Endocrine Abstracts

Introduction: Despite the commonality of hyponatraemia in everyday clinical medicine it is often a poorly management condition in acute medical patients. A European guideline for diagnosis and management was published in 2014 to address such problems.

Aims: To assess the standard of management of patients with hyponatraemia admitted to the medical departments in a rural District General Hospital. To improve investigation, diagnosis, and management of these patients where necessary.

Methods: A review of medical notes and biochemical tests was carried out for 69 patients admitted to the medical assessment unit with serum sodium below 130 mmol/l over a 3-month period. Adoption of the European guideline diagnostic pathway, creation of an investigation set’ and educating junior doctors and nurses were used as tools to improve management. Emphasis was placed on use of urine osmolality and sodium as a first line investigation in the diagnostic process. Subsequent re-review of management after change was carried out for 79 patients over a similar timeframe.

Results: Before change: only 13% of euvolaemic patients had a urine osmolality and sodium performed, only 25% of patients had causative medications stopped and only 45% of all patients had a cause established. After change: 51% of euvolaemic patients had a urine osmolality and sodium performed, 66% of causative medications stopped, and 73% of all patients had a cause established. In patients who had a urine osmolality and sodium performed a 90% diagnostic pick-up rate was found, compared to just 63% in those who didn’t.

Conclusions: Investigation and management is often neglected in acute medical patients. Using guidelines, education and support tools for doctors and nurses improvements can be made in both investigation and management of these patients. Our findings support European guidance on use of urine osmolality and sodium early in the diagnostic process.