Abstract
Introduction: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay. Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher’s exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant. Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4–10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001). Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores.
Highlights
Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality
Serum sodium concentration is tightly controlled by mechanisms including antidiuretic hormone (ADH) and the thirst response
This study, we describe the prevalence of hyponatraemia in a tertiary institution in Ghana, and describe the causes and outcomes among patients in terms of in-hospital mortality and length of hospital stay
Summary
Hyponatraemia, defined by a serum sodium concentration of less than 135 mmol/L, is the most common electrolyte abnormality in hospitalized patients [1,2]. It is present in approximately 15% of hospital admissions [3], is associated with increased morbidity and mortality, and is often poorly recognised and managed. Mortality rates associated with hyponatraemia range from 0.9–29.6% of hospital admissions with the highest among patients in the intensive care units [7,8] It is not certain whether hyponatraemia contributes to the higher mortality or is just a marker of the poor prognosis in chronic conditions [9]. This study, we describe the prevalence of hyponatraemia in a tertiary institution in Ghana, and describe the causes and outcomes among patients in terms of in-hospital mortality
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