Endocrine Abstracts

Introduction: Hyponatremia is a common electrolyte disorder in clinical practice. We did a retrospective analysis of 100 patients admitted between Jan 2019 to June 2019 with moderate hyponatremia (Na-125-129 mmol/l) to see if there was a difference in management and outcome of the patients who were formally coded as hyponatremia and those who were not coded as such.

Results: Mean age was 74 years in the coded group (n=50) and 79 years in the non-coded group (n=50). Male patients were 38% and 22% respectively in coded and non-coded groups. Volume status was assessed in 72% of the patients in both groups. Drug reviews were done in 64% of the patients in the coded group and 40% in the non-coded group. Serum osmolality was measured in 42% of the patients in coded group and 18% in non-coded group. 24% of the patients in the coded group were measured for urine osmolality/urinary sodium and 16% respectively in the non-coded group. Cortisol was measured in 28% of the coded patients whereas in the non-coded group, only 8% of the patients were checked for cortisol. TSH was checked in 46% of the patients in both groups. 8% of patients with hyponatremia in both groups were treated inappropriately. In the coded group, 8 patients died in the hospital (16%). 12 patients died in the hospital (24%) in the non-coded group. 2 patients had inpatient falls in the coded group. In the non-coded group, the percentage of inpatient falls was 10% (5 patients).

Conclusion: Coded diagnosis implies that the diagnosis has been identified on a senior clinician review and documented as such on the post-take ward round or discharge letter. Coding of hyponatremia and hence senior recognition is associated with better medication reviews, more investigations including osmolalities and cortisol measurements and slightly better outcomes.