Electrolyte Disturbances in Chronic Alcohol-Use Disorder

To the Editor: We agree with Palmer and Clegg (Oct. 5 issue) 1 that improper treatment of hyponatremia in patients with liver disease can produce cerebral demyelination, as reported by us 2 and others. Moreover, another factor promoting demyelination is a hypoxic or anoxic episode before treatment of hyponatremia. 2 In animals with normonatremia, hypoxia produces demyelination. 3 However, a safe approach for the therapy of hyponatremic encephalopathy in patients with liver disease should be revisited. In our practice, we have used a 100-ml bolus of 3% saline rather than a continuous infusion. 4 This can be repeated one or two times in sequential fashion . . .