Endocrine Abstracts

Population and methodology: Patients with profound hyponatraemia (serum Na ≤125 mmol/l) admitted 1 November 2014 to 30 April 2015 were identified using hospital admission registry, laboratory’s database and qualitative data from the patients’ electronic records. Discharge summaries and death certificates were reviewed.

Objectives: This is a retrospective audit set to asses: i) whether initial investigations of hyponatraemia were performed in accordance to published European guidelines. ii) incidence of profound hyponatraemia among acutely ill iii) sodium level on discharge and crude mortality.

Results: 201 patients (59% females) with serum sodium of ≤125 were admitted during the audit period. Serum Na ranged between 125 and 105 mmol/l, with 10% having Na (114. Incident increased with age (37% were >80 years).

Overall incidence of profound hyponatraemia in patients presenting to A&E department for the audit period was 2.51%.

In hospital mortality including 6 weeks post-discharge was 19% (38 patients).

When deceased patients were excluded, only 32 out of remaining 163 patients (20%) had complete initial investigations. These were completed within 24 hours of presentation in nine out of 32 patients (28%), 24–72 h in 10 (31%), and >72 h in 13 (41%). Of the 131 patients (80%) who did not have essential investigations, only 40 (31%) had recorded cause of hyponatraemia.

Discharge Na ranged between 120 and 146 with trend of improvement (average Δ+7.87%).

For deceased patients Na level ranged between 113 and 125, with varied registered cause of death.

Conclusion: Significant profound/severe hyponatraemia is common in acutely ill patients with increased incidence in elderly and associated with high crude mortality. Current practice lag well behind the desired standard of appropriate management. Three strategies were proposed to improve management; i) Electronic pop up alert, ii) readily available checklist, and iii) Incorporation of diagnosis in patients’ records.