Treatment of Water Intoxication With Mannitol

Sir.—We read with interest the article by Keating et al,¹ published in the September 1991 issue of AJDC. We certainly agree with the authors' conclusion that this entity is underreported and may constitute a major problem within the poverty-stricken inner-city population. However, we would like to suggest an alternative mode of therapy that we have used during the past 8 years to treat the cerebral edema that can result from acute water intoxication. The following is an example of our treatment regimen.

Report of a Case.—A 3-month-old previously healthy and neurologically normal male child of an unmarried, borderline mentally retarded 15-year-old girl presented to the emergency department with tonic-clonic movements of all extremities followed by lethargy. The rectal temperature was 34.9°C; heart rate, 108 beats per minute; respiratory rate, 40 breaths per minute; and blood pressure, 89/40 mm Hg. The infant did not have respiratory difficulty, was