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Niida S, Ogawa F, Nakajima K, Sakai K, Uchiyama M, Abe T, Takeuchi I. A Case of Central Pontine Myelinolysis Occurred During Treatment of Hyperosmolar Hyperglycemic Syndrome. Int Med Case Rep J 2021; 14:407-412. [PMID: 34177275 PMCID: PMC8219389 DOI: 10.2147/imcrj.s316943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/04/2021] [Indexed: 12/05/2022] Open
Abstract
Central pontine myelinolysis (CPM) is a rare demyelinating condition which has been reported to occur in a variety of clinical settings, but most commonly in association with a rapid rise in plasma osmolality during correction of chronic hyponatremia. The clinical consequences can vary from a mild motor weakness that resolves completely over time to the devastating locked-in syndrome. In this presentation, we report a case of hyperosmolar hyperglycemic syndrome (HHS) with ponto-occipital disintegration. A 71-year-old female was transferred to our ER by an ambulance due to consciousness disorder and continuous fever for 10 days. We diagnosed septic shock caused by urinary tract infection (UTI), cerebral multiple infarctions, acute kidney injury (AKI) and HHS without treatment for diabetes. Then, we started therapeutic interventions for them based on the guideline with severe control for blood sugar (BS; primary 1635 mg/dl) under insulin therapy and hypernatremia (primary 153 mEq/l) under crystal infusion control in advanced care unit, apparently on routine lab data. However, the initial serum sodium value of 153 mEq/l was slowly compensated to 148 mEq/l in 60 hours under guideline on routine lab data, the initial compensated sodium value with osmolality was changed from 178 mEq/l to 150 mEq/l in the period. She recovered from her primary diagnosis and unconsciousness. After stabilized sepsis and HHS, we detected CPM on brain MRI due to following up multiple cerebral infarctions with left leg paralysis and verbal disorder. She gradually recovered over several months with intensive rehabilitation and eventually regained near normal functional capacity with stabilized BS. When we consider HHS with hypernatremia, it may be necessary to pay attention to not only to BS control and sodium control according to the guideline but also to osmolality changes to prevent CPM.
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Affiliation(s)
- Shoko Niida
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Fumihiro Ogawa
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuya Sakai
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Munehito Uchiyama
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
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Decaux G. Approach to and management of abnormalities in plasma sodium. Acta Clin Belg 2019; 74:7-20. [PMID: 30311550 DOI: 10.1080/17843286.2018.1531616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The differential diagnosis between hypertonic, isotonic and hypotonic hyponatremia are presented. The help of some usual serum (urea, uric acid and TCO2) and urine parameters (mainly osmolality and sodium concentration) are discussed and help to determine the best treatment. Morbidity associated with untreated hyponatremia and with the different treatment available is also discussed. Who to prevent and treat ODS (osmotic demyelating syndrome) is recalled. The pathophysiology and treatment of hypernatremia are also discussed.
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Affiliation(s)
- G. Decaux
- Service de Médecine Interne, Hôpital Universitaire Erasme, Bruxelles, Belgium
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Marshall DC, Salciccioli JD, Goodson RJ, Pimentel MA, Sun KY, Celi LA, Shalhoub J. The association between sodium fluctuations and mortality in surgical patients requiring intensive care. J Crit Care 2017; 40:63-68. [PMID: 28347943 DOI: 10.1016/j.jcrc.2017.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/04/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Serum sodium derangement is the most common electrolyte disturbance among patients admitted to intensive care. This study aims to validate the association between dysnatremia and serum sodium fluctuation with mortality in surgical intensive care patients. METHOD We performed a retrospective analysis of the Medical Information Mart for Intensive Care II database. Dysnatremia was defined as a sodium concentration outside physiologic range (135-145mmol/L) and subjects were categorized by severity of dysnatremia and sodium fluctuation. Univariate and multivariable logistic regressions were used to test for associations between sodium fluctuations and mortality. RESULTS We identified 8600 subjects, 39% of whom were female, with a median age of 66years for analysis. Subjects with dysnatremia were more likely to be dead at 28 days (17% vs 7%; P<.001). There was a significant association between sodium fluctuation and mortality at 28 days (adjusted odds ratio per 1mmol/L change, 1.10 [95% confidence interval, 1.08-1.12; P<.001]), even in patients who remained normotremic during their intensive care unit stay (1.12 [95% confidence interval, 1.09-1.16; P<.001]) CONCLUSIONS: This observational study validates previous findings of an association between serum sodium fluctuations and mortality in surgical intensive care patients. This association was also present in subjects who remained normonatremic throughout their intensive care unit admission.
