Introduction: Hyponatraemia is the most common electrolyte disturbance, affecting 1520% of emergency admissions to hospital. It is associated with increased mortality and length of stay in hospital. This audit was performed to evaluate how well hyponatraemia is being investigated and managed in the Acute Assessment Unit (AAU).
Methods: Sodium level on admission for all patients attending AAU at Conquest Hospital over a 1-month period was recorded from computer records. The notes of 30 patients with hyponatraemia on admission were studied and NICE recommendations were used for comparison. These state that paired serum osmolalities, urinary sodium, thyroid function tests and serum cortisol should be performed. The advised management steps include fluid restriction/hypertonic saline and stopping causative medications. The average length of stay, re-admission rates and mortality rates, from July-November 2016 (time of audit), were recorded.
Results: 71 patients of the 481 patients admitted to AAU in July 2016 had hyponatraemia on initial blood test (16.2%). Of the 30 hyponatraemic patients studied, 46.7% of had hyponatraemia documented as a problem in their notes. 56.7% had their fluid status assessed and 20% had one or more of the recommended investigations performed. 23% had one or more of the recommended management steps documented in the plan. The average length of stay of this group of patients was 10 days, compared with the national average of 5 days in 20152016. Re-admission rates were 33.3% and mortality rates 18.5%
Conclusion: It is evident that hyponatraemia is not being consistently recognised as a problem and is insufficiently investigated and managed. Given the morbidity and mortality associated with hyponatraemia and the variety of underlying causes, it is imperative that changes are made to improve care. We have produced guidelines locally and plan to re-audit following implementation of these.