Endocrine Abstracts

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of policy, 2015, audit of change in policy after 2013 US guidelines¹. In each period we analysed the results of treatment in patients with SHN and moderate hyponatraemia (120–125 mmol/l, MHN). The results were derived from case notes and computerised laboratory records and analysed by Chi Square. The period between 2005 and 2010 was marked by a significant rise in the rate of endocrine referral, and an increase in the use of active management of SHN, associated with a reduction in mortality from 37.8% to 12.2%. Management rates rose further after the introduction of updated guidelines¹, and although the improved mortality was maintained, there was no further reduction in mortality. The rate of referral and treatment of MHN rose between 2005 and 2015 (P<0.001), though at substantially lower rates than for SHN; mortality remained unchanged (2005, 16%, 2010, 12%,2015, 10%, P=0.26). Increased specialist management of SHN was associated with a sustained reduction in mortality in SHN.

Reference

¹Verbalis JG. Am J Med, 126; S1–S42 (2013).