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Affiliation(s)
- Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK.
| | - Justin D Salciccioli
- Academic Foundation Program, Northeast Thames Foundation School, London, UK; Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Ross J Goodson
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Marco A Pimentel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Kristi Y Sun
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Leo Anthony Celi
- Beth Israel Deaconess Medical Centre, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK
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Liamis G, Filippatos TD, Elisaf MS. Evaluation and treatment of hypernatremia: a practical guide for physicians. Postgrad Med 2016; 128:299-306. [PMID: 26813151 DOI: 10.1080/00325481.2016.1147322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypernatremia (serum sodium concentration >145 mEq/L) is a common electrolyte disorder with increased morbidity and mortality especially in the elderly and critically ill patients. The review presents the main pathogenetic mechanisms of hypernatremia, provides specific directions for the evaluation of patients with increased sodium levels and describes a detailed algorithm for the proper correction of hypernatremia. Furthermore, two representative cases of hypovolemic and hypervolemic hypernatremia are presented along with practical clues for their proper evaluation and treatment. Accurate diagnosis and appropriate treatment is crucial since undercorrection or overcorrection of hypernatremia are both associated with poor patients' prognosis.
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Affiliation(s)
- George Liamis
- a Department of Internal Medicine , School of Medicine, University of Ioannina , Ioannina , Greece
| | - Theodosios D Filippatos
- a Department of Internal Medicine , School of Medicine, University of Ioannina , Ioannina , Greece
| | - Moses S Elisaf
- a Department of Internal Medicine , School of Medicine, University of Ioannina , Ioannina , Greece
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Bhatia S, Kapoor AK, Sharma A, Gupta R, Kataria S. Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia. Indian J Radiol Imaging 2014; 24:57-60. [PMID: 24851006 PMCID: PMC4028916 DOI: 10.4103/0971-3026.130697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extrapontine myelinolysis, a fairly common metabolic disorder, is associated with neurological complications. Central pontine and extrapontine myelinolysis are commonly recognized with rapid correction of sodium. Myelinolysis, however, has rarely been described with hypernatremia. We report a rare case of post-partum hypernatremic encephalopathy associated with serum sodium levels as high as 200 mEq/l on presentation. Although the serum sodium levels were brought down gradually, subsequent imaging showed progression of demyelination and deterioration of the neurological status.
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Affiliation(s)
- Sonia Bhatia
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Abhay Kumar Kapoor
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Anurag Sharma
- Department of Internal Medicine, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Rajiv Gupta
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Sushila Kataria
- Department of Internal Medicine, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
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Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care 2013; 28:216.e11-20. [DOI: 10.1016/j.jcrc.2012.05.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/12/2012] [Accepted: 05/09/2012] [Indexed: 02/07/2023]
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Ismail FY, Szóllics A, Szólics M, Nagelkerke N, Ljubisavljevic M. Clinical semiology and neuroradiologic correlates of acute hypernatremic osmotic challenge in adults: a literature review. AJNR Am J Neuroradiol 2013; 34:2225-32. [PMID: 23413245 DOI: 10.3174/ajnr.a3392] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The complex interplay between hypernatremic osmotic disturbances and cerebral lesions is yet to be clarified. In this review, we discuss, on the basis of the reported data of hypernatremic CNS challenge in the adult population, the clinical and radiologic features of the condition. Our search captured 20 case studies and 1 case series with 30 patients in total who acquired acute hypernatremia due to different etiologies and developed CNS lesions. We explored the associations between premorbid conditions, clinical presentation, hypernatremic state, correction rate, and radiologic appearance, including the localization of brain lesions and the outcomes. The results revealed that altered mental status was the most commonly reported symptom and osmotic demyelination syndrome in the form of extrapontine myelinolysis was the prevailing radiologic pattern. Finally, we contrasted, when appropriate, clinical and experimental data related to hypernatremic and hyponatremic osmotic insults to aid the understanding of the pathophysiology of CNS osmotic brain injury.
