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Sveinsson ÓÁ, Pálsson R
Central and extrapontine myelinolysis following correction
of extreme hyponatremia. Case report and review of the literature
We report a case of a 43-year-old woman who developed
osmotic demyelination syndrome following correction
of extreme hyponatremia that was considered to be of
chronic nature. The serum sodium level was 91 mmol/L
on admission to hospital. It was decided to correct
the serum sodium slowly with the goal that the rate of
correction would be no more than 12 mmol/l per 24 hours.
This was achieved during the first two days of treatment
but during the third day the rise in serum sodium was 13
mmol/l. On the 11 th day of admission the patient had
developed manifestations of pseudobulbar palsy and
spastic quadriparesis. Magnetic resonance imaging study
confirmed central and extrapontine myelonolysis. The
patient received supportive therapy and eventually made
full recovery. Current concepts in the pathophysiology of
osmotic demyelination syndrome and the treatment of
hyponatremia are reviewed. We recommend that the rate
of correction of chronic hyponatremia should not exceed 8
mmol/l per 24 hours.
Keywords Central pontine myelinolysis, cerebral adaptation, hyponatremia, osmotic demyelination syndrome.
Correspondence Runólfur Pálsson, runolfur&landspitali.is
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