Endocrine Abstracts

Background: Hyponatremia is the most common electrolyte disorder encountered in clinical practice. Vulnerable cohorts tend to be hospitalised patients where it tends to occur in 15-20% of the patients and the other category being nursing home residents. Significant risk factors are increasing age, and polypharmacy.

Aims: We aimed to look at the management of hyponatremia at our hospital, check adherence with the trust guidelines and assess the standards of referrals to the endocrine team.

Methology: Retrospective data was collected over the past 4 months (from January 23 to April 23) by compiling clinical information from patient notes and biochemistry from lab database. 34 online referrals were done to the endocrinology for specialist input regarding hyponatremia. Standards looked at were the trust guidelines.

Outcome: Of the 34 patients referred to the endocrinology, 29 cases (85.35) had severe hyponatremia. Only 3 patients amongst these were symptomatic.18 referrals did not have volume status assessed.17 cases had all recommended investigations carried out as per guidelines. Twenty instances (58.8%) had fluid charts while 14 cases (41.2%) did not. Only 8 cases (23.5%) used hypertonic saline. Culprit drugs were ACE I/ARB. 16 patients had a possible diagnosis of SIADH (47%) with screening investigations done beforehand. Endocrine causes of hyponatremia were identified in 2 patients. Treatment of hyponatremia was documented in 27 cases. 6 patients did not have the cause of hyponatremia noted in the discharge summary.

Conclusion: Hyponatremia in hospital setting is often overlooked. Early referral to specialist remains pertinent. Our results could be skewed by small sample size but this was a pilot study done prior to a larger prospective cohort study.