, 95% patients had a diagnosis of hyponatraemia documented compared to 65% of patients in the original audit. Eight investigations were identified as essential investigations in hyponatraemia. 40% had greater than or equal to seven investigations compared to only 13% in the original audit. 55% of patients had a urine sodium, urine osmolality, and serum osmolality requested compared to 27% in the original audit. 35% of patients were either seen by the endocrine team compared to 4% in the original audit.
Discussion: This audit demonstrates that the use of education and a guideline has improved recognition of hyponatraemia. It has resulted in an increase in the number of relevant investigations requested and in the number of patients reviewed by the endocrine team. Hopefully, this has led to an improvement in the management of patients with subsequent reduction in morbidity, mortality and length of stay.