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To the Editor: Dr Alam and colleagues¹ described 40 children treated with oral rehydration solution for diarrheal dehydration who experienced seizures associated with severe hyponatremia (sodium, <120 mEq/L). In their study, hyponatremia was treated with 12 mL/kg of 3% sodium chloride over a 4-hour period. This would be expected to raise the serum sodium by a minimum of 12 mEq/L in 4 hours, a more rapid increase than may be safe.² The appropriate use of 3% sodium chloride for the treatment of symptomatic hyponatremia is controversial, as some studies have suggested that an excessive correction of hyponatremia can lead to the development of cerebral demyelination.³ If these children had a good neurological outcome, it would support the safety of using 3% sodium chloride in children with symptomatic hyponatremia.

Financial Disclosures: None reported.

Michael L. Moritz, MD
michael.moritz@chp.edu
Department of Pediatrics
Children's Hospital of Pittsburgh
Pittsburgh, Pa

1. Alam NH, Yunus M, Faruque AS, et al. Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution. JAMA. 2006;296:567-573. FREE FULL TEXT 2. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581-1589. FREE FULL TEXT 3. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol. 2005;20:1687-1700. FULL TEXT | ISI | PUBMED

JAMA. 2007;297:41.

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RELATED LETTER

Fluid Replacement for Severe Hyponatremia—Reply
Nur H. Alam
JAMA. 2007;297(1):41-42.
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