The Claimant received £25,000 for the death of his wife on 15/08/2017 following an adverse reaction to treatment of hyponatremia which led to her developing a fatal osmotic demyelination syndrome.


On 31/07/2017 the Deceased, aged 80, was admitted to Epsom General Hospital with confusion following a collapse at home. In the Emergency Department she was reviewed, intravenous fluid was prescribed and bloods taken. The bloods showed a profound hyponatremia (a decrease in serum sodium concentration) of 111 mmol/l and that she had low potassium levels. She was admitted under the care of the on call medical physician and she was prescribed sodium chloride and potassium replacement fluids intravenously.

On 01/08/2017 the Deceased was reviewed by a consultant emergency care physician and her serum sodium was noted to have risen to 129 mmol/l. Her prescription was changed to potassium replacement only.

The NICE Guidelines recommend that sodium levels should not be raised by more than 10 mmol/l in the first 24 hours, and by 8 mmol/l in subsequent days until the normal range of 135 – 145 mmol/l is achieved.

There is no evidence that staff understood that the rapid rate of increase was beyond the recommended national guidelines and no steps were put in place to regularly assess the Deceased's serum sodium levels.

On 02/08/2017 the Deceased was reviewed by another consultant emergency care physician. Her sodium serum was noted to be 134 mmol/l. She continued to remain on potassium replacement.

On 03/08/2017 the Deceased was reviewed again and considered medically fit for discharge. Her sodium level was measured at 146 mmol/l, having increased from 134 mmol/l the previous day. The Deceased remained in a confused state however, no action was considered in relation to the further rise in sodium levels and no plans were implemented to assess serum sodium as recommended by national guidelines.

On 04/08/2017 the Deceased was transferred to the care of the elderly medical ward. She had become very drowsy. Throughout the day her neurological state deteriorated with GCS at 4/15. Her serum sodium was found to have risen to 164 mmol/l.

A CT scan of the brain was carried out and on review the rapid rise in sodium levels since admission was noted with its attendant risk of osmotic demyelination syndrome in the brain. Intravenous fluid was administered in an effort to reduce the sodium level.

The sodium level was reduced slowly to 150 mmol/l over the course of the next two days but no improvement in the Deceased's neurological state was noted.

Radiological examination on 09/08/2017 confirmed the diagnosis of central pontine myelinolysis. Despite optimal treatment from that point onwards, the Deceased showed no signs of recovery and she died on 15/08/2017.


The Deceased suffered a fatal osmotic demyelination syndrome secondary to the rapid correction of low sodium level.


The Root Cause Analysis Investigation Report concluded that in the Deceased's case the rise in sodium was too quick and too far. The fatal osmotic demyelination syndrome would probably have been avoided had her bloods been checked more frequently and those results acted upon. A number of recommendations were suggested to avoid such an incident happening again.

The Inquest hearing took place in May 2018. At the hearing it was accepted that the Deceased died as a direct consequence of the failure to appropriately assess and manage hyponatremia. The Coroner returned a conclusion of sub-optimal care contributed to by neglect.

The Coroner issued a Regulation 28 Report - Action to Prevent Future Deaths - which highlighted several matters of concern, some of which were:

  • "the failure to follow the national recommended guidelines…."
  • "the apparent lack of understanding of the appropriate management of hyponatremia by the treating consultants…"
  • "the documentation was inadequate with no record of assessment or a coherent plan in place to ensure appropriate care…"

Epsom General Hospital publicly apologised to the Deceased's family stating that the care provided to her fell below the high standards the Trust expects and strives for.

Following the inquest the Defendant was invited to an early admission of breach of duty and causation. At the same time, the Claimant made an early settlement offer in the sum of £32,000 in an effort to bring the matter to an early resolution without the need to incur costs of obtaining expert medical evidence. In response, the Defendant did not comment on breach of duty and/or causation but instead made a counter-offer of £25,000, which was accepted by the Claimant.


The claim was settled on a global basis for £25,000. A rough breakdown of the settlement figure is as follows:

General damages: £3,000; Bereavement award: £12,980

Special damages: £6,000 funeral expenses; £3,000 loss of services, love and affection.

The Defendant also agreed to pay the Claimant's costs of the case, which had been run under a conditional fee agreement.

For the Claimant:

Solicitor: Alla Kingswood, Russell-Cooke LLP

Defendant: Epsom and St Helier University Hospitals NHS Trust