Endocrine Abstracts

Background: Hyponatremia is the most common electrolyte imbalance encountered in clinical practice. It is associated with increased morbidity and mortality. Despite this, it remains a diagnostic and therapeutic challenge and its management varies across different settings.

Aim: The aim of this study is to provide an overview of the management of severe hyponatremia in HDU and ITU settings of a District General Hospital and to determine whether patients with severe hyponatremia were managed in line with the trust’s guidelines.

Method: A descriptive, retrospective hospital record study was performed using a bespoke audit tool (Snap). All patients with an episode of severe hyponatremia (sodium level <125mmol/l) managed in HDU and ITU during a calendar year (2023) were identified and audited (56 patients).

Results: 42% of the patients were discussed with the ITU/Medical registrar on presentation. 27% were given a single bolus of hypertonic saline (2.7% Sodium Chloride) via peripheral venous access as per the local guidelines and indication. 27% of them received a second infusion of hypertonic saline and 30% required a third dose of hypertonic saline. Only 4% were monitored with hourly venous blood gases. None of them were monitored for phlebitis following the administration of hypertonic saline.11% had an endocrinology team consultation. 46% of patients achieved the desired sodium level rise of less than 8mmol in the first 24 hours of presentation.

Conclusion: No assurance was found and most of the key standards of care were found to be absent. Immediate action was implemented by the introduction of a proforma for management of severe hyponatremia. The findings were presented in the audit meeting and a re-audit will take place in order to test the implemented change.