title: A Case of Osmotic Demyelination Presenting with Severe Hypernatremia.
abstract: Osmotic demyelination syndrome is a demyelinating disorder associated with rapid correction of hyponatremia. But, it rarely occurs in acute hypernatremia, and it leads to permanent neurologic symptoms and is associated with high mortality. A 44-year-old woman treated with alternative medicine was admitted with a history of drowsy mental status. Severe hypernatremia (197mEq/L) with hyperosmolality (415mOsm/kgH2O) was evident initially and magnetic resonance imaging revealed a high signal intensity lesion in the pons, consistent with central pontine myelinolysis. She was treated with 0.45% saline and 5% dextrose water and intravenous corticosteroids. Serum sodium normalized and her clinical course gradually improved. Brain lesion of myelinolysis also improved in a follow-up imaging study. This is the first report of a successful treatment of hypernatremia caused by iatrogenic salt intake, and it confirms the importance of adequate fluid supplementation in severe hypernatremia.
authors.affiliation: Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Min Jee
authors.initials: MJ
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Incheon Christian Hospital, Incheon, Korea.
authors.forename: Do Hyoung
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Incheon Christian Hospital, Incheon, Korea.
authors.forename: Young Hwa
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Incheon Christian Hospital, Incheon, Korea.
authors.forename: In Mo
authors.initials: IM
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Incheon Christian Hospital, Incheon, Korea.
authors.forename: Joon Hyung
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, National Rehabilitation Center, Seoul, Korea.
authors.forename: Moon Ki
authors.initials: MK
authors.lastname: Hong
keywords: Hypernatremia; Magnetic resonance imaging; Osmotic demyelination syndrome