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Sodium, Water, and Congestive Heart Failure

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Bowman Gray School of Medicine of Wake Forest University; WinstonSalem, North Carolina

Ann Intern Med. 1984;100(6):902-904. doi:10.7326/0003-4819-100-6-902
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Hyponatremia is a marker of abnormal water metabolism. Mild hyponatremia causes no symptoms and is itself not serious. It is, however, a clear warning to clinicians that continued excess water intake may lead to more severe hyponatremia with adverse, sometimes catastrophic, effects on the central nervous system.

Chronic hyponatremia frequently complicates congestive heart failure of class III or IV. Restricting water intake may prevent severe hyponatremia from developing, but often fails to normalize the serum sodium concentration. In this issue, Dzau and Hollenberg (1) and Packer and associates (2) report that therapy with captopril combined with the loop diuretic furosemide


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