Pontine/extrapontine myelinolysis occurring in the setting of an eating disorder

Central pontine myelinolysis in anorexia nervosa: case report of a Chinese adolescent

Central pontine myelinolysis (CPM) is a rare neurologic disorder characterized by symmetric demyelination in the central region of pons. Until recently its prognosis was considered poor if not fatal. CPM may manifest as a severe complication of eating disorders, especially anorexia nervosa (AN), primarily due to a rapid correction of hyponatremia. In this report, we presented the case of a 13-year-old girl with a five-month history of AN who exhibited typical CPM brain lesions, confirmed by magnetic resonance imaging (MRI) examination without the context of severe electrolyte imbalances. Surprisingly, despite the patient's critical clinical manifestations in the initial stages, her prognoses of both AN and CPM were relatively optimistic. We discussed these observations in the light of recent reports on CPM and AN comorbidity. Although the clinical implications of MRI-detected lesions remain uncertain, psychiatrists should be cautious about CPM when refeeding patients with AN. Further studies about the relationship between CPM and AN are imperative.

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.