Intermediate Care

Sodium disorders

 

​

Hyponatraemia

 

Definitions

• Mild: Na 130–134 mmol/L

• Moderate: 125–129 mmol/L

• Severe: <125 mmol/L or any neurological symptoms

​​

1) Assess whether acute or chronic

This is the key discriminator.

• Chronic (>48 hrs or unknown): brain adapted → lower immediate risk

• Acute (<48 hrs): higher risk of cerebral oedema → escalate earlier

​​

2) Community-holding criteria (safe for GP / SDEC)

Patient may be managed in the community if ALL apply:

• Na ≥125 mmol/L

• No confusion, seizure, severe headache, vomiting

• NEWS2 normal/mild

• No severe volume depletion

• Able to drink

• Medication review possible (diuretics, SSRIs, PPIs, carbamazepine)

• Clear plan for repeat sodium

Plan:

• Identify cause (drugs, SIADH, dehydration, adrenal issues).

• Review medications and fluids.

• Repeat Na in 24–48 hours (earlier if frail); Hospital at Home may be able to help here

​​

3) Discuss with Acute GP for Same Day Emergency Care (SDEC)

Suitable for SDEC (not ED) if:

• Na 120–125 mmol/L AND

• Patient clinically well, alert, haemodynamically stable

• No seizures, no acute confusion

• Need for supervised volume assessment, fluid challenge or medication optimisation

• Can return home after brief observation

​​

4) Consider admission if

• Na <120 mmol/L acutely

• Any neurological symptoms: reduced GCS, seizures, severe headache

• Acutely worsening hyponatraemia (<48 hrs)

• Severe vomiting or inability to maintain oral intake

• Concern for adrenal crisis

• Sodium drop >8–10 mmol/L in <24 hrs during treatment (over-correction risk)

 

 

 

Hypernatraemia

 

Definitions

• Mild: 145–149

• Moderate: 150–159

• Severe: ≥160

​​

1) Community-holding criteria (safe for GP)

Appropriate for GP management if:

• Na 145–149

• Patient well, drinking adequately

• No confusion or focal neurology

• No shock or hypotension

Plan:

• Encourage oral water (unless hypervolaemic cause)

• Review meds (diuretics, lithium)

• Repeat Na in 24–48 hrs (Hospital @ Home may be able to help here)

​​

2) Discuss with Acute GP for Same Day Emergency Care (SDEC)

Suitable for non-ED same-day unit if:

• Na 150–159

• Mild symptoms only (thirst, lethargy)

• No confusion or seizures

• Requires IV hydration but not monitoring

​​

3) Consider admission if

• Na ≥160 mmol/L

• Acute confusion, reduced consciousness, seizures

• Shock, fever, significant dehydration

• Inability to drink or concerns about rapid correction

 

​