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James P. Knochel, MD

JAMA. 1999;281:2342-2343.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

There has been an ongoing controversy regarding the treatment of chronic hyponatremia. The initial reports^1-2 suggesting that overzealous treatment of hyponatremia with hypertonic saline may cause central pontine myelinolysis or osmotic demyelination in the brain provoked a voluminous literature that continues to be just as lively now as it was at the time the first reports were published.³ Today, most clinicians who deal with electrolyte disorders appear to agree that acute symptomatic hyponatremia, or more precisely, acute water intoxication, imposes the risk of cerebral edema, uncal herniation, and death. In these patients, when hyponatremia is of recent onset, immediate administration of hypertonic saline in a quantity calculated to increase serum sodium levels by approximately 10 mmol/L may be lifesaving.⁴ However, total correction or overcorrection may result in irreversible damage to the brain.⁵

Experimentally, studies have shown that brain cells adapt to hypotonicity by expelling potassium, some . . . [Full Text of this Article]

Author Affiliation: Department of Internal Medicine, Presbyterian Hospital of Dallas, University of Texas Southwestern Medical Center School of Medicine, Dallas.

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