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We thank Dr. Nordstrom for his excellent comments. We feel we can exclude water intoxication in this patient for the following reasons:
The patient, who weighed 209 lb (94.8 kg), lost considerable fluid through perspiring. The hemoglobin of 20.0 gm/100 cc and the packed red blood cell volume of 57%, obtained approximately 36 hours prior to death, suggest hemoconcentration. A serum sodium sample submitted at the same time was reported as 145 mEq/liter. Clinically, the patient did not vomit or have diarrhea such as is often seen in dilutional hyponatremia. Lastly, in our own experience and that of many others consulted, hyperthermia to the degree observed in this patient is not associated with water intoxication.
Swanson LA. Death After Withdrawal of Meprobamate-Reply. JAMA. 1963;185(10):807. doi:10.1001/jama.1963.03060100087029
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