To the Editor.
—I cannot agree with the treatment regimen for diureticinduced hyponatremia advocated in the editorial by J. Carlos Ayus, MD, in the July issue of the Archives.1 While the recommended treatment with hypertonic saline is usually innocuous,1 some patients will be seriously and unnecessarily harmed by it.2 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 defect1), the urinary excretion of free water may accelerate, increasing the serum sodium concentration more rapidly than intended—sometimes with disastrous results.1-3 Some hyponatremic patients, both alcoholic and nonalcoholic, have developed central pontine myelinolysis after receiving this recommended treatment.2Is potentially dangerous treatment with hypertonic saline necessary in patients with very low serum sodium concentrations? The editorial cites the "well-documented morbidity and mortality" when severe hyponatremia is
Sterns RH. Diuretic-Induced Hyponatremia. Arch Intern Med. 1986;146(12):2414-2415. doi:10.1001/archinte.1986.00360240162029