Electrolyte Blood Press.  2015 Jun;13(1):30-36. 10.5049/EBP.2015.13.1.30.

A Case of Osmotic Demyelination Presenting with Severe Hypernatremia

Affiliations
  • 1Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Incheon Christian Hospital, Incheon, Korea.
  • 3Department of Internal Medicine, National Rehabilitation Center, Seoul, Korea. mk2066@hanmail.net

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.

Keyword

Hypernatremia; Osmotic demyelination syndrome; Magnetic resonance imaging

MeSH Terms

Adrenal Cortex Hormones
Adult
Brain
Complementary Therapies
Demyelinating Diseases*
Female
Follow-Up Studies
Glucose
Humans
Hypernatremia*
Hyponatremia
Magnetic Resonance Imaging
Mortality
Myelinolysis, Central Pontine
Neurologic Manifestations
Pons
Sodium
Water
Adrenal Cortex Hormones
Glucose
Sodium
Water
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