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Hyponatremia and Myelinolysis
- Barbara I. Karp, MD; and
- Robert Laureno, MD
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IN RESPONSE:
Rapid correction of hyponatremia can cause myelinolysis. This iatrogenic illness has been well documented in humans [1, 2] and in controlled experiments in three mammalian species [3-5].
Drs. Ayus and Arieff state that the rate of correction of plasma sodium concentration is “irrelevant,” yet they warn that a rate of correction of “more than 25 mmol/L in 48 hours can lead to cerebral demyelinating lesions.” These statements are contradictory. The authors then discuss one possible outcome of symptomatic hyponatremia. We have always recognized that neurologic complications are associated with both hyponatremia and its correction. We hope that Drs. Ayus and Arieff will soon recognize the amassed data showing that rapid correction of hyponatremia may cause myelinolysis.
We advise that the increase in serum sodium concentration be limited, whenever possible, to a rate of less than 10 mmol/L in any 24-hour period.
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 Unpublished letters cannot be returned.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
