Introduction: -Hyponatremia is the commonest electrolyte abnormality which clinicians encounter in daily practice. Hyponatremia is defined as serum sodium < 135 meq/l. Studies show that poorly managed hyponatremia is associated with high morbidity and mortality. Most often, hyponatremia is managed by various specialties such as general medicine, intensive care, endocrinology, nephrology and hence lacks a unified consensus regarding protocols and guidelines. This in-turn makes hyponatremia management sometimes challenging and sub-standard.
Objective: Using combined European Society and British Medical Journal clinical practice guideline on hyponatremia as the benchmark, assess how hyponatremia was managed in Armadale Hospital; a public hospital in Perth, WA, Australia.
Methodology: - Data from 50 patients admitted to Armadale hospital medical ward during the period March 2016- June 2016, who had hyponatremia were retrieved. 48 out of 50 patients had hyponatremia on admission. Demographic details and factors influencing hyponatremia were collected and analyzed in Excel.
Results: - 91.6 % (n=44) of the patients had sodium level < 130 meq/L. Severe hyponatremia (Na < 120) was detected only in 2.1 % of the patients. Considering the stepwise approach in the management of hyponatremia, only 14.5 % (n=7) of the patients were assessed for serum osmolality. Among the patients, evaluated for serum osmolality (n=7) all had hypotonic hyponatremia (serum osmolality <280 mmol/L). Among these patients, urine spot Na and urine osmolality were checked only in 4 patients. Though there were 3 patients with urine spot Na >30 and urine osmolality>100 with likely SIADH, only one patient was treated with fluid restriction.
Conclusion: -Hyponatremia is sub-optimally managed in Armadale Hospital. There is a lot of scope for improvement regarding the diagnosis and management of hyponatremia. The importance of adhering to a widely-accepted practice guideline should be emphasized to improve the outcome.