The video version of this podcast can be found here: · https://youtu.be/JxNOCJZP10MThis episode makes reference to guidelines produced by North Bristol NHS Trust, Royal United Hospitals Bath NHS Trust and Royal Cornwall Hospitals NHS Trust. The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by them.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I look at hyponatraemia, its classification, clinical presentation, pathophysiology and causes. I have looked at the guidelines produced by North Bristol NHS Trust, and Royal United Hospitals Bath NHS Trust, as well as other guidance, focusing on what is relevant to Primary Care only. The links to the sources consulted can be found below. I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here:Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: · The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The links to the Hyponatraemia guidelines consulted can be found:North Bristol NHS Trust · https://www.nbt.nhs.uk/sites/default/files/Hyponatraemia%20in%20Primary%20Care.pdfRoyal United Hospitals Bath:· https://www.ruh.nhs.uk/pathology/documents/clinical_guidelines/PATH-019_hyponatraemia_in_primary_care.pdfRoyal Cornwall Hospitals NHS trust:· https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/EndocrineAndDiabetes/ManagementOfHyponatraemiaClinicalGuideline.pdfGreater Glasgow and Clyde:· https://handbook.ggcmedicines.org.uk/media/1099/195-hyponatraemia-flowchart-1-final-200717e.pdfGloucestershire hospitals NHS Trust · https://www.gloshospitals.nhs.uk/media/documents/Hyponatraemia.pdfIntro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at hyponatraemia, its classification, clinical presentation, pathophysiology and causes. I have looked at the guidelines produced by North Bristol NHS Trust, and Royal United Hospitals Bath NHS Trust, as well as other guidance, focusing on what is relevant to Primary Care only. The links to the sources consulted are in the episode description. The next episode will be on the further assessment and management of hyponatraemia so make sure not to miss it.Right, without further ado, let’s get started.Hyponatraemia tends to be more common in the elderly, in patients admitted, in those with a history of alcohol excess and in patients treated with thiazide diuretics. It is associated with complications such as seizures and increased mortality and, the risk increases with the severity of hyponatraemia. So, starting with the basics, what is hyponatraemia? Well, the normal range of sodium is from 135 to 145 mmol/L so hyponatraemia, that is a low sodium, is when the sodium is below 135. However, guidelines in North Bristol and Bath define it as a sodium below 133 mmol/l, so we should always look at our local path lab reference range. The severity of hyponatraemia can be classified into mild, moderate and severe. NICE recommends the following thresholds:· Mild is when the sodium is between 130-135· Moderate is when the sodium is between 125-129 and· Severe is when the sodium is less than 125 However, other guidelines give different thresholds. For example, in Bath severe hyponatraemia is below 120 and in North Bristol is below 115. But, from a primary care perspective, it will be better to err on the side of caution so we will stick to 125. This is a very important for us because we are advised to admit to hospital patients with severe hyponatraemia, as well as those who are symptomatic, irrespective of the sodium levels. And what are the symptoms of hyponatraemia? The primary symptoms are due to cellular swelling, particularly in the brain, because of the osmotic movement of water into cells in response to low sodium levels. The brain is ...
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