Correction of hyponatremia and osmotic demyelinating syndrome: have we neglected to think intracellularly?

Pham, Phuong Mai T.; Pham, Phuong Anh; Pham, Son V.; Pham, Phuong Truc T.; Pham, Phuong Thu; Pham, Phuong Chi T.

doi:10.1007/s10157-014-1021-y

Cited by 19 publications

(19 citation statements)

References 34 publications

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“…The substance exchange through vascular wall increased and damaged nerve myelin sheath cell. At the same time, the elevation of serum sodium concentration associated with serum osmotic changes by a large fluctuation, may be break up the steady state of cell volume [10]. It then developed central nervous myelinolysis diseases.…”

Section: Discussionmentioning

confidence: 99%

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Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

Wang

Jiang

Zhang³

et al. 2018

Chin Neurosurg Jl

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Background: The extrapontine myelinolysis (EPM) of osmotic demyelination syndrome (ODS) is a rare and dangerous disorder of the central nervous system. The mechanism is not fully understood and the treatment is controversial. There are few reports of EPM occurred after endonasal endoscopic resection of pediatric craniopharyngioma. Case presentation: We report two unusual cases of such a rare condition. Both are procedured uneventful endonasal endoscopical craniopharyngioma resection, after operation, the patients suffered serious diabetic insipidus with remarkable fluctuation of serum sodium though we applied pitutrin continual management to maintain everyday normal urine and correct serum sodium disorder. MR images occured caudal and lentiform nuclei myelinolysis following these serious conditions. Conclusions: In this study relevant literatures are reviewed in order to further understand this complication and contribute to the prevention and treatment of EPM caused by inappropriate correction of serum sodium disorder.

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Section: Discussionmentioning

confidence: 99%

“…It then developed central nervous myelinolysis diseases. And hypertonic stress leads to cell death in variety of cell types, particulaly oligodendrocytes [10]. Associated with the coexsiting factors, such as malnutrition, alcoholism, and so on, contribute to this process.…”

Section: Discussionmentioning

confidence: 99%

Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

Wang

Jiang

Zhang³

et al. 2018

Chin Neurosurg Jl

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“…Potassium is an osmotically active solute like sodium and the repletion of low potassium levels will increase the serum osmolality and result in the shifting of sodium from intracellular to extracellular space [ 16 ]. Monitoring and provision of other osmotically active substrates such as serum phosphate and magnesium are also necessary in the correction of hyponatremia by reducing osmolality differences between compartments [ 17 ]. Our patient was managed with the guiding principle that the serum sodium concentration should be corrected at a rate of no more than 10 meq/L in the first 24 hours, 18 meq/L in the first 48 hours, and 20 meq/L in the first 72 hours to prevent iatrogenic brain injury and central pontine myelinolysis [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Approach to the Management of Severe Asymptomatic Hyponatremia

Ijaiya

Manohar

Lakshmi

2017

Case Reports in Nephrology

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Hyponatremia is an electrolyte imbalance encountered commonly in the hospital and ambulatory settings. It can be seen in isolation or present as a complication of other medical conditions. It is therefore a challenge to determine the appropriate therapeutic intervention. An understanding of the etiology is key in instituting the right treatment. Clinicians must not be too hasty to correct a random laboratory value without first understanding the physiologic principle. We present such a case of a patient who presented with sodium of 98 mmol/L, the lowest recorded in the current literature, and yet was asymptomatic. Following appropriate management driven by an understanding of the underlying pathophysiologic mechanism, the patient was managed to full recovery without any clinically significant neurological sequelae.

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“…Hypophosphatemia may be a risk factor for ODS [ 3 ]. Our routine hyponatremia treatment protocol requested a STAT level, which was likely life-saving.…”

Section: Discussionmentioning

confidence: 99%

Multiple Electrolyte and Metabolic Emergencies in a Single Patient

Cadacio

Pham

Bhasin

et al. 2017

Case Reports in Nephrology

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While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [SNa] 107 mEq/L), hypophosphatemia (“undetectable,” <1.0 mg/dL), and hypokalemia (2.2 mEq/L), moderate diabetic ketoacidosis ([DKA], pH 7.21, serum anion gap [SAG] 37) and hypocalcemia (ionized calcium 4.0 mg/dL), mild hypomagnesemia (1.6 mg/dL), and electrocardiogram with prolonged QTc. Following two liters of normal saline and associated increase in SNa by 4 mEq/L and serum osmolality by 2.4 mosm/Kg, renal service was consulted. We were challenged with minimizing the correction of SNa (or effective serum osmolality) to avoid the osmotic demyelinating syndrome while replacing volume, potassium, phosphorus, calcium, and magnesium and concurrently treating DKA. Our management plan was further complicated by an episode of significant aquaresis. A stepwise approach was strategized to prioritize and correct all disturbances with considerations that the treatment of one condition could affect or directly worsen another. The current case demonstrates that a thorough understanding of electrolyte physiology is required in managing complex electrolyte disturbances to avoid disastrous outcomes.

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Correction of hyponatremia and osmotic demyelinating syndrome: have we neglected to think intracellularly?

Cited by 19 publications

References 34 publications

Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

Therapeutic Approach to the Management of Severe Asymptomatic Hyponatremia

Multiple Electrolyte and Metabolic Emergencies in a Single Patient

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