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Measurement of urine osmolality and urine sodium is often advocated in the evaluation of severe hyponatraemia. In a recent article in the Journal of Clinical Pathology, Saeed and colleagues documented the frequency with which these investigations were performed.1 However, the results of urine biochemistry obtained in the assessment of severe hyponatraemia are rarely reported.2
We examined the computer records of 59 patients (44 women, 15 men; age range, 22–93 years) found in 2002 to have a serum sodium of less than 120 mmol/litre, in whom a urine osmolality was requested at around the same time (the total number of patients with a serum sodium of less than 120 mmol/litre during the same period was 304). Case notes were available for 34 of these patients. Figures 1 and 2 show the results of urine osmolality and sodium measurement, respectively. Serum osmolality confirmed a hypo-osmolal state in 41 of the 45 patients in whom …