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Surgical Hyponatremia

Charles L. Witte, MD; Marlys H. Witte, MD
JAMA. 1981;246(3):213. doi:10.1001/jama.1981.03320030011008.
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To the Editor.—  During the course of teaching fluid and electrolyte management to medical students and in everyday clinical care on a surgical service, we have observed a potentially dangerous phenomenon in adult patients undergoing abdominal operations. We have traced the development of this phenomenon to misuse of hypoosmotic salt solutions and termed it "surgical hyponatremia."Fifteen years ago, crystalloid solutions available for replacement infusion were limited to isoosmotic (5%) dextrose in water (D5W), normal or 0.9% saline solution (NS), and lactated Ringer's (RL). In the averagesized adult patient without oral intake after laparotomy, it was commonplace to administer 1,500 mL D5W daily to offset insensible water loss and to maintain adequate urinary output. Normal saline solution or RL, on the other hand, was provided to replace isoosmotic losses from other sites, artificial or natural, and to cover sequestered edema in newly created wounds. After an uncomplicated operation this added


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