MICHAEL F. MICHELIS, M.D., F.A.C.P.
To the editor: The paper by DeFronzo, Goldberg, and Agus, "Normal Diluting Capacity in Hyponatremic Patients" (Ann Intern Med 84:538-542, 1976), proposes three criteria for the diagnosis of reset osmostat in patients with hyponatremia: a normal response to water loading, concentration of the urine when serum tonicity is raised above the reset level, and failure to correct the hyponatremia with salt loading.
I wish to take issue with the last of these proposed criteria. One of the points emphasized in a recent report (1), cited by DeFronzo and associates, was that reset phenomena could be demonstrated in a patient with
MICHELIS MF. Reset Osmostat in Hyponatremia. Ann Intern Med. ;85:403–404. doi: 10.7326/0003-4819-85-3-403_2
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Published: Ann Intern Med. 1976;85(3):403-404.
Endocrine and Metabolism, Fluid and Electrolyte Disorders, Nephrology.
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