Management of severe in-patient hyponatraemia: An audit in two teaching hospitals in Yorkshire, UK. (January 2015)

• Record Type: Journal Article
• Authors: Narayanan, Deepa; Mbagaya, Wycliffe; Aye, Mo; Kilpatrick, Eric S.; Barth, Julian H.
• Is Part Of: Scandinavian journal of clinical & laboratory investigation. Volume 75:Number 1(2015)
• Page Start: 1
• Page End: 6
• Publication Date: 2015-01
• Subjects: Clinical biochemistry -- Periodicals; Physiology, Pathological -- Periodicals; Physiology, Experimental -- Periodicals; Medicine -- Research -- Periodicals; Clinical medicine -- Periodicals; 616.0072
• DOI: 10.3109/00365513.2014.926563
• Languages: English
• ISSNs: 0036-5513

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background</italic>.</bold> Hyponatraemia, the commonest electrolyte abnormality amongst in-patients, is associated with increased mortality. Until recently, there has been a lack of international consensus management of patients with severe hyponatraemia. <bold><italic>Aim</italic>.</bold> We performed a retrospective study in two teaching hospitals in Yorkshire, UK, to evaluate the management of patients with severe hyponatraemia (serum Na ≤ 110 mmol/L) and to assess the frequency of complications observed in this group, in particular central pontine myelinolysis (CPM) and death. <bold><italic>Methods</italic>.</bold> Retrospective data collection was performed on all of patients admitted with severe hyponatraemia in a calendar year in two teaching hospitals in Yorkshire. A detailed case note evaluation was conducted to determine the patient clinical characteristics, aetiology, investigations performed, treatment, complications and outcome of patients. <bold><italic>Results</italic>.</bold> We identified 39 patients in total at both sites over a calendar year. There was a notable female predominance (<italic>n</italic> = 27), with the median (range) age being 65 (45–92) years and median sodium concentration 107 (94–110) mmol/L. Hyponatraemia was classified as acute (onset < 48 h) in six patients, chronic (onset > 48 h) in 20 patients and of unknown duration in 13 patients. Iatrogenic hyponatraemia secondary to drugs, especially thiazides was the most commonly observed aetiology. The mortality rate was 48.7% (<italic>n</italic> = 19) at the end of one year after admission episode and CPM was seen in 7.6% (<italic>n</italic> = 3) of patients. <bold><italic>Conclusions</italic>.</bold> Severe hyponatraemia is associated with significant morbidity and mortality. Drug-induced hyponatraemia was the most common aetiology observed in our group of patients.</p> </abstract>