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correspondence

Indian Pediatr 2010;47: 284

Reply


M Jayashree and Sunit Singhi

Division of Pediatric Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh. 
 


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.
 

 

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