Osmotic myelinolysis following chronic hyponatremia corrected at an overall rate consistent with current recommendations.
Rapid correction of chronic hyponatremia (CH) may lead to the development of osmotic myelinolysis (OM), a condition with high mortality and high incidence of devastating neurological sequelae. Treatment guidelines suggest "safe" overall rates of correction of serum sodium concentration ([Na](s)) over the first 24 and 48 hours of treatment of CH. We report a patient with CH who developed fatal OM despite overall rates of correction of [Na](s) that were within the recommended rates. The potential risk factors for the development of OM in this patient included short (within a few hours) rises in [Na](s) exceeding 0.5 mmol/l per hour and the presence of severe protein malnutrition. We suggest that the rate of correction of [Na](s) in CH should be uniformly slow and that the overall rate of correction should be slower than the currently recommended rate in severely malnourished patients.
Dellabarca
Casey
C
Medicine Service and Radiology Service, New Mexico Veterans Affairs Health Care System, University of New Mexico School of Medicine, Albuquerque, New Mexico 87108, USA.
Servilla
Karen S
KS
Hart
Blaine
B
Murata
Glen H
GH
Tzamaloukas
Antonios H
AH
D000368:Aged; D001921:Brain / Q000473:pathology; D002908:Chronic Disease; D017809:Fatal Outcome; D006801:Humans; D007010:Hyponatremia / Q000150:complications* / Q000628:therapy; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis / Q000209:etiology*; D011502:Protein-Energy Malnutrition / Q000150:complications; D012965:Sodium Chloride / Q000008:administration & dosage*
D012965:Sodium Chloride