Q J Med 1999; 92: 293
© 1999 Association of Physicians
Correspondence |
Treatment of SIADH with isotonic saline
University Hospital Aintree Ninewells Hospital Dundee
Sir,
Drs Musch and Decaux report on the beneficial effects of isotonic saline infusion in a sub-group of patients with hyponatraemia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).1 Though of scientific interest, there are considerable potential problems and dangers in such active treatment of SIADH, which the authors do not address.
The first concerns the recognized association between rapid correction of hyponatraemia in SIAD with osmotic demyelination syndromes (notably central pontine myelinolysis).2 This complication is most likely when the rise in plasma sodium (Na) is greater than 10 mmol/24 h.3 Though in the series presented by Drs Musch and Decaux, the rises in plasma Na were generally small, there was a more responsive sub-group of patients with relatively low plasma osmolality levels, and more prolonged saline treatment could be potentially hazardous in such patients.
The second question is whether treatment is needed in these patients at all. Most cases of SIADH remit spontaneously, and even in chronic cases (due for example to untreatable malignancies), active management may not be necessary or wise unless plasma Na levels are especially low or the patients is deemed symptomatic from the hyponatraemia.4
Hyponatraemia is frequently benign and asymptomatic, and active management of hyponatraemia per se is usually unecessary, as the condition often remits spontaneously. Management of the underlying disease process, where possible, is the prime target of management.
References
1.
Musch W, Decaux G. Treating the syndrome of inappropriate ADH secretion with isotonic saline.Q J Med 1998; 91:749–53.
2.
Laureno R, Karp BI. Myelinolysis after correction of hyponatraemia. Ann Intern Med 1997; 126:57–62.
3. Ellis SJ. Severe hyponatraemia: complications and treatment.Q J Med 1995; 88:905–9.
4.
Gill G, Leese G. Hyponatraemia: biochemical and clinical perspectives. Postgrad Med J 1998; 74:516–23.
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