Salt 'n' Safe: introduction of guidelines for the management of hyponatraemia at a specialist oncology treatment centre
Halkyard, Emma Alsayed, T Angus, F Barnes, J Cooksley, Timothy J Kasipandian, Vidya Monaghan, Phillip J Trainer, Peter J
Halkyard, Emma
Alsayed, T
Angus, F
Barnes, J
Cooksley, Timothy J
Kasipandian, Vidya
Monaghan, Phillip J
Trainer, Peter J
Citations
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Abstract
Introduction: Hyponatraemia is a common electrolyte disturbance;
local audit at a specialist oncology treatment centre identified low
sodium in 4% of patients. In a cohort of 358 patients with cancerrelated
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH),
53% had lung cancer. Biochemical testing to include urine and
serum osmolality, urine sodium, cortisol, thyroid function tests
and glucose is necessary to accurately diagnose hyponatraemia
and inform management. Severe (Na+ <125mmol/L), symptomatic
hyponatraemia is optimally treated with hypertonic saline in a
critical care setting, however, its use is associated with over-rapid
correction of sodium (16% occurrence) with potential risk of central
pontine myelinolysis (CPM).
Methods: The case of a patient with metastatic small cell lung cancer
(SCLC) with poor prognosis, and requiring emergency admission for
administration of hypertonic saline, was subject to executive board
level retrospective review. Highlighted was the absence of a process
for consenting patients to this intervention and a lack of consistent
multi-disciplinary team (MDT) approach to deciding a ‘ceiling of
care’ specifically in relation to hyponatraemia management.
Results: Guidelines for the management of hyponatraemia
were being written at the time of the case review. Subsequent
recommendations included discussion with the patient to support
informed consent to the benefits and risks of administration of
hypertonic saline, and MDT consensus on ceiling of care relating
to hyponatraemia management. Furthermore, case review findings
were presented at the Trust-wide morbidity meeting to share
learning with colleagues.
Conclusion: It is essential to consider prognosis, the aims of current
anti-cancer treatment, opinions of the senior MDT and the patient’s
wishes and expectations to determine appropriate hyponatraemia
management which avoids exposure to clinical interventions that
are not without risk. Most importantly, this necessitates timely and
sensitive conversations with the patient about when and when not
to treat hyponatraemia.
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Halkyard E, Alsayed T, Angus F, Barnes J, Bayman NA, Blackhall FH, et al. Salt 'n' Safe: introduction of guidelines for the management of hyponatraemia at a specialist oncology treatment centre. Lung Cancer. 2020;139:S84-S