Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • hypernatraemia or hyponatraemia with acute confusion/delirium, gait disturbance, impaired consciousness or seizures
  • serum sodium less than 120 mmol/l with/without symptoms
  • suspected or confirmed adrenal insufficiency with hyponatraemia
  • suspected or confirmed diabetes insipidus with hypernatraemia
  • discuss with duty endocrine registrar if serum sodium 120 to 125 mmol/l

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • suspected or confirmed diabetes insipidus with mild hypernatraemia
  • suspected adrenal insufficiency

Category 2 — appointment clinically indicated within 90 days

  • asymptomatic hyper or hyponatraemia

Category 3 — appointment clinically indicated within 365 days

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical history, including:
    • heart failure, liver cirrhosis, renal failure, malignancy, psychiatric conditions
    • potential causes of pseudo-hyponatraemia e.g. marked hyperglycaemia, hypertriglyceridaemia and hyperglobulinaemia
  • current medications and dosages, specifically drugs that cause hyponatraemia including:
    • diuretics, especially indapamide and hydrochlorothiazide
    • selective serotonin reuptake inhibitors (SSRIs)
    • serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • carbamazepine
  • allergies and sensitivities
  • use/frequency of alcohol, tobacco, and other drugs
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • physical examination
  • height/weight
  • body mass index (BMI)
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • urea, electrolyte, and creatinine (UEC)
  • liver function test (LFT)
  • random blood glucose level
  • thyroid function tests (TFTs):
    • thyroid stimulating hormone (TSH)
    • free thyroxine (FT4)
  • cortisol (0800-0900)
  • paired serum and urine sodium and osmolality 24-hour urine volume if polyuria

Clinical management advice

Hyponatraemia is a condition marked by low levels of sodium in the blood (serum sodium below 135 mmol/L). Mild cases are often asymptomatic. Treatment approach varies based on severity, altered consciousness, probable cause, and rate of development. Chronic hyponatraemia is better tolerated than acute hyponatraemia. The management strategy for hyponatraemia varies based on the severity of clinical manifestations, particularly:

  • any alteration of the conscious state
  • the probable cause
  • rate of development

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.