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Editor's Correspondence
July 12, 1999

Hypernatremia With Edema

Arch Intern Med. 1999;159(13):1499. doi:

Kahn1 reports a sad but elucidating series of 7 patients with hypernatremia and edema. In my view, Kahn has performed a considerable service with this insightful report. The patients were for the most part elderly, critically ill, and had a host of concomitant medical problems. Notable is the weight gain observed in these patients, 5 of whom died in the hospital, from a weight of 85 to more than 110 kg; 110 to more than 132 kg; 83 to more than 109 kg; 111 kg with "weeping edema; " 77 to more than 106 kg; 54 to more than 62 kg; and 56 to more than 68 kg. Kahn points out that this weight gain consisted of an expansion in the extracellular fluid (ECF) volume. The ECF in young, healthy, 70-kg persons is about 13 L. The mean weight gain and ECF gain in these patients was about 20 kg or liters, respectively. Kahn proceeds with a scholarly discussion of the mechanisms that were likely to contribute to sodium and water dysregulation in these patients. However, in my view he neglected to discuss the management strategies these patients received. All of these patients had grossly overt evidence of a massive increase in the ECF, including the patient with weeping edema. One patient received an additional 6500 mL of fluid although the systolic right atrial pressure was reported to be 40 mm Hg.