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Master Thesis

L'hyponatrémie hypotonique aux urgences adultes de Saint-Pierre à l'île de la Réunion : évaluation d'un protocole diagnostique et thérapeutique

Abstract : Introduction: hyponatremia (defined as a serum sodium level <134mmol/l) is the most common electrolytic disorder in hospitalized patients. It’s associated with adverse outcomes and considerable mortality. Objective: the main objective of this study was to compare the time taken to correct natremia to the threshold of 130mmol/l in patients with hyponatremia, hypo and euvolaemic before and after the management of a diagnostic and therapeutic aid protocol. The secondary objective was to carry out the first epidemiological study of this disorder on Réunion Island Methods: we conducted a retrospective, monocentric and observational study. Patients over the age of 18 admitted to the adult emergency department of the hospital of Saint-Pierre on Réunion Island, with a corrected natrémia< 129mmol/l were included. The first phase took place from September to October 2018, then the protocol was included in the computer-based emergency management software for the second part of the study. This second part took place in November 2018 to February 2019. The main judgement criterion was correction time up to the threshold of 130mmol/l. The secondary judgement criteria were correction time to the 135mmol/l threshold, length of hospitalization and hospital mortality. Results: the median correction times to the threshold of 130mmol/l were similar before the implementation of the protocol: 2[1;4] days. The median correction time to the 135mmol/l threshold before the protocol was 3 [2; 4,25] days. The median post-protocol correction time was 5 [4; 8.5] days. Throughout the implementation of the protocol median length of hospitalization was 7 [4; 10] days: 6 [4; 9] days before the protocol is implemented and 7 [3,5; 11,5] days after it was implemented. The difference between our two groups is not significant (p=0.8). Mortality during the pre-protocol period was 13%. It was 6.5% during the post-protocol period. The numberof deceased decreased after the implementation of the protocol, but not significatly. Conclusion: the implementation of a diagnostic and therapeutic management protocol did not reduce the correction time up to the threshold of 130mmol/L. Only mortality decreases but not significantly.
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Master Thesis
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Émilie Le Maux. L'hyponatrémie hypotonique aux urgences adultes de Saint-Pierre à l'île de la Réunion : évaluation d'un protocole diagnostique et thérapeutique. Médecine humaine et pathologie. 2019. ⟨dumas-02397534⟩

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