Hyponatremia During ACTH Infusions

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Although we have found the 48-h ACTH test of Rose and associates (1) to be an excellent diagnostic tool, in three cases, the infusion of ACTH in 5% dextrose in water produced severe hyponatremia despite dexamethasone therapy. Rose and associates had identified this problem and advised care in doing the test. However, standard textbooks either do not mention the intravenous fluid to be used or recommend dextrose in water (2, 3); some pharmaceutical literature recommends 5% dextrose in water (4, 5).

Forty units of ACTH (acthar) added to 500 mL of 5% dextrose in water was used as the infusing

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