Endocrine Abstracts

Background: Hyponatraemia is one of the most common electrolyte abnormalities in hospitalised patients and is associated with increased morbidity, mortality, and length of stay. It affects approximately 15–20% of inpatients and often reflects underlying systemic illness or inappropriate fluid or medication management. Accurate diagnosis and timely, guideline-directed treatment are essential to improve outcomes. This quality improvement project aimed to evaluate and enhance the inpatient diagnosis and management of hyponatraemia across eight adult medical wards in a District General Hospital.

Method: A retrospective two-cycle clinical audit was conducted over a 14-day period. Adult inpatients with confirmed hyponatraemia (serum sodium <135 mmol/l) were included. Data were collected on five key parameters: (1) sodium level at diagnosis, (2) biochemical work-up (serum/urine osmolality, urine sodium, cortisol, thyroid, liver, and lipid profiles), (3) assessment and documentation of volume status, (4) referral to the Endocrinology team for moderate to severe cases, and (5) initiation of treatment according to Trust guidelines.

Interventions: Following Cycle 1, targeted interventions were implemented, including educational sessions delivered during AMU teaching, on-take/post-take ward rounds, and clinical meetings. Posters summarising the Trust’s hyponatraemia management algorithm were displayed across all medical wards and medical take office. Audit findings were also presented at Endocrinology departmental and AMU teaching sessions to raise awareness and promote standardised care.

Results: In Cycle 1, 272 patients were screened, identifying 66 (24%) with hyponatraemia (60 analysed). In Cycle 2, 252 patients were screened, identifying 59 (23.2%) cases (48 analysed). Documentation of volume status improved from 43% to 88%, Endocrinology referrals from 17% to 34%, and adherence to treatment guidelines from 50% to 92%.

Conclusion: Educational and awareness interventions significantly improved fluid status documentation, adherence to guidelines, and multidisciplinary collaboration in hyponatraemia management. Continued education and re-audits will sustain and further enhance these improvements in patient care.