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Recognizing Maltose-induced Hyponatremia
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TO THE EDITOR:
Palevsky and colleagues [1] did not discuss the importance of recognizing that the hyponatremia induced by maltose is hypertonic, nor do they mention whether their patient's sensorium was altered. Unless a serum osmolarity is checked, the less experienced clinician might consider hyponatremia in a patient receiving an intravenous immune globulin infusion to be hypotonic and administer hypertonic saline to “correct” the serum sodium.
One clue could be the absence of central nervous system toxicity expected for that degree of hyponatremia. Symptoms in the more common hypotonic hyponatremia develop because of transcellular shifts in water and the development of cerebral edema. Because a patient with maltose-induced hyponatremia would be iso- to hypertonic in the face of severe hyponatremia, significant central nervous system toxicity is absent. The use of an isotonic or a hypertonic saline solution in such patients could cause catastrophic volume overload.
The patient's renal failure made the issue of hypertonic saline administration moot. They note that their patient received dialysis, although it is not clear whether the dialysis was for urgent correction of the serum sodium or whether it was a routine dialysis for the patient's uremia. In such a patient, specific therapy for the hyponatremia is probably not indicated.
Robert C. Hollander, MD
Wadsworth Veterans Affairs Medical Center; Los Angeles, CA 90073
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
