In Reply.—Since water intoxication has been a rare entity, it is not surprising that studies providing critical comparison of hypertonic saline vs mannitol have not been published. I agree with Nutman and Hill that mannitol is a reasonable choice, but it has not been proven to be safer or more effective.
Although discussion of refinements of therapy is interesting, prevention is a more attractive topic. Interventions directed to the population at risk might include education, public service announcements, or modification of the instructions given to new mothers when they leave the hospital. Incentives to promote breast-feeding in the context of the Supplemental Food Program for Women, Infants, and Children (WIC) may be the most meaningful project. Finberg1 has suggested financial incentives to eligible mothers in the WIC program who breast-feed. Study of that approach in an appropriately structured fashion is overdue.