Endocrine Abstracts

Hyponatraemia is the commonest electrolyte disturbance in clinical practice and accounts for 15–20% of emergency admissions to hospital. It is thought that up to 30% of hospitalized patients develop a degree of hyponatraemia at some point during their admission. It is therefore an important problem. Management of inpatients with hyponatraemia remains problematic and an audit of our practice at St Mary’s Hospital, Imperial College Healthcare NHS Trust, has confirmed that. The audit was conducted on the management of severe hyponatraemia (defined as serum sodium level 125 mmol/l) in medical and surgical adult inpatients over a 3-month period, between October 2012 and December 2012. The audit findings indicated the need for further education and training with regards to the management of hyponatraemia within the general medical and surgical specialties, as well as the need for the introduction of a guidance which includes helpful steps in the accurate assessment and initial treatment of patients with hyponatraemia. Our Endocrine team created a protocol that describes the early identification of hyponatraemia and management strategies, especially when it is severe. The guidance indicates that all patients with severe hyponatraemia should have their volume status established and documented clearly, appropriate biochemical assessment in the form of paired plasma and urine osmolalities and urinary sodium measurements and endocrine specialist input in some form, as inpatients, as well as a definitive diagnosis for the hyponatraemia prior to discharge. The guidance relates to all junior and senior medical staff that cares for adult inpatients. Dedicated training was provided to medical staff to familiarize themselves with the protocol. Following its implementation, we decided to audit the adherence to this guidance. The study included all adult medical and surgical inpatients at St. Mary’s Hospital with sodium level equal to or less than 125 mmol/l during the period 1–31 March 2016. The results demonstrated that the patients’ volume status was clearly established in 51% cases, osmolalities and urinary sodium were measured in 21% cases, endocrine review was performed in 13% cases and definitive diagnosis for the hyponatraemia was made in 60% cases. In the majority of cases the hyponatraemia was treated successfully. It is possible that following the implementation of the Hyponatraemia Guideline the non-endocrine teams feel more confident in managing the above electrolyte abnormality without seeking specialist advice. We plan to continue the training of our staff and re-audit in spring 2019.