title: Improving care and outcomes of inpatients with syndrome of inappropriate antidiuresis (SIAD): a prospective intervention study of intensive endocrine input vs. routine care.
abstract: OBJECTIVE
  The syndrome of inappropriate antidiuresis is often undertreated with most patients discharged with persistent hyponatraemia. This study tested the hypothesis that an endocrine input is superior to routine care in correcting hyponatraemia and can improve patient outcomes.
  
  
  METHODS
  This single-centre prospective-controlled intervention study included inpatients admitted at a UK teaching hospital, with serum sodium ≤ 127 mmol/l, due to syndrome of inappropriate antidiuresis over a 6-month period. The prospective intervention group (18 subjects with mean serum sodium 120.7 mmol/l) received prompt endocrine input, while the historical control group (23 patients with mean serum sodium 124.1 mmol/l) received routine care. The time needed for serum sodium increase ≥ 5 mmol/l was the primary endpoint.
  
  
  RESULTS
  The intervention group achieved serum sodium rise by ≥5 mmol/l in 3.5 vs. 7.1 days in the control group (P = 0.005). In the intervention group, the mean total serum sodium increase was 12 mmol/l with only 5.8 % of patients discharged with serum sodium < 130 vs. 6.3 mmol/l increase (P < 0.001) and 42.1 % of the subjects discharged with serum sodium < 130 mmol/l in the control group (P = 0.012). The mean length of hospital stay in the intervention group (10.9 days) was significantly shorter than in the control group (14.5 days; P = 0.004).The inpatient mortality rate was 5.5 % in intervention arm vs. 17.4 % in control arm, but this difference was not statistically significant.
  
  
  CONCLUSIONS
  Since the endocrine input improved time for correction of hyponatraemia and shortened length of hospitalisation, widespread provision of endocrine input should be considered.
authors.affiliation: Centre for Neuroendocrinology, Royal Free Campus, University College London Medical School, London, NW3 2QG, UK. Ploutarchos.tzoulis@nhs.net.
authors.forename: Ploutarchos
authors.initials: P
authors.lastname: Tzoulis
authors.affiliation: Centre for Neuroendocrinology, Royal Free Campus, University College London Medical School, London, NW3 2QG, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Carr
authors.affiliation: Centre of Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Bagkeris
authors.affiliation: Centre for Neuroendocrinology, Royal Free Campus, University College London Medical School, London, NW3 2QG, UK.
authors.forename: Pierre Marc
authors.initials: PM
authors.lastname: Bouloux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D003707:Demeclocycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D000077602:Tolvaptan; D016896:Treatment Outcome
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D012462:Saline Solution, Hypertonic; D000077602:Tolvaptan; D003707:Demeclocycline; D012964:Sodium
keywords: Hyponatraemia; SIADH; Sodium; Syndrome of inappropriate antidiuretic hormone secretion; Vasopressin