We thank Jain and Manchanda for their interest in our paper and raising
valid issues regarding the fall of serum sodium and electrolyte free water
(EFW) intake.
In Fig.1 of our paper, we have depicted
the observed relationship between fall of serum sodium and electrolyte
free water intake. The line which runs diagonally is a theoretical line
depicting expected fall in sodium following addition of EFW. Jain and
Manchanda have provided a figure along with a regression line. We thank
them for this effort. Their figure depicts the same point which we have
emphasized in our paper i.e., fall in serum sodium was not related
to volume of EFW intake.
We also tried to look into the suggestion given by them
regarding a similar figure for normonatremic patients to substantiate the
hypothesis that fall in sodium is inversely related to EFW intake. This
exercise seems improbable as it was difficult to get values for ‘X’ axis
that represents fall in serum sodium. In the normonatremic group serum
sodium changes were less dramatic and stayed within normal range. Table
II of our paper, however clearly shows that the EFW intake (mL/kg/day)
is inversely related to development of hyponatremia. EFW intake (mL/kg/day)
in hyponatremic patients in the pre-hyponatremic phase was significantly
lower than in patients without hyponatremia. (A vs C, 70.7 mL/kg/day
vs 83.2 mL/kg/day; P=0.0001). Hence it seems that the
development of hyponatremia was possibly related to factors other than EFW
excess alone.