The diagnosis and management of inpatient hyponatraemia and SIADH

Abstract

BackgroundHyponatraemia is a very common medical condition that is associated with multiple poor clinical outcomes and is often managed suboptimally because of inadequate assessment and investigation. Previously published guidelines for its management are often complex and impractical to follow in a hospital environment, where patients may present to divergent specialists, as well as to generalists.DesignA group of senior, experienced UK clinicians, met to develop a practical algorithm for the assessment and management of hyponatraemia in a hospital setting. The latest evidence was discussed and reviewed in the light of current clinical practicalities to ensure an up‐to‐date perspective. An algorithm was largely developed following consensus opinion, followed up with subsequent additions and amendments that were agreed by all authors during several rounds of review.ResultsWe present a practical algorithm which includes a breakdown of the best methods to evaluate volume status, simple assessments for the diagnosis of the various causes and a straightforward approach to treatment to minimise complexity and maximise patient safety.ConclusionThe algorithm we have developed reflects the best available evidence and extensive clinical experience and provides practical, useable guidance to improve patient care.

SIADH Induced by Pharyngeal Squamous Cell Carcinoma: Case Report and Literature Review

“…Grant et al recently published algorithm for inpatient management of hyponatremia [16]. Symptomatic hyponatremia requires immediate hypertonic saline (3%).…”

Paraneoplastic endocrine syndromes

“…More studies are required to address the potential safety concerns of chronic use, because tolvaptan, a V2-receptor antagonist, is an excellent choice, especially in patients with lung malignancies (Grohe et al 2015, Thajudeen et al 2016). It has recently been shown that prompt endocrine input improved time for the correction of hyponatraemia and shortened length of hospitalisation, and the widespread provision of endocrine input should be considered (Verbalis et al 2014, Grant et al 2015, Tzoulis et al 2016). …”

Treatment of subarachnoid haemorrhage complicated by hyponatraemia

“…It is important nurses administering hypertonic saline are aware of these side effects especially to observe for hypernatraemia, as rapid changes in serum sodium can have detrimental and permanent neurological effects on the patient. Hence, serum sodium should not rise more than 10mmol/L within 24 hours and 18mmol/L within 48 hours to prevent osmotic demyelination syndrome (Ball & Iqbal, 2015;Grant et al, 2015;Rafat et al, 2014;Sood, Sterns, Hix, Silver, & Chen, 2013). Osmotic demyelination syndrome typically occurs 2-7 days post treatment and is clinically characterised by irreversible neurological damage (Sood et al, 2013).…”