Hyponatremia and grade of hyponatremia is associated with symptom burden and intensity in patients receiving specialist palliative care (SPC), according to a study published in Supportive Care in Cancer.

Hyponatremia is an electrolyte imbalance that occurs in up to 25% of patients with malignant solid tumors, which may result in longer hospitalization times and increased risk of mortality. Study authors investigated the prevalence and associated symptoms in patients receiving SPC.

In this retrospective study, researchers found that 275 of 710 (38.7%) eligible patients receiving SPC presented with hyponatremia. Thirty-one percent, 6.2%, and 1.6% of patients showed mild, moderate, and severe forms of hyponatremia, respectively.

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Hyponatremia was detected in 19.4% of patients with brain tumors, and in 39.2% of all patients with cancer. Of the patients with hyponatremia, 25.1% had hepatic metastases while only 16.3% of normonatremic patients did.

Study authors assessed the symptoms evaluated by the Hospice and Palliative Care Evaluation (HOPE), such as breathlessness, nausea, depressiveness, vomiting, constipation, poor appetite, and weakness. These symptoms were observed at a much higher frequency in hyponatremic patients compared with normonatremic patients (7.71 vs 6.63; P <.001).

The severity of hyponatremia correlated with greater symptom intensity as well (mean = 13.29 vs 11.28; P <.001). 

Patients with hyponatremia suffer from more symptoms with greater severity than normonatremic patients, but the study found no significant association between in-hospital mortality or length of hospital stay and hyponatremia.

The authors conclude that “a prospective analysis is needed to further examine this association and the influence of hyponatremia correction on symptom burden and intensity and survival.” 


1. Kremeike K, Wetter R, Brust V, et al. Prevalence of hyponatremia in inpatients with incurable and life-limiting diseases and its association with physical symptoms – a retrospective descriptive study [published online August 18, 2017]. Support Care Cancer. doi: 10.1007/s00520-017-3837-y