Pre PACES Podcast #131 Hyponatraemia
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Jan 18, 2026 Dr. Leila Thurston, a consultant in endocrinology and diabetes at Imperial College London, dives into the world of hyponatraemia—highlighting its clinical significance and risks of mismanagement. She explores the variability of symptoms and the importance of assessing volume status. The discussion also covers underlying causes like heart and kidney failures, and the nuances of SIADH, polydipsia, and pseudohyponatraemia. Dr. Thurston shares practical management strategies and emphasizes essential diagnostics for effective treatment.
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Hyponatraemia's Clinical Importance
- Hyponatraemia is the most common electrolyte abnormality and a frequent endocrine referral.
- Incorrect management can cause severe patient harm, so apply structured algorithms.
Fluid Status Frames Diagnosis
- Classify hyponatraemia by fluid status: hypervolemic, euvolemic, or hypovolemic.
- Accurate fluid assessment (history, exam, labs) directs diagnosis and treatment.
Expect Euvolemic Cases In PACES
- In PACES you'll rarely see clinically obvious hyper- or hypovolemia; euvolaemic SIADH is common in exam stations.
- Examiners can use actors for history-only euvolemic cases, so expect SIADH scenarios.