Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 19;12(10):3567.
doi: 10.3390/jcm12103567.

Diagnostic Workup and Outcome in Patients with Profound Hyponatremia

Johann Isaak  1   2 , Maria Boesing  1   2 , Laura Potasso  1   2   3 , Christoph Lenherr  1   4 , Giorgia Luethi-Corridori  1   4 , Joerg D Leuppi  1   2 , Anne B Leuppi-Taegtmeyer  1   2   5
Affiliations

Diagnostic Workup and Outcome in Patients with Profound Hyponatremia

Johann Isaak et al. J Clin Med. .

Abstract

Hyponatremia is the most common electrolyte disorder. A proper diagnosis is important for its successful management, especially in profound hyponatremia. The European hyponatremia guidelines point at sodium and osmolality measurement in plasma and urine, and the clinical evaluation of volume status as the minimum diagnostic workup for the diagnosis of hyponatremia. We aimed to determine compliance with guidelines and to investigate possible associations with patient outcomes. In this retrospective study, we analysed the management of 263 patients hospitalised with profound hyponatremia at a Swiss teaching hospital between October 2019 and March 2021. We compared patients with a complete minimum diagnostic workup (D-Group) to patients without (N-Group). A minimum diagnostic workup was performed in 65.5% of patients and 13.7% did not receive any treatment for hyponatremia or an underlying cause. The twelve-month survival did not show statistically significant differences between the groups (HR 1.1, 95%-CI: 0.58-2.12, p-value 0.680). The chance of receiving treatment for hyponatremia was higher in the D-group vs. N-Group (91.9% vs. 75.8%, p-value < 0.001). A multivariate analysis showed significantly better survival for treated patients compared to not treated (HR 0.37, 95%-CI: 0.17-0.78, p-value 0.009). More efforts should be made to ensure treatment of profound hyponatremia in hospitalised patients.

Keywords: audit; guidelines; mortality; rehospitalisation; sodium; survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart diagram for patient selection process.
Figure 2
Figure 2
Initial treatment setting after diagnosis of profound hyponatremia, ICU = intensive care unit, IMC = intermediate care unit.
Figure 3
Figure 3
Number of patients grouped according to number of documented aetiologies for profound hyponatremia.
Figure 4
Figure 4
Distribution of documented aetiologies when clinicians suggested a single cause. SIAD = syndrome of inappropriate antidiuresis.
Figure 5
Figure 5
Treatment of hyponatremia in patients with plasma sodium < 125 mmol/L by group, D-Group: minimum diagnostic workup complete, N-Group: incomplete minimum diagnostic workup.
Figure 6
Figure 6
Kaplan–Meier curves for (a) 12-month rehospitalisation by group (log rank, p-value 0.82) and (b) 12-month overall survival by diagnostic group (log-rank, p-value 0.68), D-Group: minimum diagnostic workup complete, N-Group: incomplete minimum diagnostic workup.
Figure 7
Figure 7
Kaplan–Meier curves for 12-month survival by treatment (log rank p-value 0.03).
See this image and copyright information in PMC

References

    1. Upadhyay A., Jaber B.L., Madias N.E. Incidence and prevalence of hyponatremia. Am. J. Med. 2006;119:S30–S35. doi: 10.1016/j.amjmed.2006.05.005. - DOI - PubMed
    1. Shapiro D.S., Sonnenblick M., Galperin I., Melkonyan L., Munter G. Severe hyponatraemia in elderly hospitalized patients: Prevalence, aetiology and outcome. Intern. Med. J. 2010;40:574–580. doi: 10.1111/j.1445-5994.2010.02217.x. - DOI - PubMed
    1. Spasovski G., Vanholder R., Allolio B., Annane D., Ball S., Bichet D., Decaux G., Fenske W., Hoorn E.J., Ichai C., et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur. J. Endocrinol. 2014;170:G1–G47. doi: 10.1530/EJE-13-1020. - DOI - PubMed
    1. Saeed B.O., Beaumont D., Handley G.H., Weaver J.U. Severe hyponatraemia: Investigation and management in a district general hospital. J. Clin. Pathol. 2002;55:893–896. doi: 10.1136/jcp.55.12.893. - DOI - PMC - PubMed
    1. Clayton J.A., Le Jeune I.R., Hall I.P. Severe hyponatraemia in medical in-patients: Aetiology, assessment and outcome. QJM Mon. J. Assoc. Physicians. 2006;99:505–511. doi: 10.1093/qjmed/hcl071. - DOI - PubMed

LinkOut - more resources