Endocrine Abstracts

Background: Hyponatremia is associated with increased, inpatient mortality and length of stay and correct management necessitates doing appropriate investigations for accurate diagnosis of the cause.

Aim: The aim of this audit was to identify, the number of medical and surgical patients admitted with hyponatreima over a 4-week period; number of cases with mild (<135) vs moderate to severe cases of hyponatremia (<130 mmol/l); determine if hyponatremia was investigated and the number of cases of moderate to severe hyponatraemia, where aetiology was established, enabling us to compare our practice with current best practice – Clinical Resource Efficiency Support Team (CREST) guideline.

Methodology: All (n=283) patients with hyponatremia (Na <135 mmol/l) admitted to the medical assessment unit (MAU, n=203) and surgical triage unit (STU, n=80) during the month of November 2012, were identified. The audit focused on patients with serum sodium levels <130 mmol /l. All relevant clinical and biochemical parameters were collected by looking at electronic records including discharge letters and online biochemistry results.

Results: The prevalence of all degrees of hyponatraemia was 30% with the prevalence of moderate-severe hyponatremia being 8.6%.

In patients with Na <130 mmol/l – only 11% had any investigation done to delineate the underlying cause. Only in 23% of patients was an underlying aetiology identified. The average length of stay was nearly 3- and 1.5-days longer in medical and surgical patients as compared to other patients admitted in November 2012, in MAU and STU respectively.

Conclusion: The prevalence of hyponatremia was high, however the entity seemed to be under recognised and poorly investigated, leaving potential for inappropriate treatment, adversely affecting outcome and increasing length of stay.

An easy to use protocol, to appropriately investigate and manage hyponatremia has since been introduced and awareness of its existence created. The plan is to conduct a re-audit, to assess the impact of this protocol.