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Hyponatremia in congestive heart failure occurs principally in the terminal phases of the natural history of heart disease. Fortunately, in some instances it may occur as a transient event in a setting of sudden deterioration in cardiac function. In such instances, it may be reversible. The most important factor in the occurrence of hyponatremia in these patients is an inordinate retention of water. Thus, the hyponatremia is the result of dilution. Correction of hyponatremia requires the elimination of water in excess of sodium. The futility and dangers of the use of hypertonic sodium chloride are emphasized. A method of controlled administration of mercurial diuretics after elevation of the plasma chlorides toward normal with consequent production of acidosis with chloride salts is reviewed. Diuresis following this procedure results in sodium losses in urine that are hypotonic in relation to plasma. The plasma sodium gradually returns to normal, and the patient progressively loses weight.

The Correction of Hyponatremia in Congestive Heart Failure