Therapy of Hyponatremia: End of Era or Minority Report?

Ahmed N Ghanem*

Received: November 21, 2018;   Published: December 03, 2018

DOI: 10.26717/BJSTR.2018.11.002130

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Abstract

I congratulate the authors on their success in investigating and treating this case of severe hyponatremia (HN) [BMJ 2008;337: a2377]. I admire the impressive style and delightfully stimulating “Endgame” analysis. The report highlighted hormonal pathways that play vital role in the patho-physiology and replacement/ maintenance therapy of secondary HN of Sheehan Syndrome (SS). The case report seems impeccable but appraisal/criticism using scientific reasoning analysis illustrates the multidimensional complexity of HN puzzle. It demonstrates how the primary insult causing SS and its secondary HN remains obscure that may be a different primary cause of HN. In sport spirit, may I contribute thoughts to this intellectual “Endgame” analysis? I have spent my career life seriously studying, analysing and resolving the puzzle of HN starting with that of the transurethral resection of the prostate (TURP) syndrome [1] and beyond [2]. The first reported case of HN as the TURP syndrome [3] was made possible after serum sodium estimation became available in clinical practice- as based on previous original animal research work [4].

Abbreviations : SS: Sheehan Syndrome; TURP: Transurethral Resection of the Prostate; ADH: Anti-Diuretic Hormone; ARF: Acute Renal Failure; VO: Volumetric Overload; HST: Hypertonic Sodium Therapy