Background: Hyponatremia, defined as a serum sodium concentration of ≤135 mEq/L, is the most common electrolyte disorder encountered in clinical practice, occurring in up to 30% of hospitalized patients. Our research aimed to investigate (1) the impact of hyponatremia on patient outcomes and resource utilization, (2) the impact of hyponatremia correction on patient outcomes and resource utilization, and (3) utilization of osmolality testing to determine the etiology of hyponatremia and ensure appropriate patient management.
Methods: We conducted a thorough systematic review of the PubMed database. Our search criteria included English-language peer-reviewed articles published from 1967 to 2022 by institutions located nationally and internationally. In total, we analyzed over 60 publications including prospective and retrospective research studies, clinical practice guidelines, expert panel recommendations, and consensus statements.
Results: Our research revealed a scientific consensus in the literature. Several key findings included (1) the association of hyponatremia with poor patient outcomes and high resource utilization, (2) the association of hyponatremia correction with improved patient outcomes and decreased resource utilization, (3) underutilization of osmolality testing in determining the etiology of hyponatremia (ordered in as little as 23% of patients), and (4) the association of ordering osmolality with improved patient outcomes. Further, we observed evidence of a gap in education on hyponatremia management.
Conclusion: In summary, hyponatremia is an important medical and economic problem. Osmolality testing is used to determine the etiology of hypontremia, yet the test is underutilized in clinical practice. Education on the value of measuring osmolality, in addition to protocolizing the test into clinical pathways, may help drive appropriate utilization and, in turn, improve patient care and reduce excess resource utilization.
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