Prevalence, Etiology and Management of Hyponatremia in Hospitalized Patients

Abstract

Objective: The objective was to alleviate cerebral edema, not to correct sodium. So give to only severely symptomatic patients.

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the National Hospital and Medical Center, Lahore, Pakistan over 90 days period from October 1, 2016 till December 31, 2016.

Materials and Methods: Total of 108 (4.2%) patients out of 2560 patients had hyponatremia defined as serum sodium level of less than 135 mmol/L. There were 60 (55.5%) male patients and 48 (44.4%) female patients, Average age was 56 years.

Results: Severe hyponatremia (defined as Na+ < 120 mmol/L) was detected in 24 patients (22.2%). The largest group of hyponatraemic patients were euvolemic [48 (44.4%)], followed by hypervolemic [32 (29.6%)] and hypovolemia [28 (25.9%)].Out of total 108, thirty (27.7%) patients fulfilled the criteria for syndrome of inappropriate anti diuretic hormone (SIADH). During the hospital stay, 4/108 (3.7 %) hyponatraemic patients died. None of the deaths were secondary to hyponatremia. Tolvaptan (a V2RA) was not given to any patient and only 4/108 (3.7%) received 3% saline. At discharge, 84/108 (77.7%) had serum sodium more than 135 mmol/L.

Conclusion: Hyponatremia is common in hospitalized patients of Pakistan. Euvolemic hyponatremia was the most common type, a significant number of which was secondary to SIADH. Management of hyponatremia is challenging but we were able to manage hyponatremia in most of our patients despite non-availably of 3% saline or V2 receptor antagonists.