Osmotic demyelination syndrome after correction of chronic hyponatremia with normal saline.
Rapid correction of severe chronic hyponatremia with hypertonic saline has been known to cause osmotic demyelination syndrome (ODS). Less recognized are the dangers of rapid correction with normal saline. A 60-year-old woman on thiazide diuretics for hypertension presented with profound hyponatremia (94 mmol/L) and hypokalemia (1.9 mmol/L) associated with volume depletion. Normal saline (2 L/day) and (KCl 40 mmol/day) were given for 5 days. Serum Na+ concentration rose to 106 mmol/L within 18 hours. With improvement of her hyponatremia, she became more alert although the hypokalemia persisted. However, she developed progressive obtundation, quadriplegia, and respiratory failure 6 days later. Magnetic resonance imaging of the brain clearly showed typical features of pontine and extrapontine myelinolysis. We suggest that the aggressive KCl supplement would have been the first-line therapy for this patient presenting with chronic hyponatremia and hypokalemia associated with volume depletion.
Lin
Shih-Hua
SH
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. l521116@ndmctsgh.edu.tw
Chau
Tom
T
Wu
Chia-Chao
CC
Yang
Sung-Sen
SS
D001581:Benzothiadiazines; D002908:Chronic Disease; D020278:Demyelinating Autoimmune Diseases, CNS / Q000139:chemically induced* / Q000473:pathology; D004232:Diuretics; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007008:Hypokalemia / Q000139:chemically induced; D007010:Hyponatremia / Q000139:chemically induced / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012462:Saline Solution, Hypertonic / Q000009:adverse effects*; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects; D013577:Syndrome
D001581:Benzothiadiazines; D004232:Diuretics; D012462:Saline Solution, Hypertonic; D049993:Sodium Chloride Symporter Inhibitors