Clinical Case Database / Category: Patient Management

Hyponatreamia: An approach to investigation & managment

Publication details

Babu Mukhopadhyay, Samuel Duffy
Foundation Years Journal, volume 8, issue 5, p.42 (123Doc Education, London, May 2014)


Hyponatraemia is the most common electrolyte abnormality in clinical practice (1). It is defined as serum sodium of less than 135mmol/L (2). Its presentation varies between patients and will often relate to both the severity of hyponatraemia as well as the rate of fall (3). The causes of hyponatraemia are numerous, and a systematic diagnostic workup is necessary in most cases. This article will review the case of a 65 year old lady who presented with complications of severe hyponatraemia, and discuss a structured method of investigating and managing similar patients in the hospital setting.

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Babu Mukhopadhyay

Honorary Senior Lecturer and Consultant Endocrinologist,
Dept of Medicine, Hairmyres Hospital,
Eaglesham Road, East Kilbride, G75 8RG.

Samuel Duffy

FY2 Trainee, Dept of Medicine, Hairmyres Hospital,
Eaglesham Road, East Kilbride, G75 8RG.


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Endocrinology. 2010 Jun;162 Suppl 1:S1-3.
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5. Katz MA et al. Hyperglycaemia-induced hyponatraemia – calculation of expected serum sodium depletion. New England Journal of Medicine. 1973 Oct 18;289(16):843-4.
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12. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007 Nov;120(11 Suppl 1):S1-21.
13. Sterns RH, Riggs JE, Schochet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia. New England Journal of Medicine. 1986; 314:1535–42.
14. Schrier R, Gross P, Gheorghiade M, Berl T, Verbalis J, et al. Study of Ascending Levels of Tolvaptan in Hyponatremia (SALT-1 and -2 trials) N Engl J Med 2006 Nov 16;355(20):2099.
15. Spasovski G, Vanholder R, Allolio B, et al. Clinical Practice Guidelines on diagnosis and treatment of hyyponatraemia. European Journal of Endocrinology 2014; 170: G1 – G47.
16. Rozen-Zvi B, Yahav D, Gheorghiade M, et al. Vasopressin receptor antagonists for the treatment of hyponatraemia: systematic review and meta-analysis. American Journal of Kidney Diseases 2010; 56: 325 – 337.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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