Ann Liver Transplant.  2024 Nov;4(2):108-111. 10.52604/alt.24.0007.

Pre-operative sodium benzoate can rapid increase sodium level and induce central pontine myelinolysis after liver transplantation: Case report

• Jashi L
• Lee KW
• Yi NJ
• Choi Y
• Kim JY
• Hong SK
• Suh KS

• KMID: 2561856
• DOI: http://doi.org/10.52604/alt.24.0007

Abstract

Central pontine myelinolysis (CPM) is a severe neurological complication observed after liver transplantation (LT), with a mortality rate exceeding 50%. This study presents a case report of a 43-year-old female patient with alcoholic liver cirrhosis who underwent liver transplantation and subsequently developed CPM. The patient admitted with symptoms and signs of acute on chronic liver failure, such as hyponatremia, and hepatic encephalopathy Grade 3 Glasgow Coma Scale (GCS) 10. Sodium benzoate was started together with lactulose. Ammonia level was decreased and mentality was also improved. However, sodium level was increased up to 160 mmol/L. After liver transplantation, the patient become drowsier (GCS 6–9) even with good liver function. The brain magnetic resonance imaging at the post-LT 5th day showed CPM. The mentality was slowly improved after conservative management with low level of tacrolimus. This case gives a lesson that pre-operative sodium benzoate treatment can increase the risk of CPM by increasing sodium level in patients with severe hyponatremia. Therefore, careful monitoring of sodium level is important when sodium benzoate is prescribed.

Keyword

Central pontine myelinolysis; Liver transplantation; Sodium benzoate; Lactulose; Hepatic encephalopathy