Central Pontine and Extrapontine Myelinolysis following Correction of Severe Hyponatremia

Abstract

A chronically hyponatremic patient developed neurological features of pontine level disconnection following the raising of serum sodium. At autopsy histopathological examination confirmed the presence of myelinolysis in the central pons and similar symmetrical lesions in the thalamus. In chronic hyponatremic patients, more than the rapidity of correction, the magnitude of the osmolar change may predispose to development of these lesions.

Biochemical and etiological characteristics of acute hyponatremia in the emergency department

“…Prompt correction is warranted to prevent these life-threatening complications (4 -7). In contrast, osmotic demyelination syndrome (ODS) may occur with rapid correction in patients with chronic hyponatremia, defined as that developing over more than 48 h (9,10). In clinical practice, when faced with a patient with neurological symptoms and hyponatremia, a wide spectrum of diseases needs to be excluded first to eliminate their causative relationship.…”

Central Pontine and Extrapontine Myelinolysis after Rapid Correction of Hyponatremia by Hemodialysis in a Uremic Patient

“…One patient with severe hyponatremia (serum sodium, 104 meq/L) developed osmotic demyelination syndrome following lockedin status four days after hemodialysis. [4] However, this patient also had chronic malnutrition and was an alcoholic, both of which are risk factors for CPM. The patient in this report has an initial serum sodium concentration of 100 mEq/L.…”

“…[4] Uremia was considered a possible protective factor. A recent report described a patient with acute on chronic renal failure and hyponatremia who tolerated hemodialysis well without any neurological effects despite a serum correction of sodium rate of 3 mEq/L/hr.…”

Successful Treatment of Extreme Hyponatremia in an Anuric Patient Using Continuous Venovenous Hemodialysis

“…Thus, intermittent hemodialysis would be expected to result in a rapid rise in the serum sodium level in cases of severe predialytic hyponatremia. Nonetheless, only two cases of osmotic demyelination syndrome following rapid correction of severe hyponatremia with hemodialysis have been reported [13,14]. In one of these cases [13], the serum sodium concentration increased by 35 mmol/l over 4 days, and in the other case [14], the serum sodium level rose by 21 mmol/l following a single hemodialysis session.…”

“…Nonetheless, only two cases of osmotic demyelination syndrome following rapid correction of severe hyponatremia with hemodialysis have been reported [13,14]. In one of these cases [13], the serum sodium concentration increased by 35 mmol/l over 4 days, and in the other case [14], the serum sodium level rose by 21 mmol/l following a single hemodialysis session. In addition, a singe case of fatal osmotic demyelination syndrome in a patient with chronic renal failure and severe hyponatremia that was rapidly corrected by peritoneal dialysis has been reported [15].…”