Reply from the Authors

Reply from the Authors: We thank Dr. Goldman for his comments regarding the importance of postoperative hyponatremia. Unfortunately, he had the impression there was a contradiction in terms regarding our recommendations for the therapy for this disorder. In fact, the method of therapy for patients such as those described by Goldman is straightforward and described on page 326. ^[1] When the patient has a plasma sodium of 120 mmol/L with symptoms, therapy is as follows: move the patient to an ICU setting; infuse 514 mmol/L NaCl as described ^[1,4] such that plasma sodium increases by no more than 25 mmol/L in the initial 48 hours, or the patient becomes asymptomatic. If the patient's plasma sodium is about 120 mmol/L, it should only be increased by 10 to 15 mmol/L in the initial 48 hours of therapy. However, the initial 10 mmol/L, particularly if the patient has respiratory insufficiency, ^[5] should probably be done during the initial 5 to 10 hours of treatment. The misunderstanding of Dr. Goldman appears to be that the plasma sodium had to be increased by 25 mmol/L in the initial 48 hours. …