Introduction

The kidney is important in the pathogenesis of hyponatremia, but the target organ for sequelae which produce morbidity and mortality is the brain. Brain edema associated with hyponatremia can result in several devastating clinical entities, such as pulmonary edema, central diabetes insipidus, cerebral infarction, cortical blindness, and a persistent vegetative state. Seizures, coma, and death in patients with hyponatremia have been described for over 60 years, as has recovery following active treatment with hypertonic NaCl. Although it was often perceived that hyponatremic deaths were due to associated underlying medical conditions, it has become clear over the last decade that hyponatremic encephalopathy can progress to death or permanent brain damage in otherwise healthy individuals ( Fraser... and...Arieff...1990; Ayus.etal' 1992).

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