—There seems to be some contradiction in Dr Sterns' letter. Although he starts by disagreeing with my approach in the treatment of diuretic-induced hyponatremia, he recommends, in the last paragraph of his letter, "if the patient presents with either seizures or deep coma, it is reasonable to administer enough hypertonic saline to improve these symptoms." This is the exact therapeutic approach that I have advocated since my initial article on this subject in 1982,1 and I am glad to see that Dr Sterns also thinks that these patients should be treated rapidly with hypertonic saline to correct the neurologic symptomatology! In our experience, these neurologic symptoms usually subside when the serum sodium concentration is raised to 120 to 125 mEq/L (120 to 125 mmol/L). After this, the patient needs to be closely monitored for several days to avoid overcorrection.
In spite of Dr Sterns' recommendation of administering hypertonic saline