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In Reply.—I agree completely with Dr Naylor and associates that breast-feeding for the first 6 months is indeed highly desirable and the best feeding regimen known. On the other hand, I do not believe that fact is relevant to the water intoxication that is occurring in inner cities. Even if pure water is ingested at approximately the same rate that it is being lost in urine and insensibly, one does not get water intoxication. If few or no associated calories are ingested, what results is starvation and marasmus.
Water intoxication requires the rapid intake of water, which significantly dilutes extracellular fluid solute. This, in turn, produces cerebral swelling because of the existence of tight junctions in the cerebral vessel endothelium. Water moves by osmosis disproportionately into the central nervous system over other tissues and cells. This is one of the points I tried to make in my editorial comment. On occasion,
FINBERG L. Oral Water Intoxication-Reply. Am J Dis Child. 1992;146(8):893-894. doi:10.1001/archpedi.1992.02160200015003