Hyponatraemia is common, present in some 1520% of non-selected acute hospital admissions in the UK. Hyponatraemia is associated with increased mortality and morbidity across a range of medical problems; emphasising its importance. Despite these factors, the management of patients with hyponatraemia remains challenging. Early recognition of life threatening hyponatraemia (where action is required quickly) is critical. This situation is rare and requires an emphasis on rapid treatment with hyperosmolar fluids rather than detailed investigation. In less critical clinical situations, a systematic approach to differential diagnosis and a stepped approach to course-specific treatment is key. Measurement of both urine osmolality and sodium concentration is pivotal in the differential diagnosis. Common confounders in using these data are concurrent or recent treatment with diuretics, ACE inhibitors or Angiotensin Receptor blockers. This presentation will focus on an evidence-based management strategy for hyponatraemia. It will also highlight common human factors that are obstacles to optimal delivery of care and both strategic and operational approaches to address these over time, improving outcomes and patient experience.