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Maltose-Induced Hyponatremia

Paul M. Palevsky, MD; David Rendulic, MBA, MS; and Warren F. Diven, PhD
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From the University of Pittsburgh School of Medicine; the Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Requests for Reprints: Paul M. Palevsky, MD, Renal-Electrolyte Division, Room F-1159, Presbyterian University Hospital, DeSoto at O'Hara Streets, Pittsburgh, PA 15213.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(7):526-528. doi:10.7326/0003-4819-118-7-199304010-00007
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Although hyponatremia is usually indicative of hypotonicity, the accumulation in the plasma of high concentrations of glucose, mannitol, sorbitol, glycerol, or radiocontrast agents may lead to hyponatremia with hypertonicity. We describe a patient with renal failure in whom maltose intoxication, resulting from treatment with intravenous immune globulin, produced severe hyponatremia. During repeated infusions of intravenous immune globulin, the serum sodium concentration decreased in association with an increase in serum osmolality, a rising osmolal gap, and an accumulation of maltose in the blood. Maltose-containing intravenous solutions should be used with caution in patients with renal insufficiency; the development of hyponatremia during maltose infusion should suggest hypertonicity due to the accumulation of maltose.

Figures

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Figure 1.
Serum sodium, osmolal gap, and serum maltose concentrations during intravenous immune globulin infusions.top panelmiddle panelbottom panelPPPPPP

Serum sodium ( ), osmolal gap ( ), and serum maltose ( ) concentrations before (pre-IVIG), during the final 4 hours of (end-IVIG), and 6 to 12 hours after the completion of (post-IVIG) infusions of intravenous immune globulin (IVIG) in 10% maltose in a patient with acute renal failure. Data are expressed as mean ±SD. (Serum sodium: Pre-IVIG versus end-IVIG, < 0.01; end-IVIG versus post-IVIG, < 0.05. Osmolal gap: pre-IVIG versus end-IVIG, = 0.066; end-IVIG versus post-IVIG, < 0.05. Serum maltose: pre-IVIG versus end-IVIG, < 0.02; end-IVIG versus post-IVIG, < 0.05).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Serum sodium concentrations in relation to serum maltose concentrations and the osmolal gap.(Panel A)(Panel B)

Linear regression of the serum sodium concentration in relation to serum maltose concentrations and the osmolal gap , before, during, and after repeated infusions of intravenous immune globulin in 10% maltose in a patient with acute renal failure.

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