title: Osmotic demyelination syndrome after correction of chronic hyponatremia with normal saline.
abstract: 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.
authors.affiliation: Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. l521116@ndmctsgh.edu.tw
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
authors.forename: Tom
authors.initials: T
authors.lastname: Chau
authors.forename: Chia-Chao
authors.initials: CC
authors.lastname: Wu
authors.forename: Sung-Sen
authors.initials: SS
authors.lastname: Yang
mesh_terms: 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
chemical_list: D001581:Benzothiadiazines; D004232:Diuretics; D012462:Saline Solution, Hypertonic; D049993:Sodium Chloride Symporter Inhibitors