Endocrine Abstracts

Introduction: Hyponatraemia is the commonest electrolyte disturbance encountered in the clinical practice. However, its initial evaluation is commonly found inadequate. We conducted a retrospective audit on evaluation of inpatient hyponatraemia in a large district general hospital.

Study methodology: Retrospective data of patients admitting with or who developed moderate to severe hyponatraemia during the hospital stay were collected over 4 week’s period (1st to 28th of July 2023). Out of them, 84 randomly selected patients’ clinical records were assessed regarding initial evaluation.

Results: Eighty-four cases with moderate to severe hyponatraemia were identified and included in the study. 38 (45.2%) were male and 55 (65.4) % were above 65 years old. Patients with age range from 27 years to 92 years were included. 68 (80.9%) had hyponatraemia on admission while rest had hospital acquired hyponatraemia. Severe hyponatraemia was found only in 3 (3.5%), while the rest had moderate hyponatraemia. Serum osmolality, urine osmolality and urine sodium were documented in 26(30.9%), 12 (14.2%), 9 (10.7%) respectively. 16 (19%) had hypotonic hyponatraemia, however volume status was documented only in 11 out of the above 19 patients and only 4 had fluid balance charts maintained. Out of the patients with hypotonic hyponatraemia 9 (56%) had their cortisol levels done and hypothyroidism was excluded in 10 (62.5%) despite the unavailability of rest of the investigations such as urine osmolality or urine sodium. Out of the 3 patients with severe hyponatraemia, only one had osmolality studies available. 14(16%) of hyponatraemic patients succumbed to death during the same admission.

Conclusions: Hyponatraemia is a frequently occurring condition associated with high mortality rates. However, it is evident that the initial evaluation remains insufficient despite the widespread availability of guidelines. Therefore, it is necessary to take steps to improve the initial investigation process.