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She has had two days of fever and dysuria. Today she is drowsy, with a temperature of 38.9°C, blood pressure of 88/54 mmHg and pulse of 118/min.
A 72-year-old patient presents with palpitations and light-headedness that began earlier today. They are alert and haemodynamically stable.
A phase 1 study tested NeoVax, a vaccine tailored to each patient’s tumor mutations, in ten patients with platinum-sensitive high-grade epithelial ovarian cancer after chemotherapy, followed by delayed anti-PD-1 therapy. No unexpected safety signals emerged, and biomarker analyses suggested biological activity in six patients, alongside vaccine-specific immune responses. The small, uncontrolled trial assessed feasibility and safety; it does not establish clinical efficacy.
Published: 14 October 2026
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Hyponatraemia is serum sodium below 135 mmol/L. Check symptoms and duration, glucose and serum osmolality to confirm hypotonicity. Then use urine osmolality and a paired urine sodium with the clinical context to investigate the cause. For example, in a patient taking a thiazide with sodium of 124 mmol/L, review the medication and obtain serum and urine studies while arranging prompt assessment.
Treat the underlying cause and tailor care to symptoms and volume status. Severe neurologic symptoms require urgent hospital treatment, often with hypertonic saline under close monitoring. For less severe cases, decisions may include stopping a causative medicine, fluid restriction for SIAD, or isotonic fluid for hypovolaemia. Avoid overly rapid correction, especially when hyponatraemia is chronic or its duration is unknown.
Hyponatraemia is common in hospital care and ranges from an incidental laboratory finding to a medical emergency. Assess neurologic symptoms, how quickly sodium fell, the likely cause and comorbid illness. Acute severe cases risk cerebral oedema; chronic cases corrected too rapidly risk osmotic demyelination. Prognosis depends on severity and the underlying cause.
Most clinically significant hyponatraemia is hypotonic: there is too much water relative to exchangeable sodium and potassium. Impaired water excretion, often involving persistent vasopressin activity, is a common pathway. Hyperglycaemia can lower measured sodium by shifting water into the bloodstream, so interpret sodium alongside glucose and measured osmolality.
Further reading: European clinical practice guideline on diagnosis and treatment of hyponatraemia.
