Clinical practice guideline on diagnosis and treatment of hyponatraemia

TLDR

Hyponatraemia, defined as serum sodium <135 mmol/L, is the most common electrolyte disorder in clinical practice, causing symptoms from mild to life‑threatening and increasing mortality, morbidity, and hospital stay, yet its management remains inconsistent across specialties. The guideline was jointly developed by ESICM, ESE, and ERA‑EDTA to provide a unified, holistic approach to diagnosing and treating hyponatraemia. Its development followed a rigorous methodology prioritizing patient‑important outcomes and practical utility for clinicians in everyday practice.

Abstract

Hyponatraemia, defined as a serum sodium concentration &lt;135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association – European Dialysis and Transplant Association (ERA–EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.