To the Editor: I congratulate Al-Absi et al on an excellent review of the concepts and management of hypernatremia. As the authors point out, when hypervolemic hyponatremia is encountered, sodium-rich urine must be diuresed in an attempt to induce a negative sodium balance in excess of the negative water balance to bring down plasma sodium level and subsequently total-body volume. Could this goal not be achieved better with thiazide-group diuretics, either alone or alternating with loop diuretics? By promoting proximal water reabsorp-tion and upregulating distal aquaporin 2 channels, thiazides might help avoid the need to give simultaneous hypotonic infusions, especially in outpatients and/or nursing home residents.
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