I read every word of the recent Editor’s Roundtable on hyponatremia and the role of vasopressin antagonists, a fascinating review of physiology as well as pathophysiology. Franny Moore (a remarkable surgeon!) was the first to show, in the early 1950s, that many chronic diseases, including heart failure, demonstrated the paradox of low serum sodium but an increase in total body sodium and water.

As a medical intern at Brigham in 1952 and 1953, I had a patient with this combination, which I recognized but my resident unfortunately did not, and he required me to administer 3% sodium chloride, despite my written objection that it would lead to pulmonary edema. Sadly, I was correct.

It is encouraging to learn that a much better treatment is now available with vasopressin antagonists.