Clinical research studyUtility and Limitations of the Traditional Diagnostic Approach to Hyponatremia: A Diagnostic Study
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Study Design and Population
All patients with serum sodium concentration <130 mmoL/L and serum osmolality <280 mosm/kg at admission to the University Hospital of Würzburg were consecutively enrolled in this diagnostic study between April and November 2007 (n = 121). Patients aged <18 years were not eligible. Study design, conduct, and reporting followed the criteria proposed by the “Standards for the Reporting of Diagnostic Accuracy Studies” initiative.7 The study was approved by the Ethical Committee of the University of
Baseline Characteristics
In total, 121 hyponatremic patients (53 male, 68 female) were enrolled. Fifteen patients exhibited severe hyponatremia (serum sodium <115 mmol/L; 12.4%) and 62 patients moderate hyponatremia (<125 mmol/L; 51.2%). The mean age was 64 years (range 22-91 years). The causes of hyponatremia according to the Reference Standard were as follows: primary polydipsia 4%, hypervolemia 20%, hypovolemia 32%, SIADH 35%, diuretic-induced 7%, and adrenal insufficiency 2%. In 10 patients (8%), severe or moderate
Discussion
For a classification to be useful, it must guide the clinician to arrive at the correct diagnosis in due course in order to commence the appropriate therapy. In this study, we analyzed the diagnostic accuracy of a given diagnostic algorithm to hyponatremia, originating from 2 approaches published by Schrier8 and Verbalis9 with minor modifications. To the best of our knowledge, this is the first analysis carried out in consecutive hyponatremic subjects within a real-world setting.
Surprisingly,
Conclusion
In conclusion, we demonstrated for the first time the utility of an established hyponatremia algorithm in a real-world clinical setting. Strict adherence to the existing algorithm by a young physician yielded a higher diagnostic accuracy compared with the diagnostic performance of a senior physician.
However, the algorithm revealed several shortcomings, making it difficult to apply in clinical practice. Whether the proposed modifications to this algorithm may enhance its diagnostic accuracy and
References (16)
- et al.
Incidence and prevalence of hyponatremia
Am J Med
(2006) - et al.
Hyponatremia treatment guidelines 2007: expert panel recommendations
Am J Med
(2007) - et al.
Hyponatremia: clinical diagnosis and management
Am J Med
(2007) Disorders of body water homeostasis
Best Pract Res Clin Endocrinol Metab
(2003)- et al.
Clinical assessment of extracellular fluid volume in hyponatremia
Am J Med
(1987) Consequences of inadequate management of hyponatremia
Am J Nephrol
(2005)- et al.
Diagnosis and management of hyponatremia in acute illness
Curr Opin Crit Care
(2008) - et al.
Hyponatraemia in clinical practice
Postgrad Med J
(2007)
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Funding: None.
Conflict of Interest: The authors have no conflicts to disclose.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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Both authors contributed equally.