RT Journal Article
SR Electronic
T1 Multicentre study of investigation and management of inpatient hyponatraemia in the UK
JF Postgraduate Medical Journal
JO Postgrad Med J
FD The Fellowship of Postgraduate Medicine
SP 694
OP 698
DO 10.1136/postgradmedj-2014-132885
VO 90
IS 1070
A1 Tzoulis, Ploutarchos
A1 Evans, Rhys
A1 Falinska, Agnieszka
A1 Barnard, Maria
A1 Tan, Tricia
A1 Woolman, Emma
A1 Leyland, Rebecca
A1 Martin, Nick
A1 Edwards, Rebecca
A1 Scott, Rebecca
A1 Gurazada, Kalyan
A1 Parsons, Marie
A1 Nair, Devaki
A1 Khoo, Bernard
A1 Bouloux, Pierre Marc
YR 2014
UL http://pmj.bmj.com/content/90/1070/694.abstract
AB Purpose Hyponatraemia is associated with significant morbidity and mortality. The objectives of this study were to evaluate the investigation and management of hyponatraemia and to assess the use of different therapeutic modalities and their effectiveness in routine practice. Study design This multicentre, retrospective, observational study was conducted at three acute NHS Trusts in March 2013. A retrospective chart review was performed on the first 100 inpatients with serum sodium (sNa) ≤128 mmol/L during hospitalisation. Results One hundred patients (47 male, 53 female) with a mean±SD age of 71.3±15.4 years and nadir sNa of 123.4±4.3 mmol/L were included. Only 23/100 (23%) had measurements of paired serum and urine osmolality and sodium, while 31% had an assessment of adrenal reserve. The aetiology of hyponatraemia was unrecorded in 58% of cases. The mean length of hospital stay was 17.5 days with an inpatient mortality rate of 16%. At hospital discharge, 53/84 (63.1%) patients had persistent hyponatraemia, including 20/84 (23.8%) with sNa <130 mmol/L. Overall 37/100 (37%) patients did not have any treatment for hyponatraemia. Among 76 therapeutic episodes, the most commonly used treatment modalities were isotonic saline in 38/76 cases (50%) and fluid restriction in 16/76 (21.1%). Fluid restriction failed to increase sNa by >1 mmol/L/day in 8/10 (80%) cases compared with 4/26 (15.4%) for isotonic saline. Conclusions Underinvestigation and undertreatment of hyponatraemia is a common occurrence in UK clinical practice. Therefore, development of UK guidelines and introduction of electronic alerts for hyponatraemia should be considered to improve clinical practice.