Information
Hyponatraemia can be defined as serum sodium <135 mmol/L. The clinical significance of hyponatraemia depends on its severity, its speed of onset and its underlying cause. Severe hyponatraemia can be life threatening.
Most common symptoms are headache, nausea, vomiting, diarrhoea, tiredness, muscle spasms, seizures and mental changes.
Asymptomatic mild hyponatraemia is common and management decisions will be based on clinical symptoms.
M.A, K.E & J.W. 12-2-26
Who to refer:
Any patient with a cancer diagnosis who is on treatment, within 6 weeks of treatment, has had immunotherapy within last 12 months or who is under oncology follow up who has symptoms associated with confirmed Hyponatremia blood result.
Who not to refer:
If in doubt please do not hesitate to call the on call oncology team.
How to refer:
Contact the Acute Oncology teamat the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
SIADH is the most common cause of hyponatraemia in this patient cohort either as a direct result of their cancer or drug related. Mild hyponatraemia (130-135) is often asymptomatic – check for any potential drug causes and repeat in a few days. If unsure please discuss with the On Call Team.
All patients on or within six weeks of treatment should be encouraged to monitor symptoms and call The Cancer Treatment Helpline (CTH; 08009177711) with any treatment-related concerns. Please note, the CTH is a call operator service provided by NHS 24, who then refer on to an acute care specialist. They cannot give specialist advice.
If the patient has been assessed by a healthcare practitioner in Primary Care, and Oncology advice/input is felt to be required, the Primary Care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre (based in the WGH) and discuss directly. The Acute Oncology team can be contacted during working hours (Mon-Fri 9-5) on 07798774842; If out of hours, please discuss with the Oncology Registrar On-Call via NHS Lothian Switchboard (0131 537 1000).
If the primary care clinician requires any further guidance on the suitability of referral to Acute Oncology, they can consult Pg 10 of the The UKONS Oncology/Haematology 24 Hour Triage Toolkit.
Note if a patient has presented to primary care for assessment, the patient should NOT be advised to call the CTH themselves to pass on this information or seek further advice.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
