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In Reply: Dr Moritz raises concerns about the safety of infusing 3% sodium chloride (12 mL/kg) over a 4-hour period in the management of seizure associated with severe hyponatremia. This was a phase 4 study to determine if routine use of a new formulation of reduced osmolarity oral rehydration solution (compared with a previous formulation) would be associated with symptomatic hyponatremia; unlike physiological studies, it did not have the provision for frequent monitoring of serum electrolytes.

Although the use of intravenous infusion of 3% sodium chloride in the treatment of severe symptomatic (seizure/coma) hyponatremia is recommended, a slower correction is generally recommended to limit increase in the serum sodium to a maximum of 10 mEq/L in 24 hours, which is considered safe.¹ However, in routine clinical practice under a constrained-resource and phase 4 trial situation, controlled elevation of serum sodium in a child with severe hyponatremia may not be practical . . . [Full Text of this Article]

Nur H. Alam, MD
nhalam@icddrb.org
Clinical Sciences Division
International Center for Diarrheal Disease Research
Mohakhali, Dhaka, Bangladesh

RELATED LETTER

Fluid Replacement for Severe Hyponatremia
Michael L. Moritz
JAMA. 2007;297(1):41.
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