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September 1991

Water Intoxication: A Prevalent Problem in the Inner City

Am J Dis Child. 1991;145(9):981-982. doi:10.1001/archpedi.1991.02160090033016

The article in this issue of AJDC by Keating et al1 from St Louis, Mo, adds to our warning in 1986 that the incidence of water intoxication in infants has risen during the last 15 years.2 Four additional issues not extensively addressed by Keating et al are worth comment.

First, why has there been a sharp increase in the number of patients with water intoxication? Families living in poverty have diluted formulas and fed water to hungry infants as long as any of us can remember, yet before about 1970 we clinicians working in inner-city hospitals rarely encountered water intoxication as a result. On the contrary, we encountered a high incidence of hypernatremic dehydration between 1945 and 1970.3 I believe the most important factor in bringing about this reversal was the deliberate reduction in the salt (and other "renal solute") content of infant