Endocrine Abstracts

Background: Hyponatraemia, a potentially life-threatening electrolyte disturbance, is frequently encountered in internal medicine. Prompt recognition and appropriate management - especially in patients with serum sodium <115 mmol/l or with moderate to severe symptoms - are critical for patient safety. These patients often require high-dependency or intensive care unit (ICU) management.

Method: A retrospective study was conducted at St George’s Hospital to assess how hyponatraemia is investigated and managed among medical inpatients. The study included patients admitted between 1st December 2024 and 31st January 2025 with sodium levels below 130 mmol/l. Data collected included demographic information, sodium levels, symptoms, investigations performed, causes, management strategies, time to resolution, and mortality rates. The study also compared patients managed on general wards to those referred to the Critical Care Outreach Team (CCOT) or ICU.

Results: Out of 116 patients, 95 were managed on the ward and 21 were referred to CCOT. Notably, 32.6% of ward patients should have been referred to CCOT but weren’t, while 47.6% of those referred did not meet criteria for escalation. Both groups were similar in age, gender, sodium levels on admission, time to sodium normalisation, and mortality. Drowsiness (P-value=0.002) and lower urine sodium (P-value=0.002) were more common in the CCOT group. Only a small fraction of patients in both groups received the full recommended diagnostic workup for hyponatraemia (5.26% in the ward group, 9.52% in CCOT). SSRIs (P-value=0.032) were more commonly implicated in CCOT patients, and hypertonic saline (P-value=0.038) was used more in this group.

Conclusion: The study highlights gaps in the investigation and management of hyponatraemia. Particularly in escalation practices and completion of recommended investigations for more targeted treatment. It underscores the need for improved adherence to guidelines to ensure timely referral to critical care services and appropriate treatment, including interventions such as hypertonic saline.