CLINICO-ETIOLOGICAL PROFILE OF HYPONATREMIA IN HOSPITALISED ADULT PATIENTS - A CROSS- SECTIONAL, OBSERVATIONAL STUDY

Abstract

Introduction: Hyponatremia is dened as a serum sodium level less than 135meq/L. An abnormal sodium level does not necessarily imply abnormal sodium balance, but can be due to abnormal water balance as well. Serum sodium levels and serum osmolality are normally maintained under precise control by homeostatic mechanisms involving thirst, anti-diuretic hormone and the renal handling of ltered sodium. Hyponatremia occurs in a broad spectrum of patients who are asymptomatic to critically ill patients. The clinical presentation has a wide spectrum, varying from asymptomatic patients to ones having seizures and coma. Aim: To nd out co-relation between grade of hyponatremia with hospital stay, mortality rate and to study whether the primary disease is a cause for hyponatremia and whether other features cause hyponatremia also. Materials And Methods: A 1 year cross-sectional observational study was conducted, including 100 adult patients admitted in Vivekananda Institute of Medical Sciences, Kolkata with hyponatremia (serum sodium <135 mEq/L) in General Medicine ward and in Orthopedics ward (with fragility fracture). Results: There was a wide range of etiologies, most common being SIADH (47%), renal disorder (13%), diuretic use (13%), congestive heart failure (8%), and liver disorder (4%). 16% patients had multiple causes. In 5% patients no cause could be found after extensive investigations. Mean duration of hospital stay was 7.04 days, which was signicantly higher in patients with severe hyponatremia. Incidence of fragility fracture in our study was 16%. Conclusion: SIADH was the single most important etiology of hyponatremia. Use of diuretics and chronic kidney disease were also signicant cause of hyponatremia in this study. Other major causes of hyponatremia were CHF, acute gastroenteritis and chronic liver disease. A relatively large number of patients had endocrine abnormalities (thyroid, adrenal and pituitary).Hyponatremia was found to be related to multiple etiological factors in a signicant number of patients. Neurological symptoms are common in hyponatremia patients. Symptoms of hyponatremia increased with severity of hyponatremia.