The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Reports |

Maltose-Induced Hyponatremia

Paul M. Palevsky, MD; David Rendulic, MBA, MS; and Warren F. Diven, PhD
[+] Article, Author, and Disclosure Information

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
Text Size: A A A

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.


Grahic Jump Location
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.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.