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Hegazi MO, Mashankar A. Central pontine myelinolysis in the hyperosmolar hyperglycaemic state. Med Princ Pract 2013; 22:96-9. [PMID: 22922267 PMCID: PMC5586714 DOI: 10.1159/000341718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/02/2012] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To report a rare association of central pontine myelinolysis (CPM) with hyperosmolar hyperglycaemic state (HHS). CLINICAL PRESENTATION AND INTERVENTION A diabetic female presented with HHS and prolonged severe hypernatraemia. The metabolic derangement was adequately treated with proper correction of both hyperglycaemia and hypernatraemia. Lack of improvement in the presenting confusional state and the development of a fresh neurological deterioration led to the suspicion of CPM that was confirmed with magnetic resonance imaging. She fully recovered after 4 weeks with no specific medical treatment. CONCLUSION This case report showed that osmotic demyelination was linked to hypernatraemia and that CPM could result from severe hypernatraemia of HHS.
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Fluctuations in Serum Sodium Level Are Associated With an Increased Risk of Death in Surgical ICU Patients*. Crit Care Med 2013; 41:133-42. [DOI: 10.1097/ccm.0b013e318265f576] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Levin J, Högen T, Patzig M, Pfister HW, Peters N. Pontine and extrapontine myolinolysis associated with hypernatraemia. Clin Neurol Neurosurg 2012; 114:1290-1. [DOI: 10.1016/j.clineuro.2012.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Severe hypernatremia following treatment of the syndrome of inappropriate antidiuretic hormone secretion. Am J Med Sci 2012; 343:507-9. [PMID: 22270390 DOI: 10.1097/maj.0b013e318245faaf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment strategies for hyponatremia such as hypertonic saline, normal saline with furosemide, urea, fluid restriction and demeclocycline are well established. However, these treatment modalities may themselves be associated with life-threatening complications. An important complication is rapid correction of hyponatremia with its consequent serious neurologic deficits and death. An unrecognized complication is the development of severe hypernatremia as a result of strict fluid restriction and concomitant excessive free water excretion from prolonged outpatient demeclocycline therapy. The authors report a case of a patient with hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion who developed severe hypernatremia as a result of rigid fluid restriction and demeclocycline therapy.
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Zia S, Enam A, Salahuddin I, Khan A. Role of irrigation with hypertonic saline for a recurrent skull base hydatid cyst: case report and review of the literature. EAR, NOSE & THROAT JOURNAL 2011; 89:E22-6. [PMID: 20859857 DOI: 10.1177/014556131008900906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. This disease is a rare finding in the head and neck region, and its presentation varies according to the area involved. We report the case of a 25-year-old woman who presented with bilateral neck swelling, which was found on histopathologic examination to be caused by a hydatid cyst. The patient underwent surgical drainage of the cyst and a modified radical mastoidectomy, followed by a 3-month course of treatment with albendazole. However, she experienced a recurrence in the left neck region 1 year later. At that time, reexploration of the left mastoid cavity was performed, with debridement of diseased occipital bone and foramen magnum. Intraoperatively, we used a novel method of saline irrigation with 3% hypertonic saline, previously not tested on exposed nerves, in an attempt to prevent further recurrence. Four years after the second surgery, no disease recurrence was found, and no neurologic sequelae were noted. We conclude that hypertonic saline irrigation can be considered as an option for preventing recurrence in cases that are difficult to clear surgically, especially around cranial nerves, although more studies are needed to document the safety of this approach.
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Affiliation(s)
- Sadaf Zia
- Department of Otolaryngology-Head and Neck Surgery, Liaquat National Hospital, Karachi, Pakistan.
