Wednesday 26 February 2014

Salt imbalance occurs in nearly a third of hospitalized patients!

Simple guidelines for diagnosing and treating a salt imbalance occurring in up to 30% of hospitalized patients are published in the European Journal of Endocrinology. The guidelines recommend that any hospital-based clinician must be able to correctly diagnose, classify and treat hypernatremia, which is associated with morbidity, mortality and length of hospital stay in a wide range of conditions.

Hypernatremia is a complicated disorder of water balance, with a relative excess of body water compared to sodium and potassium (defined as a serum sodium concentration <135mmol/l). It has a wide variety of underlying causes, and results in swelling (known as cellular edema). Cells of the brain are particularly vulnerable to damage by swelling, making severe cases medical emergencies. Milder cases can be associated with impaired mobility and cognition, as well as osteoporosis and fracture.

The guidelines describe a pathway for diagnosis which is less reliant on specialist laboratory resources, and can be conducted in the general hospital setting. The treatment pathway described in the document focuses more closely on the patients' symptoms, giving lower priority to biochemical diagnosis. The guidelines recommend that as the risks to the patient's brain are so great, in severe cases action is more important than investigation until the patient is stabilized.

The full guidelines can be downloaded for free from the European Journal of Endocrinology, the official journal of the European Society of Endocrinology.

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