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Management of Inpatient Hyponatraemia: Past, Present, and Future

Tzoulis, Ploutarchos; (2018) Management of Inpatient Hyponatraemia: Past, Present, and Future. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

This research work includes 5 studies evaluating mortality, investigation, and treatment of inpatient hyponatraemia. The first, a case–control study showed that hyponatraemic patients had 17.3% inpatient mortality rate and were 12 times more likely to die during admission than normonatraemic controls, concluding that hyponatraemia is an independent predictor of mortality. The second study in the same cohort confirmed that hyponatraemia is frequently underinvestigated with 5% of patients without endocrine input having complete work-up compared to 80% of those receiving endocrine input. The third, multicentre observational study found that only 23% of participants had measurement of paired serum / urine osmolality and sodium, while 37% did not have any treatment for hyponatraemia and 63% had persistent hyponatraemia at discharge. The fourth study, a case series of 61 tolvaptan-treated SIADH patients over a 3-year period, demonstrated the great efficacy of tolvaptan, evidenced by a mean 24-hour serum sodium rise of 9 mmol/l with 96.7% of patients having increased serum sodium by ≥ 5 mmol/l within 48 hours. However, tolvaptan carried a significant risk of overly rapid sodium correction with 23% of patients with starting serum Na < 125 mmol/l exceeding correction limits. The fifth, a prospective-controlled intervention study showed, for the first time, that endocrine input is superior to routine care in correcting hyponatraemia since the intervention group achieved ≥ 5 mmol/l sodium rise in 3.5 vs. 7.1 days in controls. The endocrine input shortened hospitalisation by a mean of 3.6 days. The likely contribution of hyponatraemia by itself to excess mortality, in combination with underinvestigation and undertreatment of hyponatraemia characterising real-life clinical practice, highlight the need to improve clinical care. A key finding of these studies is that widespread provision of endocrine input can result in more effective hyponatraemia treatment and shorter hospitalisation.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Management of Inpatient Hyponatraemia: Past, Present, and Future
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Third party copyright material has been removed from ethesis.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery-pp.ucl.ac.uk/id/eprint/10055617
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