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QJM Advance Access originally published online on July 22, 2006
QJM 2006 99(8):505-511; doi:10.1093/qjmed/hcl071
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome

J.A. Clayton, I.R. Le Jeune and I.P. Hall

From the Division of Therapeutics and Molecular Medicine, Queen's Medical Centre, Nottingham, UK

Address correspondence to Dr J.A. Clayton, Division of Therapeutics and Molecular Medicine, Queen's Medical Centre, Nottingham NG7 2UH. email: jennifer.marshall{at}nottingham.ac.uk

Received 23 December 2005 and in revised form 4 May 2006

Background: Hyponatraemia is the most commonly identified electrolyte abnormality. Published data on severe hyponatraemia in general medical in-patients is lacking.

Aim: To determine the aetiology, adequacy of assessment, and outcome of severe hyponatraemia in general medical in-patients.

Design: Retrospective case-note review.

Methods: All general medical in-patients (n = 108) with serum sodium <=125 mmol/l were identified from the clinical chemistry database, over a six-month period. A full review of notes and computer records was undertaken at the index date and a pre-determined follow-up date.

Results: Follow-up data were available in 105 patients. There was a wide range of aetiologies: diuretic therapy (loop and thiazide), congestive cardiac failure and liver disease were the most common, and 75.3% of patients had multiple causes. None of the 48% of patients whose history suggested a possible diagnosis of the syndrome of inappropriate anti-diuretic hormone (SIADH) met the generally accepted diagnostic criteria. Overall mortality was 20% during the index admission and 44.6% at follow-up, vs. 7.1% and 22%, respectively, for other patients admitted to the same directorate over the same time period (p < 0.001). Mortality was linked to aetiology, but not to reduced absolute serum sodium concentration at admission.

Discussion: Severe hyponatraemia in general medical patients is associated with a complex, multifactoral aetiology and a very poor prognosis. Outlook is governed principally by aetiology, and not by serum sodium level. Assessment of patients with hyponatraemia requires a practical clinical algorithm for diagnosing SIADH.


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B. Whelan, K. Bennett, D. O'riordan, and B. Silke
Serum sodium as a risk factor for in-hospital mortality in acute unselected general medical patients
QJM, March 1, 2009; 102(3): 175 - 182.
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