Clinical practice guideline on diagnosis and treatment of hyponatraemia

Abstract

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice.It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions.Despite this, the management of patients remains problematic.The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment.To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia.In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice. . FO R E W O R DHyponatraemia is a clinical feature in 15-20% of emergency admissions to hospital.It is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions.Hyponatraemia is therefore both common and important.Despite this, the management of patients remains problematic.The prevalence of hyponatraemia under widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment.However, the paucity of well-designed, prospective studies in the field has limited the evidence-base to these approaches.Previous guidance has often been based on experience or practice, without a systematic approach to evaluation and lacking a clear, patient-centred focus.Clinicians using previous guidance may have noted a number of problems: