J. Carlos Ayus, MD; Allen I. Arieff, MD
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Ayus JC, Arieff AI. Postoperative Hyponatremia. Ann Intern Med. 1997;126:1005. doi: 10.7326/0003-4819-126-12-199706150-00030
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Published: Ann Intern Med. 1997;126(12):1005.
TO THE EDITOR:
We read with interest the study by Steele and colleagues  suggesting that near-isotonic fluid infusion could decrease the plasma sodium level in postoperative patients. They have thus confirmed that the phenomenon in which volume expansion in persons with elevated plasma antidiuretic hormone levels results in a substantial quantity of infused NaCl excreted in the urine  also applies to persons who have just had surgery. However, these findings should not suggest that infusion of isotonic (154 mmol of NaCl per L) can lead to postoperative hyponatremic encephalopathy. Among 158 postoperative patients with hyponatremic encephalopathy studied at our laboratory and 31 additional patients described between 1935 and 1990, not 1 patient was given isotonic NaCl . Three were given Ringer lactate solution (130 mmol of sodium per L).
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