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Investigation and treatment of hyponatraemia in hospital patients

We read with interest the recently published article by Woodward et al. entitled ‘Diagnosis and management of hyponatraemia in the older patient’. Of interest, Woodward et al. discuss the importance of correct investigation and management of hyponatraemia in older people. We observed in our recent audit of inpatient hyponatraemia investigation and management that it was most prevalent in older people, with 50% of inpatients identified with hyponatraemia being over 80 years old. With such a large proportion of older patients, we agree with the importance of improving the understanding of the correct investigation and management of this frequent electrolyte disorder. We undertook three retrospective audits of the investigations and management of inpatients with hyponatraemia (serum sodium <130 mmol/L) for over 3 days (2017) or 7 days (2011, 2014) in a university teaching hospital. We measured our standards against the European clinical practice guidelines for the diagnosis and management of hyponatraemia. In 2017 we audited 20 inpatients, 50% were female (2011: 47%; 2014: 47%) and 50% were over 80 years old (2011: 30%; 2014: 53%). Patients had been admitted for a range of medical problems, with the commonest being a fall or social admission. This highlights the importance of considering frailty, which as discussed by Woodward et al., adds to the burden of illness in the