ROBERT S. BROWN, M.D.
To the editor: In the ANNALS of December 1970 (1) Dr. Raja and his associates described a patient with hyperosmotic coma, which followed 72 hr of peritoneal dialysis using hypertonic sorbitol dialysate. The patient's serum osmolality was 408 mOsm/liter; blood urea nitrogen, 94 mg/100 ml; glucose, 264 mg/100 ml; and sorbitol, 750 mg/100 ml. At the end of the dialysis the patient had lost 32 lb, and his hematocrit had risen from 28 to 40. He developed progressive coma, became hypotensive, and died. While the elevated blood sorbitol level contributed about 40 mOsm/liter to the serum osmolality, the serum sodium,
BROWN RS. Hypernatremia in Hyperosmotic Coma?. Ann Intern Med. 1971;74:642–643. doi: 10.7326/0003-4819-74-4-642
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Published: Ann Intern Med. 1971;74(4):642-643.
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