In reply
I thank Dr Luft for his comments. Luft and colleagues' study1 emphasizes that the normal person can excrete much greater quantities of salt and water than these ill patients were given, so the main question is why these patients cannot excrete salt water normally.2 Our patients received some extra water because the notion that hypernatremia must reflect water depletion is so pervasive. One note on a patient's chart stated the presence of edema and ascites and then went on to calculate the degree of water depletion from a formula based on the elevated serum sodium concentration. Others have written "efforts to explain the frequent occurrence of hypernatremia in decompensated cirrhotic patients must then by necessity involve an analysis of factors that might lead to a relative deficiency of total body water volume."3