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Hyponatraemia
Frequency of U+E Monitoring and Osmotic Demyelination Syndrome

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Frequency of U+E Monitoring and Osmotic Demyelination Syndrome

Diabetes & endocrinology

ODS

Risk factors for Osmotic Demyelination Syndrome (ODS)

Serum sodium at presentation. ODS is rare with serum sodium >120 at presentation out with the context of diabetes insipidus or post liver-transplant.
Duration of hyponatraemia. Recent onset (48 hours) onset of hyponatraemia confers a low risk of ODS. Chronic hyponatraemia should be assumed where duration is unknown.
Rate of correction. A rise of more than 10 mmol in 24 hours should be avoided. If this occurs or is likely to occur, then endocrinology should be involved. Polyuria is an early sign of rapid correction and should prompt early check of U&Es.
Hypokalaemia.
Liver disease.
Alcohol excess.
Malnutrition.

Frequency of U+E monitoring

Patients at high risk of ODS will require frequent (e.g. 4-hourly) monitoring of serum sodium and hourly urine volumes.
UEs should also be checked immediately after infusion of hypertonic saline.
Severely unwell or high-risk patients may require more frequent monitoring in a critical care setting.
In stable patients with asymptomatic chronic hyponatraemia BD U&Es may be sufficient.