October 1978

Hyponatremia Associated With Tap Water Debridement

Author Affiliations

Montreal, PQ H3A 1A1, Canada

Arch Surg. 1978;113(10):1211. doi:10.1001/archsurg.1978.01370220097017

To the Editor.—A 20-year-old woman was admitted to the hospital after falling into a campfire, sustaining a 60% to 70% third-degree burn. While receiving tap water tub baths twice daily for debridement, her serum sodium level was noted to decline progressively from 137 mEq/liter on admission to 122 mEq/liter on the tenth hospital day, when the sodium loss in an average tub bath was measured (Table). A tub was filled with 160 liters of tap water and sodium determinations were made using undiluted flame photometry specimens. Time O is just before the patient entered the

tub. At 30 minutes, debridement was initiated. Even prior to debridement, 30 mEq/liter of sodium was lost into the tub water. As seen in the Table, approximately 100 mEq/liter of sodium was lost with two one-hour tap water tub baths daily.

Sodium loss after burn treatment with 0.5% silver nitrate dressings, a hypotonic solution

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