Abstract
<h3>To the Editor.</h3> —I cannot agree with the treatment regimen for diureticinduced hyponatremia advocated in the editorial by J. Carlos Ayus, MD, in the July issue of theArchives.<sup>1</sup>While the recommended treatment with hypertonic saline is<i>usually</i>innocuous,<sup>1</sup>some patients will be seriously and unnecessarily harmed by it.<sup>2</sup>When thiazide-induced hyponatremia is treated with large volumes of saline and withdrawal of the diuretic (thereby eliminating both the hypovolemic stimulus for antidiuretic hormone release and the renal diluting defect<sup>1</sup>), the urinary excretion of free water may accelerate, increasing the serum sodium concentration more rapidly than intended—sometimes with disastrous results.<sup>1-3</sup>Some hyponatremic patients, both alcoholic and nonalcoholic, have developed central pontine myelinolysis after receiving this recommended treatment.<sup>2</sup> Is potentially dangerous treatment with hypertonic saline<i>necessary</i>in patients with very low serum sodium concentrations? The editorial cites the "well-documented morbidity and mortality" when severe hyponatremia is
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
