Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation

Lee, Eun Mi; Kang, Joong Koo; Yun, Sangwon; Kim, Ki‐Hun; Kim, Sang Joon; Hwang, Kyu-Sam; Lee, Sung‐Gyu

doi:10.1159/000242426

Cited by 78 publications

(79 citation statements)

References 58 publications

(43 reference statements)

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“…CPM is defined pathologically as a symmetric area of myelin disruption in the center of the basis pontis and shows characteristic findings on imaging studies: 1. MRI findings of symmetric hypointense signals in T1-weighted images and hyperintense signals in T2-weighted images in the central pons; 2. diffusion-weighted MR showing hyperintensities in the central pons with decreased apparent diffusion coefficient values in the same areas; 3. brain CT showing low density in the central pons (Kumar et al 2006;Lee et al 2009). Although we could not find definite cases of CPM or patients with permanent neurologic sequelae in the medical records, cases with minor symptoms that resolved might have existed.…”

Section: Discussionmentioning

confidence: 99%

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Lee

et al. 2013

Tohoku J. Exp. Med.

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Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation. However, the clinical significance of correction rate of hyponatremia is not well investigated. The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed. A total of 512 patients who received orthotopic liver transplants were enrolled. The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation. Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/ L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.

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Section: Discussionmentioning

confidence: 99%

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Lee

et al. 2013

Tohoku J. Exp. Med.

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“…Serum albumin is very important to keep serum colloid osmolality. Liver dysfunction has been reported to be a risk factor for CPM [5]. Serum levels of BUN, sodium and glucose have been used for calculation of serum osmolality, indicating an importance of these parameters for serum osmolality [6].…”

Section: Discussionmentioning

confidence: 99%

The Development of Central Pontine Myelinolysis in a Type 1 Diabetic Patient With Anti-Insulin Antibody and Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome

Yoshikawa¹

2012

J Endocrinol Metab

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Central pontine myelinolysis is a demyelinating disorder, which is commonly associated with the rapid correction of hyponatremia. We repot an 84-year-old type 1 diabetic woman with high level of anti-insulin antibody, who developed central pontine myelinolysis, in spite of a careful correction of hyponatremia. We believe that high level of anti-insulin antibody and similar clinical manifestations to autoimmune polygrandular syndrome such as Candidiasis, hypothyroidism, type 1 diabetes and liver cirrhosis possibly due to autoimmune hepatitis may be associated with the development of central pontine myelinolysis.

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“…15,25,27,31,37 In the presence of these conditions, correction of serum sodium should not exceed 6 mEq/L in any 24-hour period. Fear of inducing osmotic demyelination from overcorrection of hyponatremia caused by excessive aquaresis has prompted the recommendation of treating severe hyponatremia with the combination of hypertonic saline and desmopressin.…”

Section: Therapeutic Principlesmentioning

confidence: 99%

The Challenge of Hyponatremia

Adrogué

Madias

2012

Journal of the American Society of Nephrology

136

172

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Treatment of hypotonic hyponatremia often challenges clinicians on many counts. Despite similar serum sodium concentrations, clinical manifestations can range from mild to life threatening. Some patients require active management, whereas others recover without intervention. Therapeutic measures frequently yield safe correction, yet the same measures can result in osmotic demyelination. To address this challenge, we present a practical approach to managing hyponatremia that centers on two elements: a diagnostic evaluation directed at the pathogenesis and putative causes of hyponatremia, the case-specific clinical and laboratory features, and the associated clinical risk; and a management plan tailored to the diagnostic findings that incorporates quantitative projections of fluid therapy and fluid losses on the patient's serum sodium, balances potential benefits and risks, and emphasizes vigilant monitoring. These principles should enable the clinician to formulate a management plan that addresses expeditiously three critical questions: Which of the determinants of the serum sodium are deranged and what is the underlying culprit? How urgent is the need for intervention? What specific therapy should be instituted and which are the associated pitfalls?

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Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation

Cited by 78 publications

References 58 publications

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

The Development of Central Pontine Myelinolysis in a Type 1 Diabetic Patient With Anti-Insulin Antibody and Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome

The Challenge of Hyponatremia

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