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Title: Management of inpatient hyponatraemia : past, present, and future
Author: Tzoulis, Ploutarchos
ISNI:       0000 0004 7429 2624
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2018
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available