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Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis. J Neurol Sci 2010; 291:5-11. [DOI: 10.1016/j.jns.2010.01.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/09/2010] [Accepted: 01/14/2010] [Indexed: 01/14/2023]
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Bagshaw SM, Townsend DR, McDermid RC. Disorders of sodium and water balance in hospitalized patients. Can J Anaesth 2008; 56:151-67. [PMID: 19247764 DOI: 10.1007/s12630-008-9017-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/10/2008] [Accepted: 11/18/2008] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To review and discuss the epidemiology, contributing factors, and approach to clinical management of disorders of sodium and water balance in hospitalized patients. SOURCE An electronic search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and a search of the bibliographies of all relevant studies and review articles for recent reports on hyponatremia and hypernatremia with a focus on critically ill patients. PRINCIPAL FINDINGS Disorders of sodium and water balance are exceedingly common in hospitalized patients, particularly those with critical illness and are often iatrogenic. These disorders are broadly categorized as hypo-osmolar or hyper-osmolar, depending on the balance (i.e., excess or deficit) of total body water relative to total body sodium content and are classically recognized as either hyponatremia or hypernatremia. These disorders may represent a surrogate for increased neurohormonal activation, organ dysfunction, worsening severity of illness, or progression of underlying chronic disease. Hyponatremic disorders may be caused by appropriately elevated (volume depletion) or inappropriately elevated (SIADH) arginine vasopressin levels, appropriately suppressed arginine vasopressin levels (kidney dysfunction), or alterations in plasma osmolality (drugs or body cavity irrigation with hypotonic solutions). Hypernatremia is most commonly due to unreplaced hypotonic water depletion (impaired mental status and/or access to free water), but it may also be caused by transient water shift into cells (from convulsive seizures) and iatrogenic sodium loading (from salt intake or administration of hypertonic solutions). CONCLUSION In hospitalized patients, hyponatremia and hypernatremia are often iatrogenic and may contribute to serious morbidity and increased risk of death. These disorders require timely recognition and can often be reversed with appropriate intervention and treatment of underlying predisposing factors.
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Affiliation(s)
- Sean M Bagshaw
- Department of Anesthesiology and Pain Medicine, Division of Critical Care Medicine, University of Alberta Hospital, 3C1.16 Walter C. Mackenzie Centre, 8440-112 Street, Edmonton, AB, Canada, T6G 2B7.
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Abstract
OBJECTIVE To determine if a return to normonatremia is required for symptomatology to resolve in collapsed hypernatremic runners and if intravenous (IV) administration of an isotonic solution would adversely affect serum sodium concentration ([Na+]) in collapsed normonatremic runners. DESIGN Observational study. SETTING 2006 Comrades Marathon. PARTICIPANTS 103 collapsed runners. MAIN OUTCOME MEASURE Final serum [Na] upon discharge. RESULTS 58% of all collapsed runners were hypernatremic. Hypernatremic runners reported significantly more vomiting than normonatremic runners (79 versus 34%; P < 0.001). A significant decrease in serum [Na] in hypernatremic collapsed runners occurred after the IV administration of either 1 L of 0.45% normal saline (150.5 +/- 3.5 versus 148.0 +/- 4.6; P < 0.05) or Ringers lactate solution (147.7 +/- 2.2 versus 146.2 +/- 2.1; P < 0.05). One liter of IV fluid administration caused an increase in plasma volume that was not significantly different between (1) hypernatremic runners receiving a hypotonic solution (13.5 +/- 12.7%) and (2) normonatremic runners receiving an isotonic solution (15.6 +/- 11.3%). The final serum [Na+] of hypernatremic runners was above the range for normonatremia upon discharge (>145 mmol/L). CONCLUSIONS A return to normonatremia was not required for hypernatremic runners to "recover" and be discharged from the medical tent. Vomiting either aggravated and/or facilitated the development of hypernatremia. IV administration of 1 L of either (1) a hypotonic solution to hypernatremic runners or (2) an isotonic solution to both normonatremic and hypernatremic runners did not produce any adverse biochemical or cardiovascular changes and can therefore be considered a safe and effective treatment for collapsed runners if used in this context.
