Hyponatremia in Legionnaires' Disease

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To the editor: The article of Dr. Kirby and associates (1) on legionnaires' disease mentions hyponatremia as a common laboratory finding in their 24 patients with Legionnaires' disease. They attribute this to possible inappropriate secretion of antidiuretic hormone secondary to bacterial pneumonia. Fourteen of their 24 patients had serum sodium levels of less than 130 meq/litre.

I believe this may be otherwise explained, with the information given for 13 of the 14 patients. Six patients had evidence of renal impairment; five had cardiopulmonary disease, implying possible abnormal volume status, or the use of diuretics as part of their therapy; two

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