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QJM Advance Access published online on July 22, 2006
QJM, 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
Received December 23, 2005
Accepted May 4, 2006

Original Papers

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

J.A. Clayton 1 *, I.R. Le Jeune 1, and I.P. Hall 1

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

* To whom correspondence should be addressed.
J.A. Clayton, E-mail: jennifer.marshall{at}nottingham.ac.uk


  Abstract

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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