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Rapid Correction of Hyponatremia in the Syndrome of Inappropriate Secretion of Antidiuretic Hormone: An Alternative Treatment to Hypertonic Saline

DAVID HANTMAN, M.D.; BERNARD ROSSIER, M.D.; ROBERT ZOHLMAN, M.D.; and ROBERT SCHRIER, M.D., F.A.C.P.
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Grant support: grants AM 12753, HE 13319-01, and training grant AM 05670-02, National Institutes of Health; a grant from Hoechst Pharmaceutical Company; and grant NGR-05-025-007, National Aeronautics and Space Administration. Some of these studies were carried out in the General Clinical Research Center, provided by the Division of Research Facilities and Resources under grant FR-79, U.S. Public Health Service. Dr. Schrier is an Established Investigator of the American Heart Association.

▸Requests for reprints should be addressed to Robert W. Schrier, M.D., Renal Division, Department of Medicine, University of Colorado School of Medicine, 4200 E. Ninth Ave., Denver, CO 80220.


San Francisco, California


Ann Intern Med. 1973;78(6):870-875. doi:10.7326/0003-4819-78-6-870
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In the syndrome of inappropriate secretion of antidiuretic hormone, life-threatening cerebral dysfunction may necessitate rapid elevation of the serum sodium concentration. Treatment with fluid restriction may be too slow, and infusions of hypertonic saline are excreted because these patients already have volume expansion. Severe hyponatremia in five patients was corrected by inducing a diuresis with furosemide and by replacing the urinary electrolyte losses. The mean plasma sodium concentration increased in these patients from 120 ± 1 to 133 ± 2 meq/litre (P < 0.001) in 6 to 8 hours. Before treatment one of these patients was semicomatose and had grand mal seizures, symptoms that subsided as the serum sodium concentration was rapidly elevated. Although the furosemide diuresis consistently diminished urine to plasma osmolality ratios, a negative water balance may be achieved at all levels of urinary osmolality, provided the urinary electrolyte losses are replaced in a more concentrated solution.

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