Letter to the Editor: In Response
I totally agree with Gozal and Schwarzenberger that too rapid a correction of hyponatremia with intravenous hypertonic saline carries a risk of central pontine myelinolysis [1-3]. In neither of the cases in my report was hypertonic saline used. The corrections were spontaneous. I have not seen any reports of demyelinization after rapid, spontaneous correction of hyponatremia. It is the hypertonic saline used intravenously that is implicated in this syndrome. I also do not know that it is possible to control the rate of correction in the spontaneous circumstances.
Michael K. Rosenberg, MD
Department of Anesthesiology, Sinai Hospital, Sinai Surgery Center, Farmington Hills, MI 48334
1. Witz CA, Silverberg KM, Burns, WN, et al. Complications associated with the absorption of hysteroscopic fluid media. Fertil Steril 1993;60:745-56.
2. Sterns RH. The treatment of hyponatremia: first do no harm. Am J Med 1990;88:557-60.
3. Arieff AI. Management of hyponatremia. BMJ 1993;307:305-8.