Marked Hypernatremia and Hyperchloremia with Damage to the Central Nervous System

Abstract

The recent paper of Schoolman and coworkers ¹ on the syndrome of hypernatremia and hyperchloremia* draws the categorical conclusion, "the treatment of hypernatremia is the intravenous or oral administration of non-saline fluids. Such treatment is usually successful except in cases of central nervous system injury severe enough to produce death." We take issue with this conclusion, since it suggests that this treatment should be followed for all cases in which the high-salt syndrome is observed. It is our contention that if this treatment is pursued, in certain cases, to its logical conclusion it will result in salt depletion and its attendant sequelae, before the sodium and chloride levels are brought to what is considered "normal" levels for the healthy person. As typical examples, two cases are cited. Case 1. †—A 3-month-old infant was admitted because of lack of gain in weight and dehydration. Birth weight was 7 lb., 12 oz.;