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June 23/30, 1999

Hypoxia Is the Cause of Brain Damage in Hyponatremia

Author Affiliations

Author Affiliation: Department of Internal Medicine, Presbyterian Hospital of Dallas, University of Texas Southwestern Medical Center School of Medicine, Dallas.

JAMA. 1999;281(24):2342-2343. doi:10.1001/jama.281.24.2342

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