Introduction: Hyponatraemia is the commonest electrolyte disturbance affecting patients in and out of hospital. Streamlining and improving the investigation of hyponatraemia will quicken diagnosis, improve patient outcomes and prevent deterioration and unnecessary stay in hospital. We aimed to audit the assessment of patients with hyponatraemia against our existing guidelines (Hyponatraemia An Investigators Checklist).
Method: This was a retrospective audit looking at patient-admissions with a diagnosis of hyponatraemia on their discharge-summary within a 1-year period (March 2014 to March 2015). There were 80 cases in total. As well as demographics we assessed notes for assessment of severity and onset, clinical assessment of volume status, assessment of paired serum-urine osmolality and sodium, review of medications and documentation of a probable cause for hyponatraemia.
Results: We retrieved notes of 56 patients (41 were female). Average age (range) for the group was 80 (5596) years and median length of hospital stay was 5 days. Their average sodium level was 122 mmol/l and 50% had severe hyponatraemia (<125 mmol/l). The onset of hyponatraemia was equally distributed amongst acute, subacute and chronic. Assessment of severity and onset was done for 100% of patients; clinical assessment of volume status was done for 18% of patients; assessment of paired serum-urine osmolality and sodium was done for 63% of patients; a review of medications was done for 64% of patients and a probable cause was found for 78% of patients. Patients had other investigations (e.g., endocrinology, imaging, etc.) depending on initial assessments.
Conclusions: This audit demonstrated partial-substantial adherence to guidelines for most of the initial assessment steps during the investigation of hyponatraemia, apart from clinical assessment of volume status. As an action plan, an automatic reminder of the guidelines appears the system for moderate-severe hyponatraemia when checking for biochemistry results. A re-audit is planned for 3 years afterwards.