Author Affiliation: Department of Internal Medicine, Presbyterian Hospital of Dallas, University of Texas Southwestern Medical Center School of Medicine, Dallas.
There has been an ongoing controversy regarding the treatment of chronic hyponatremia.
The initial reports1,2 suggesting that overzealous
treatment of hyponatremia with hypertonic saline may cause central
pontine myelinolysis or osmotic demyelination in the brain provoked a
voluminous literature that continues to be just as lively now as it was
at the time the first reports were published.3 Today, most
clinicians who deal with electrolyte disorders appear to agree that
acute symptomatic hyponatremia, or more precisely, acute water
intoxication, imposes the risk of cerebral edema, uncal herniation, and
death. In these patients, when hyponatremia is of recent onset,
immediate administration of hypertonic saline in a quantity calculated
to increase serum sodium levels by approximately 10 mmol/L may be
lifesaving.4 However, total correction or overcorrection
may result in irreversible damage to the brain.5
Knochel JP. Hypoxia Is the Cause of Brain Damage in Hyponatremia. JAMA. 1999;281(24):2342-2343. doi:10.1001/jama.281.24.2342