Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised patients. It is an independent risk factor for mortality and is associated with increased length of hospital stay.
Method: The objective of audit was to review practice of investigations and management of hyponatraemia in adults at Bedford hospital in line with evidence based guidelines including European Society of Endocrinology 2014 clinical practice guidance. An observational retrospective evaluation of medical notes, laboratory results, prescription charts, and discharge letters was performed on randomly selected 50 patients admitted with serum sodium of less than 125 mmol/l from January to July 2014.
Results: There was no significant gender difference, and most cases were above 60 years of age. Volume status was documented in 50%, with postural BP in 2% only. In two thirds of the cases, no cause or diagnosis for hyponatraemia was documented, while others were attributed to hypervolaemia 14%, diuretics 12%, GI losses 4% and SIADH 4%. Diuretics were stopped where appropriate. Patients had following investigations: RFTs 100%, glucose 94%, CXR 76%, CT brain 10%, plasma osmolality 8%, urine osmolality 6%, urine sodium 4%, TFT 4% and 0900 h cortisol 2%. We extrapolate that many patients may not have received appropriate treatment due to lack of essential investigations and clear diagnosis.
Conclusion: Management of hyponatraemia in hospital settings is often below par. Training of clinical staff and timely specialist opinion are essential for correct diagnosis and treatment and may improve patient mortality and reduce the length of hospital stay. We have delivered hyponatraemia sessions in medical teachings and displayed International guidelines on intranet and as posters in AAU. Local hyponatraemia guideline is in the process of approval, and we plan to complete the audit loop 6 months after the local guideline has been disseminated.
07 Nov 2016 - 09 Nov 2016