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Twardowschy CA, Bertolucci CB, Gracia CDM. Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:858-64. [DOI: 10.1590/s0004-282x2007000500027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 06/11/2007] [Indexed: 11/21/2022]
Abstract
Osmotic demyelination syndrome (ODS) may be precipitated by aggressive correction of a hypo or hyper-osmolar states. We describe the case of a 53-year-old woman that was started on fluoxetine 20 mg/day for depression and nine days later was found to have fluoxetine-induced syndrome of inappropriate secretion of antidiuretic hormone. After hyponatremia correction the mental status of the patient gradually improved, but subsequently she had intermittent difficulty in speaking, naming objects, memory deficits and psychomotor slowness. Magnetic resonance revealed bilateral symmetric hyperintense lesions in the basal ganglia, temporal lobe and hippocampal formation compatible with ODS. These symptoms gradually resolved and she was discharged home without any deficits. Two months later, a new image showed lesion in pons and the other lesions had disappeared. Fluoxetine therapy had never been related with a complication like that.
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Hew-Butler T, Sharwood K, Boulter J, Collins M, Tucker R, Dugas J, Shave R, George K, Cable T, Verbalis JG, Noakes T. Dysnatremia predicts a delayed recovery in collapsed ultramarathon runners. Clin J Sport Med 2007; 17:289-96. [PMID: 17620783 DOI: 10.1097/jsm.0b013e31804c779b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess (1) the incidence of dysnatremia in collapsed runners presenting to the medical tent of the 89-km Comrades Marathon and whether dysnatremia influences time to discharge, and (2) whether intravenous fluids could restore serum sodium concentration ([Na+]) to 140 mM faster than could the administration of oral fluids. DESIGN Prospective randomized controlled trial. SETTING 2005 Comrades Marathon. PARTICIPANTS One hundred thirty-three collapsed runners and 31 control-group runners. INTERVENTIONS Collapsed runners presenting to the medical tent at the finish of the 2005 Comrades Marathon were randomized into an intravenous or oral fluid administration group, with the type and amount of fluid administered dictated by initial [Na+]. MAIN OUTCOME MEASURES Time to discharge, serum [Na+]. RESULTS Forty-five percent of collapsed runners were hypernatremic, 2% were hyponatremic, and 53% were normonatremic. Normonatremic runners spent significantly less time in the medical tent (80 +/- 31 minutes) compared with hypernatremic (102 +/- 36 minutes) and hyponatremic (146 +/- 122 minutes) runners. Intravenous fluid therapy produced larger but nonsignificant reductions in [Na+] than oral therapy (-2.1 +/- 3.1 versus -0.7 +/- 1.8 mM); however, 45% of runners assigned to the oral fluid group could not tolerate oral rehydration. CONCLUSIONS A slight majority of collapsed runners were normonatremic and spent significantly less time in the medical tent compared with hyper- and hyponatremic athletes. Initial rates of correction of hypernatremia were similar with intravenous and oral hypotonic fluid therapy. Clinicians should be advised that intravenous fluid resuscitation may best benefit hypernatremic collapsed runners who are intolerant to oral fluid ingestion.
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Gutenstein M. Osmotic myelinolysis syndrome after treatment of severe deamino arginine vasopressin-associated hyponatraemia: pitfalls in emergency medicine. Emerg Med Australas 2007; 19:68-70. [PMID: 17305665 DOI: 10.1111/j.1742-6723.2007.00931.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hyponatraemia is among the more common electrolyte abnormalities encountered in the ED. Both the primary disturbance and its correction can result in life-threatening neurological sequelae. Osmotic myelinolysis syndrome is one such complication and is associated with the rapid correction of hyponatraemia. The present case report describes the mechanism of severe hyponatraemia in a patient taking deamino arginine vasopressin, and the subsequent development of both central pontine and extrapontine myelinolysis after rapid correction of sodium levels. Implications for the emergency management of such patients are discussed.
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Affiliation(s)
- Marc Gutenstein
- Anaesthetic Department, North Devon District Hospital, Barnstaple, UK.
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Hanselman B, Kruth S, Poma R, Nykamp S. Hypernatremia and Hyperlipidemia in a Dog with Central Nervous System Lymphosarcoma. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01824.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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